Finding a Consensus on Canine CVHD

*Reproduced with permission by Dr. Clarke Atkins! *

Canine chronic valvular heart disease (CVHD) is the most important nonparasitic cardiovascular diseases in veterinary medicine, but controversy remains about the best treatment. 


Canine CVHD, also known as endocardiosis, myxomatous valve degeneration, and mitral regurgitation (MR), affects approximately 85% of dogs 13 years of age or older and accounts for 75% of heart disease in dogs.1 For such a substantial disease, it may be surprising that there still is controversy and general lack of agreement about the appropriate medical management, both before and after the onset of heart failure. To this end, the American College of Veterinary Internal Medicine’s (ACVIM) Board of Regents recently selected a group of European and American board-certified cardiologists to present a formal consensus for the diagnosis and treatment of CVHD.  The 10 panel members represented diverse points of view on cardiac therapeutics. The consensus statements and recommendations of the panel are not to be taken as “cutting edge” but rather as a sampling of the “collective wisdom” that occurs when reasonable people reach a compromise after reviewing published data and their own experiences.


Based on available evidence, the ACVIM panel determined whether the potential benefits of a given treatment option clearly outweighed the risk for adverse events and if the financial impact on the patient and client would be justifiable.

Consensus was defined as all 10 panel members agreeing to a particular recommendation, but we also revealed when a majority of the panelists agreed on a recommendation even if the criteria for consensus were not met.


Although a number of classification schemes that grade cardiac disease in dogs are already in place, we created a novel scheme modeled after one used by the American Heart Association and the American College of Cardiology. Our system avoids the inclusion of progressive exercise intolerance when grading disease severity and adds a category for dogs that show no clinical signs but are at risk for the disease (eg, cavalier King Charles spaniels, dachshunds, miniature and toy poodles).

In this article, I describe some of the more important consensus and majority findings from the panel, as well as offer some insights into how these findings can translate into everyday patient care based on my own practice.

Note: Not all consensus recommendations would be appropriate for each patient. For example, it is unlikely that a dog on pimobendan would also receive dobutamine.


Bruce Keene, DVM, MSc, Diplomate ACVIM, Panel Chair

Clarke Atkins, DVM, Diplomate ACVIM (Internal Medicine, Cardiology)

John Bonagura,DVM,MS, Diplomate ACVIM

Stephen J. Ettinger, DVM, Diplomate ACVIM (Internal medicine, Cardiology)

Philip R. Fox,DVM,MS, Diplomate ACVIM/ECVIM (Cardiology) & ACVECC

Virginia Luis-Fuentes, VetMB, PhD, CertVR, DVC, MRCVS, Diplomate ACVIM & ECVIM

Sonya G. Gordon, DVM, DVSc, Diplomate ACVIM (Cardiology)

Jens Häggström, DVM, PhD, Diplomate ECVIM (Cardiology)

Robert Hamlin, DVM, PhD, Diplomate ACVIM

Rebecca Stepien, DVM, Diplomate ACVIM

Finding a Consensus on Canine CVHD and Clarke Study1Finding a Consensus on Canine CVHD and Clark Study 2Finding a Consensus on Canine CVHD and Clark Study3Finding a Consensus on Canine CVHD and Clarke Study4

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Dr Roger Johnson

Roger K. Johnson, DVM, Diplomate ACVIM (internal medicine) is a board- certified veterinary internal medicine specialist. His professional interests include cardiology as well as using advanced diagnostics to help his patients. His particular favorites include echocardiography, abdominal ultrasonography, and endoscopy.

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