Canis ISSN: 2398-2942

Heart: mitral valve degenerative disease

Synonym(s): DMVD, mitral valve disease, endocardiosis, chronic valvular disease, myxomatous mitral valve degeneration

Contributor(s): Serena Brownlie, Mark Rishniw, Ruth Willis, Mark Oyama, Pedro Oliveira

Introduction

  • Degenerative mitral valve disease (DMVD) is the most common acquired disease in dogs.
  • DMVD causes mitral regurgitation, heart enlargement, and can lead to left-sided congestive heart failure (CHF).
  • Cause: inherited predisposition in some breeds, ie Cavalier King Charles spaniel, is suspected.
  • Signs: left apical systolic murmur.
  • Diagnosis: presumptive: detection of the characteristic murmur in an adult small-breed dog; definitive: echocardiograph.
  • Treatment: only in symptomatic dogs and includes diuretics, ACE-inhibitors, and pimobendan.
  • Prognosis: variably progressive disease, progression often slow.
    Print off the owner factsheet on Mitral valve disease in dogs Mitral valve disease in dogs to give to your client.

Pathogenesis

Etiology

  • Unknown etiology.
  • Degenerative process of collagen and deposition of glycosaminoglycans in valve leaflets.
  • Does not appear to be caused by infectious or inflammatory causes.

Specific

  • Sudden exertion.
  • Stress.
  • Lack of compliance in taking medication.
  • Sudden increase in dietary salt intake (anecdotal).
  • Development of arrhythmia Heart: dysrhythmia.

