Tricuspid Valve Regurgitation (leaky heart valve) in six month old puppy - Golden Retrievers : Golden Retriever Dog Forums
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post #1 of 51 (permalink) Old 07-19-2016, 04:55 PM Thread Starter
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Question Tricuspid Valve Regurgitation (leaky heart valve) in six month old puppy

Hello,

My beautiful six month old has tricuspid valve regurgitation- does anyone have any experience (the more hopeful the better) with this condition? We are told it's currently quite mild.

Thank you xxxx
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post #2 of 51 (permalink) Old 07-19-2016, 09:47 PM
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Hello,

My beautiful six month old has tricuspid valve regurgitation- does anyone have any experience (the more hopeful the better) with this condition? We are told it's currently quite mild.

Thank you xxxx
My Golden Chance had a similar problem diagnosed/confirmed when he was seven months old. Chance's regurgitation was quite severe and life-threatening. Chance was operated on here in the U.S. (Colorado) and has lived a normal healthy life. The operation was in April 2006. Chance just turned 11 y.o. and is doing great. However, Chance sees his cardiologist regularly so it's not like the operation was the total cure. Medication has played a role as well.

The veterinary cardiologist who operated on Chance is named Christopher Orton.There is a world class veterinary cardiologist (surgeon) in England : Dr. Dan Brockman at the RVC. I would try to get a referral if you can. Dr. Orton went over to England with his team and worked with Dr. Brockman. There are many articles about it. Below is a link to a recent article about Dr. Brockman's amazing work.

Royal Veterinary College Performs Groundbreaking Open-Heart Surgery on Dog

You definitely should get your puppy to a vet cardiologist because there are medications he/she should start on that can help. This condition is something beyond the scope of the primary practice veterinarian. The fact that the regurgitation is currently mild is very good.

..... have a Golden day
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post #3 of 51 (permalink) Old 07-20-2016, 07:51 AM Thread Starter
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Originally Posted by goldy1 View Post
Chance just turned 11 y.o. and is doing great.

The veterinary cardiologist who operated on Chance is named Christopher Orton.There is a world class veterinary cardiologist (surgeon) in England : Dr. Dan Brockman at the RVC. I would try to get a referral if you can. Dr. Orton went over to England with his team and worked with Dr. Brockman. There are many articles about it. Below is a link to a recent article about Dr. Brockman's amazing work.

Royal Veterinary College Performs Groundbreaking Open-Heart Surgery on Dog

You definitely should get your puppy to a vet cardiologist because there are medications he/she should start on that can help. This condition is something beyond the scope of the primary practice veterinarian. The fact that the regurgitation is currently mild is very good.
Thank you so much for your reply. It's really helpful and I'm so glad that Chance is doing well because you got him the right treatment. What kind of surgery did he have?


The Vet who saw Sophie yesterday is a Cardiologist who works two days a week at our General Vet Practice however unfortunately my Dad had to pick Sophie up from the Vets as I was caring so I didn't get to hear all the details. I am unsure about the Cardiologist's decision not to treat her condition yet (he will re-scan in 3 months).

Sophie has some significant symptoms including:
- blueish/grey gums and back of tongue but only at times,
- tiring easily and sometimes lying down very suddenly (like a collapse but no loss of consciousness),
- a visible pounding of her heart at certain times when lying on her side,
- a visible jugular pulse in her neck
- noisy breathing but again only at times

Although I took Sophie to the Vets the first few times and requested the Echocardiogram and ECG (the regular Vet didn't hear a murmur), I do not know whether my Dad gave an accurate representation of her symptoms this time because he had thought there was nothing wrong.

So now I'm unsure what to do! My options are:

1. Leave it, wait 3 months and have her re-scanned then. In the mean time let her exercise freely and eat what she normally does.
2. Request an appointment to discuss the situation either with the Cardiologist or our general practice vet.
3. Ask for a referral for a second opinion e.g. to the specialist centre you mentioned

Reading up on it, it sounds as though in humans early treatment can help so I don't think the wait and see approach is necessarily the best one.

My other major concerns I have are that she does have a very fast heart beat at times- the Vet felt that this was just a normal puppy thing but I'm really not sure. Also I do wonder if she has a slight arrhythmia that could on be detected with 24 or 48 hour Holter ECG monitor. I would like to ask for this. The Vet felt that her collapsing episodes were just normal puppy exhaustion but I'm not sure of that.

