GertrudeCase Background

Name Gertrude
Age 10 years
Sex Female, spayed
Breed Cavalier King Charles Spaniel

Please review Gertrude's clinical history.

Gertrude is apparently healthy according to the owner. She is here today for an annual wellness exam. Has a history of Stage B1 MMVD that was diagnosed last year. Click here for the ABCD brochure.

View Gertrude's right lateral radiograph  
View Gertrude's ventral dorsal radiograph  


Location of images: Thoracic radiographs obtained.

Views of images: Right lateral and ventral-dorsal.


Technical issues: Good quality films.

Cardiac size including VHS: VHS is 11.9. There is loss of the caudal waist on the right lateral consistent with moderate left atrial enlargement.

Radiographic Interpretation: Moderate generalized cardiomegaly with left atrial enlargement in a dog with no current or previous signs of hear failure consistent with a diagnosis of Stage B2 MMVD.

 Discussion: Dogs with cardiomegaly secondary to MMVD that have no current or prior clinical signs associated with MMVD are Stage B2. Click here to learn more about the stages of heart disease. This dog had Stage B1 MMVD 12 months ago with a VHS of 10.4 (Normal is < 10.5) this represents an increase in VHS of 1.5 VHS in the last 12 months or 0.125/month increase in VHS. An increase in VHS of more than 0.07/month is a significant risk factor for the development of congestive heart failure within the next 6 months. See management plan.
Treatment/Management: No treatment has been proven to delay the onset of CHF in dogs with Stage B2 MMVD but those thought to have a high risk may benefit from an ACE inhibitor. Risk factors include a VHS >12.0, an increase in VHS > 0.07/month, and an NT-proBNP > 1500. There are additional risk factors that can be evaluated by an echocardiogram. Regardless of whether or not you choose to initiate an ACEi additional diagnostics should be recommended including a blood pressure evaluation. An echocardiogram could confirm the diagnosis and assess other risk factors for progression. If an ACE inhibitor is started it will be important to check blood chemistries and a urinalysis before and 2 weeks after therapy is initiated. The owner should be informed about what signs to watch for and instructed to start recording home breathing rates [click here to view RRR circulation article] once per day. The next recheck should be scheduled for 3-4 months or sooner if the home breathing rate is reproducibly > 30/min or other signs of heart failure develop.