Pathophysiology

  • Myxomatous degeneration progressively affects the mitral valve causing mitral regurgitation.
  • Mitral regurgitation results in activation of neurohormonal mechanisms such as the rennin-angiotensin-aldosterone system and the sympathetic nervous system resulting in vasoconstriction, tachycardia, and volume retention.
  • Volume overload results in left atrial and left ventricular enlargement.
  • Subsequent left atrial and left ventricular enlargement stretches the mitral annulus contributing to further incompetence.
  • Eccentric hypertrophy of the left ventricle is compensatory to maintain forward stroke volume in the face of mitral regurgitation.
  • Increased heart rate attempts to maintain cardiac output.
  • Increased left ventricular end-diastolic pressure and left atrial pressures → increased pulmonary venous pressure → increased pulmonary capillary wedge pressure → pulmonary edema (CHF).
  • Occasionally increased pulmonary capillary wedge pressure → reactive pulmonary vasoconstriction → increased PA pressure (pulmonary hypertension Pulmonary Arterial Hypertension (PHT) ) → RHF → ascites, pleural effusion Pleural: effusion.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Boswood A, Haggstrom J, Gordon S et al (2016) Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study-A Randomized Clinical Trial.​ JVIM 30, 1765-1779 PubMed.
  • Ebisawa T, Ohta Y, Funayama M, Yamano S, Mizuno M, Mizuno T, Kasuya A, Sawada T, Lee J, Mizukoshi T, Uechi M (2013) Plasma atrial natriuretic peptide is an early diagnosis and disease severity marker of myxomatous mitral valve disease in dogs. Res Vet Sci 94 (3), 717-721 PubMed.
  • Mattin M, Boswood A, Church D, Brodbelt D (2013) Mitral valve disease study. Vet Rec 173 (21), 531-532 PubMed.
  • Atkins C E, Häggström J (2012) Pharmacologic management of myxomatous mitral valve disease in dogs. J Vet Cardiol 14 (1), 165-84 PubMed.
  • Borgarelli M, Buchanan J W (2012) Historical review, epidemiology and natural history of degenerative mitral valve disease. J Vet Cardiol 14 (1), 93-101 PubMed.
  • Borgarelli M, Crosara S, Lamb K, Savarino P, La Rosa G, Tarducci A, Haggstrom J (2012) Survival characteristics and prognostic variables of dogs with preclinical chronic degenerative mitral valve disease attributable to myxomatous degeneration. J Vet Intern Med 26 (1), 69-75 PubMed.
  • Chetboul V, Tissier R (2012) Echocardiographic assessment of canine degenerative mitral valve disease. J Vet Cardiol 14 (1), 127-48 PubMed.
  • Dillon A R, Dell'Italia L J, Tillson M, Killingsworth C, Denney T, Hathcock J, Botzman L (2012) Left ventricular remodeling in preclinical experimental mitral regurgitation of dogs. J Vet Cardiol 14 (1), 73-92 PubMed.
  • Fox P R (2012) Pathology of myxomatous mitral valve disease in the dog. J Vet Cardiol 14 (1), 103-26 PubMed.
  • Hezzell M J, Boswood A, Moonarmart W, Elliott J (2012) Selected echocardiographic variables change more rapidly in dogs that die from myxomatous mitral valve disease. J Vet Cardiol 14 (1), 269-279 PubMed.
  • Kellihan H B, Stepien R L (2012) Pulmonary hypertension in canine degenerative mitral valve disease. J Vet Cardiol 14 (1),149-64 PubMed.
  • Oyama M A (2012) Re: Radiographic heart size and its rate of increase as tests for the onset of congestive heart failure in Cavalier King Charles Spaniels with mitral valve regurgitation. J Vet Intern Med 26 (2), 227 PubMed.
  • Reynolds C A, Brown D C, Rush J E, Fox P R, Nguyenba T P, Lehmkuhl L B, Gordon S G, Kellihan H B, Stepien R L, Lefbom B K, Meier C K, Oyama M A (2012) Prediction of first onset of congestive heart failure in dogs with degenerative mitral valve disease: the PREDICT cohort study. J Vet Cardiol 14 (1), 193-202 PubMed.
  • Singh M K, Johnson L R, Kittleson M D, Pollard R E (2012) Bronchomalacia in dogs with myxomatous mitral valve degeneration. J Vet Intern Med 26 (2), 312-319 PubMed.
  • Uechi M, Mizukoshi T, Mizuno T, Mizuno M, Harada K, Ebisawa T, Takeuchi J, Sawada T, Uchida S, Shinoda A, Kasuya A, Endo M, Nishida M, Kono S, Fujiwara M, Nakamura T (2012) Mitral valve repair under cardiopulmonary bypass in small-breed dogs: 48 cases (2006-2009). J Am Vet Med Assoc 240 (10), 1194-201 PubMed.
  • Uechi M (2012) Mitral valve repair in dogs. J Vet Cardiol 14 (1), 185-192 PubMed.
  • Wolf J, Gerlach N, Weber K, Klima A, Wess G (2012) Lowered N-terminal pro-B-type natriuretic peptide levels in response to treatment predict survival in dogs with symptomatic mitral valve disease. J Vet Cardiol 14 (3), 399-408 PubMed.
  • Boswood A, Smith S, Patteson M (2011) Evaluation of pimobendan in dogs with cardiomegaly caused by preclinical mitral valve disease. Vet Rec 168 (8), 222 PubMed.
  • Lord P F, Hansson K, Carnabuci C, Kvart C, Häggström J (2011) Radiographic heart size and its rate of increase as tests for onset of congestive heart failure in Cavalier King Charles Spaniels with mitral valve regurgitation. J Vet Intern Med 25 (6), 1312-9 PubMed.
  • Bernay F, Bland J M, Häggström J, Baduel L, Combes B, Lopez A, Kaltsatos V (2010) Efficacy of spironolactone on survival in dogs with naturally occurring mitral regurgitation caused by myxomatous mitral valve disease. J Vet Intern Med 24 (2), 331-341 PubMed.