I hope it's ok to ask some questions- Did Chance have heart failure when he was treated? Was his heart enlarged by the condition? What medication was he given?

Also can I just ask what advice you were given regarding exercise? and diet?

Thank you so very much for your help.

Issie
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post #4 of 51 (permalink) Old 07-21-2016, 07:01 PM
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It is good that you are working with a cardiologist. It appears that the murmur was not detectable during the pup's initial examinations. If your regular vet had heard a murmur, I am sure that he/she would have told you and it would be a part of your pup's medical record. When a vet hears a heart murmur then he/she will try to classify it so that if another vet reads the report, the new vet will be able to have something to compare it to in case it is getting worse. For example, she might have heard a grade 3, systolic cardiac murmur found predominately along the right thorax. The tricuspid valve is usually heard best on the right side.

That said, any puppy that has a significant heart murmur needs to have this as part of its permanent record. The exam done by the cardiologist was likely an echocardiogram. It is a good diagnostic tool but it does not give indications of all the function of the heart. Remember, the cardiologist is aware that there are no medications that will benefit your pup at this time. This is why you were given the "wait and watch" instructions. The cardiologist knows that monitoring the murmur will likely determine what type of prognosis he can expect. If the murmur was not present at initial and follow-up exams and is now a grade 3 at six months, that is not likely a good sign. If in three months it has progressed to a more significant murmur, then he will likely tell you that your dog will probably progress into congestive heart failure at some time. Then, he can give drugs to treat the CHF. There are no drugs that will delay this from happening if it is going to happen. Some vets will tell you that Enalapril will do this but it won't, and it does have some potential side effects on the kidneys. So, don't go there.

I would find an alternative vet that can help you at this time. Since there are no conventional medications that can help, excluding surgical intervention, then you need to expand your search for alternatives. I routinely use CoEnzyme Q10 and Hawthorne Berry on the pups. They help with the heart function, no matter what the stage of the disease is. I like to use Chinese medicine on these dogs as well. I will usually use an herb called Xue Fu Zhu Yu Tang (Stasis in the mansion of the blood). There are acupuncture points that will improve the heart energy and your alternative vet will know these. Be active now and don't wait until it gets really bad. Good luck and keep us posted.
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post #5 of 51 (permalink) Old 07-21-2016, 11:55 PM
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Originally Posted by Bella2 View Post
Thank you so much for your reply. It's really helpful and I'm so glad that Chance is doing well because you got him the right treatment. What kind of surgery did he have?


The Vet who saw Sophie yesterday is a Cardiologist who works two days a week at our General Vet Practice however unfortunately my Dad had to pick Sophie up from the Vets as I was caring so I didn't get to hear all the details. I am unsure about the Cardiologist's decision not to treat her condition yet (he will re-scan in 3 months).

Sophie has some significant symptoms including:
- blueish/grey gums and back of tongue but only at times,
- tiring easily and sometimes lying down very suddenly (like a collapse but no loss of consciousness),
- a visible pounding of her heart at certain times when lying on her side,
- a visible jugular pulse in her neck
- noisy breathing but again only at times

Although I took Sophie to the Vets the first few times and requested the Echocardiogram and ECG (the regular Vet didn't hear a murmur), I do not know whether my Dad gave an accurate representation of her symptoms this time because he had thought there was nothing wrong.

So now I'm unsure what to do! My options are:

1. Leave it, wait 3 months and have her re-scanned then. In the mean time let her exercise freely and eat what she normally does.
2. Request an appointment to discuss the situation either with the Cardiologist or our general practice vet.
3. Ask for a referral for a second opinion e.g. to the specialist centre you mentioned

Reading up on it, it sounds as though in humans early treatment can help so I don't think the wait and see approach is necessarily the best one.

My other major concerns I have are that she does have a very fast heart beat at times- the Vet felt that this was just a normal puppy thing but I'm really not sure. Also I do wonder if she has a slight arrhythmia that could on be detected with 24 or 48 hour Holter ECG monitor. I would like to ask for this. The Vet felt that her collapsing episodes were just normal puppy exhaustion but I'm not sure of that.

I hope it's ok to ask some questions- Did Chance have heart failure when he was treated? Was his heart enlarged by the condition? What medication was he given?

Also can I just ask what advice you were given regarding exercise? and diet?

Thank you so very much for your help.

