Advice on pet medication

Hi,

Thanks for asking your question on Just Answer. I know that getting differing opinions from two specialists is frustrating and confusing, but it is good that you are getting a third opinion. That is why we call medicine an "art" - there are variations based upon a doctor's experiences, the research and the types of animals with which we work.

The most current research (2006) is a study that is yet to be published called Vetproof. It studies the drug Enalapril and it's effect in dogs with mitral valve disease in delaying the onset of congestive heart failure.

The results of this study were:

Time to Onset of Heart Failure - The median time from study entry to heart failure was 893 days (~2.5 years).

Physical variables that determined a poorer outcome were heart rate >150 bpm and age >12 years. Murmur grade was NOT SIGNIFICANTLY correlated with worsening prognosis - gender had no demonstrable effect.

The strongest determinant of a poor outcome was radiographic evidence of severe left atrial enlargement.

Echocardiographic findings too were useful in prognostication of the outcome of these dogs, with left atrial and left ventricular size correlating to a poorer prognosis.

Somewhat surprisingly, a higher left ventricular shortening fraction predicted a hastening to heart failure.

There was no significant difference in survival between those dogs treated with enalapril or placebo with regard to the time to onset of congestive heart failure.

Bottom line, if your dog is asymptomatic, there is little indication to start on medication. The difference would be if your dog didn't have mitral valve disease, but had dilated cardiomyopathy. In that case, heart meds could make a difference.

I hope this helps. Please let me know if you need more information. Good luck!

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Thank you for your prompt answer. We are certain of the diagnosis of MVD and not Cardiomyopathy.

If we opt for starting the Enapril and the Spironolactone meds. can this do any damage to the dog or cause any harmful side effects?

Hi,

I don't recommend starting meds, the research just doesn't support it. All medications can have potentially dangerous side effects.

Enalapril/enalaprilat's adverse effect profile in dogs is principally GI distress (anorexia, vomiting, diarrhea). Potentially, weakness, hypotension, renal dysfunction and and elevated potassium level could occur. You can also see immune-mediated reactions that can destroy the dog's white blood cells.

Spironolactone - fewer side effects here - but truly, there is NO known benefit of this drug in treating mitral valve disease. There is a human study which prompted its use in veterinary medicine. According to the cardiologist who taught me in vet school, the heart muscle fibers in dogs with mitral regurgitation don't have fibrosis which is what this drug is used to combat. The drug is used for other purposes in heart disease in veterinary medicine. I don't know many cardiologists who would use it for your dog. It's just not indicated. There isn't one single study that is out there that proves it works. Combine that with the fact that your dog probably shouldn't be on meds, and it makes even less sense.

Please let me know if you need more information. I'm happy to help.

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I share your concerns and am glad you have sought out help. I strive to provide you with excellent service. If this information has been helpful to you, please Accept! Bonuses are ALWAYS APPRECIATED.