  • Borgarelli M, Haggstrom J (2010) Canine degenerative myxomatous mitral valve disease: natural history, clinical presentation and therapy. Vet Clin North Am Small Anim Pract 40 (4), 651-663 PubMed.
  • Boswood A (2010) Current use of pimobendan in canine patients with heart disease. Vet Clin North Am Small Anim Pract 40 (4), 571-580 PubMed.
  • Lord P, Hansson K, Kvart C, Häggström J (2010) Rate of change of heart size before congestive heart failure in dogs with mitral regurgitation. J Small Anim Pract 51 (4), 210-218 PubMed.
  • Moonarmart W, Boswood A, Luis Fuentes V, Brodbelt D, Souttar K, Elliott J (2010) N-terminal pro B-type natriuretic peptide and left ventricular diameter independently predict mortality in dogs with mitral valve disease. J Small Anim Pract 51 (2), 84-96 PubMed.
  • Häggström J et al (2008) Effect of pimobendan or benazepril hydrochloride​ on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: the QUEST study. JVIM 22, 1124-1135 PubMed
  • Orton E C, Hackett T B, Mama K & Boon J A (2005) Technique and outcome of mitral valve replacement in dogs. JAVMA 226 (9), 1508-1511 PubMed.
  • Griffiths L E, Orton E C & Boon J A (2004) Evaluation of techniques and outcomes of mitral valve repair in dogs. JAVMA 224 (12) 1941-1945 PubMed.
  • Olsen L H, Martinussen T and Pedersen H D (2003) Early echcardiographic predictors of myxomatous mitral valve disease in dachshunds. Vet Record 152 (10), 293-297 PubMed.
  • Kvart C et al (2002) Efficacy of enalapril for prevention of congestive heart failure in dogs with myxomatous valve disease and asymptomatic mitral regurgitation. JVIM 16 (1), 80-88 PubMed.
  • Boswood A (1999) Rationale for the use of drugs in treatment of cardiovascular disease 3. Positive inotropes. In Practice 21 (5), 253-259 VetMedResource.
  • Packer M (1998) Neurohormonal interactions and adaptations in congestive heart failure. Circulation 77 (4), 721-730 PubMed.
  • Häggström J, Kvart C & Hansson K (1995) Heart sounds and murmurs - changes related to severity of chronic valvular disease in the Cavalier King Charles Spaniel. JVIM 9 (2), 75-85 PubMed.
  • Pedersen H D, Kristensen B O, Lorentzen K A et al (1995) Mitral valve prolapse in 3 year old healthy Cavalier King Charles spaniels. An echocardiographic study. Can J Vet Res 59 (4), 294-298 PubMed.
  • Pedersen H D, Koch J, Poulson K, Jemsen A L & Flagstad A (1995) Activation of the renin-angiotensin system in dogs with mildly asymptomatic mitral valvular insufficiency. JVIM 9 (5), 328-331 PubMed.
  • The COVE Study Group (1995) Controlled clinical evaluation of enalapril in dogs with heart failure - results of the cooperative veterinary enalapril study group. JVIM 9 (4), 243-252 PubMed.
  • The IMPROVE Study Group (1995) Acute and short-term hemodynamic, echocardiographic and clinical effects of enalapril maleate in dogs with naturally acquired heart failure - results of the Invasive, Multicenter, PROspective Veterinary evaluation of Enalapril study. JVIM 9 (4), 234-242 PubMed
  • Francis G S & Chu C (1994) Compensatory and maladaptive responses to cardiac dysfunction. Current Opinion in Cardiology 9 (3), 280-288 PubMed.
  • Roudebush P, Allen T A, Kuehn N F, Magerkurth J H & Bowers T L (1994) The effect of combined therapy with captopril, furosemide and a sodium-restricted diet on serum electrolyte concentrations and renal function in normal dogs and dogs with congestive heart failure. J Vet Intern Med 8 (5), 337-342 PubMed.
  • Schlesinger D P & Rubin S I (1994) Potential adverse effects of angiotensin converting enzyme inhibitors in the treatment of congestive heart failure. Comp Cont Educ Pract Vet 16 (3), 275-283 VetMedResource.
  • Dahlström U & Karlsson, E (1993) Captopril and spironolactone therapy for refractory congestive heart failure. Am Journ Cardiol 71 (3), 29A-33A PubMed.
  • Riegger G A J (1993) ACE inhibitors in early stages of heart failure. Circulation 87 (Suppl IV), 117-119 PubMed.
  • Zannad F (1993) Angiotensin-converting anzyme inhibitor and spironolactone combination therapy. New objectives in congestive heart failure management. Am Journ Cardiol 71 (3), 34A-39A PubMed
  • Kittleson M D, Eyster G E, Knowlen G G, Olivier N B & Anderson L K (1984) Myocardial function in small dogs with chronic mitral regurgitiaton and severe congestive heart failure. JAVMA 184 (4), 455-454 PubMed.
  • Kittleson M D, Eyster G E, Olivier N B & Anderson L K (1983) Oral hydralazine therapy for chronic mitral regurgitation in the dog. JAVMA 182 (11), 1205-1209 PubMed.

Other sources of information

  • Smith P J, French Aet al(2002)Long term efficacy and safety of pimobendan in slight-to-moderate heart failure caused by myxomatous mitral valve disease in dogs.VCS Proceedings,November 2002. Loughborough.
  • Kittleson M & Kienle R (1998)Myxomatous atrioventricular valve degeneration.In:Small Animal Cardiovascular Medicine. 1st edition.Eds: M Kittleson and R Kienle. Mosby, St Louis pp 297-318.


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