Issie
You have a lot on your plate. I will answer your questions and tell you my opinion based on my experience with Chance.
Chance's heart murmur was due to a congenital mitral valve malformation - similar, but not exactly the same as your pup's.
The only option for Chance was open-heart surgery. My guess is also that your cardiologist does not do this type of corrective surgery hence the wait and see approach. At the time of Chance's diagnosis, his cardiologist told us there were only 2 places in the U.S. that perform the type of surgery Chance needed. We had to travel 1,900 miles to Colorado (from NY) for the surgery. At the time, it wasn't exactly experimental surgery but it was limited.
I'm not surprised that your vet didn't detect the murmur on initial exams. My vet didn't either. Puppies do a lot of panting at the vets office and even the cardiologist has to listen very closely with very experienced ears. I have learned a lot about that in the 10+ years we have been bringing Chance in to the cardiologist for exams.

The symptoms you list are concerning. I would limit your pup's exercise. Once diagnosed, while we were waiting for the surgery (7 weeks), this is what we were told to do. He was diagnosed at the end of February and operated on April 19. In this time, Chance's heart had enlarged to double its size and he had 2 collapsing episodes.
2 weeks after the surgery, Chance's heart was back to its normal size.
Pre-surgery, he was put on a medication that would slow the heart in prep for the surgery but there really wasn't a medication for treating it - it needed surgery.
Post-surgery, Chance has been on a low dose of metoprolol and enalapril.

I'm sorry for being long-winded, I am just recalling so many details.

Before doing anything, see if you can speak directly to the cardiologist with your questions written out. I agree with your gut feeling that her collapsing episodes are NOT just normal puppy exhaustion. Also ask if you can get a copy of the written cardiologist's report.

Here is a another link to an article about Chance's surgeon Dr. Orton going to England to train surgeons at the Royal Veterinary College.
I am hoping you can get a referral there.
CSU cardiology team takes open heart surgery to the UK
If you have any other questions, let me know.

..... have a Golden day
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post #6 of 51 (permalink) Old 07-22-2016, 02:23 PM
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I certainly hope you can use the info you got here. I have only ever had to truly face a hert condtion once. My one golden retriever had an enlarged hert chamber., It was only detected by x-ray. We had lost our just turned 5 year old to heart failure and I had the x-rays taken of the other dogs. She ws treated with a very low dose ;blood pressure med--same my hubby was taking, only much lower dose, and a baby asprin every other day. I had her seeral more years, taken by cancer, but no trouble with her heart. I really have no knowledge of the problem you sweet girl has. But I want to wish her all the luck in the world, and a long, happy life.

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BUCK 2/8/95 - 5/15/07
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KAYCEE 8-19-99 -5-25-08
HONEY ADOPTED GROWN 12/07/02 - 8/13/14
SOPHIE 1/8/04 - ADOPTED 2/17/15 - 10/12/16
GREAT PYRENEES SHAGGY adopted AT AGE 7 8/31/14 - 9/23/14 AGE 7
GREAT PYRENEES SIR MOOSE ADOPTED 9/30/14 ---- 12/5/18 AGE 11 1/2






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post #7 of 51 (permalink) Old 07-24-2016, 07:48 PM Thread Starter
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Hi All,

Thanks so much for your advice. I have since spoken to the Cardiologist who said that it was the Pulmonary not the Tricuspid valve that showed regurgitation and that it is minor so she should not be experiencing symptoms with it.

However she is experiencing the following:

- Blue tinged gums and tongue at times (usually during exercise)
- Conscious (no loss of consciousness) collapse- like a drop attack?
- Visibly fast heart rate and breathing rate
- Visible jugular pulse
- Pale colour (pinky white) under her eyes when you peel back the area

So I do not know what is wrong and she has to have X-rays and blood tests on Thursday under General Anaesthetic. That may indicate what is wrong and only if nothing is obvious will she have a 24 or 48 hour Holter test to check for undetected arrhythmias.

I'm very anxious about her and thinking about possible blood disorders and cancers, which would be devastating so I only hope it's nothing like any of that.
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post #8 of 51 (permalink) Old 07-24-2016, 10:05 PM
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It's such a worry but it sounds like you are doing the right tests and your vets will arrive at a diagnosis. Her symptoms sound like a heart problem - much the same symptoms as Chance had, but a different valve. Chance had congenital mitral valve dysplasia.

I wouldn't worry about a blood disorder or cancer. It's best not to let your mind go to these thoughts if you can.

Two years ago, Chance developed arrhythmias that caused him to collapse. The arrythmias were not detected until he wore the 24-hour Holter. That gave the cardiologist the answers and the arrythmias have been under control with no collapsing at all ever since he was put on a medication called Sotalol. Chance has the Holter test done twice a year and the cardiologist is monitoring to insure the medication and dosage is working.

But day to day, life is very normal for him now that he's on this medication.

Once they get to the cause, they will give you a treatment plan for your girl and things will look brighter. I know how hard it is to wait for the tests and the results. SOOO hard.
I will say prayers for good results on Thursday.

..... have a Golden day
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post #9 of 51 (permalink) Old 07-25-2016, 08:50 AM Thread Starter
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Thank you so much. It's so great that Chance is doing amazingly on the anti-arrhythmic drugs. It sounds like your Cardiologist is really on top of everything.

That's really interesting that he didn't have a murmur and the arrhythmia wasn't obvious until the Holter test- did the Echo show a significant valve problem though?

It's very odd that Sophie's valve dysplasia is so mild- as shown on the Echo but yet she has these symptoms. The Vets have said they think it's very unlikely (impossible?) that the valve problem is causing these symptoms so I do not know what it is. He wants to re-do the Echo in 3 months but said it really shouldn't be causing any symptoms.

You're right that it's not worth thinking about other causes- I'm worried it's leukemia or another cancer or blood disorder because I do not see why she would be anemic and have these episodes of blue tinged gums/tongue without it being something affecting her blood or her heart.

I am just hoping that it is due to a mild arrhythmia, which can be treated or a natural variation (e.g. perhaps she's growing fast, has a slight valve problem and the combination is putting a bit of strain on her heart, particularly during exercise).

Our Vet practice does not have Holter monitors available so they will order it down from Scotland if necessary but they said that the Echo should have shown more significant valve regurgitation if it was to cause problems.

I'm a bit worried about Sophie having the X-ray as she's never had an anaesthetic before but it's the Practice policy to put them under General for X-rays and I think Sophie would be very wiggly if they anaesthetize her.

She has been quite restless today and I don't know whether she is in any pain or distress- she's having a lunchtime nap in her crate but before that she was walking from door to door despite having been out to do her business (it's a bit hot to walk in the daytime atm).

Thank you again so much for your reply and all your help.
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post #10 of 51 (permalink) Old 07-26-2016, 09:45 PM
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You will soon have some answers and hopefully a good treatment plan will change everything - in a good way.

When Chance had his first Echo-cardiogram at the cardiologists office - he was 7 months old and the valve deformity was so severe, the cardiologist said without surgery he would not live very long. Basically, Chance's mitral valve was remaining open due to malformation and chordae tendineae holding the valve open.
On the positive side, Sophie's cardiologist has already done an Echo and is not seeing anything severe like that.
I have often heard that vet's most often anaesthetize in order to get clear pictures. I hate when Chance has to have it also - I worry too - but this should be a very small amount for just enough time to get the pictures.
When Chance had his open-heart surgery, it was a 6 hour operation and they actually stopped his heart and put him on a heart-lung machine. Chance is currently the longest living dog in the U.S. who had that operation. I say prayers of thanks every day. He has enriched our lives so much.
I will say prayers for your Sophie. I feel certain that once a diagnosis is confirmed a treatment plan is in place, she will do well and improve. One thing I learned is that the earlier it is discovered and treated, the better the outcomes. The heart muscle in a young dog is very flexible and will contract back to normal size much more quickly. This is what happened in Chance's case. He was in the hospital (CSU-VTH) for 2 weeks and they took daily measurements. When he was released, we had to travel back home 1,900 miles so they didn't release him until the doctor determined he could make the trip. Puppies/ young dogs are very resilient so keep that in mind. It's good that Sophie's heart problem was discovered while she is young and strong.

I wonder if Sohie's restlessness today is related or not. I will tell you, I think Chance knew when his arrythmias were happening in succession. There were unexplained times when he seemed worried and would try to be very close to me - like he needed comforting. At the time, I had no explanation - but in hindsight, I think the palpatations were unnerving to him. He hasn't had those episodes since he was put on the Sotalol.

One thing you might ask your vet on Thursday - would oxygen help at all when she gets the blue tinge to her gums? We had a portable oxygen canister and a mask called Aerocat for one of my cats who had a heart problem. It helped him when he had an attack and was breathing with his mouth open. It helped him at those times.

I am keeping positive thoughts for Sophie -and for you who loves her so much!

..... have a Golden day
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