Echocardiograms for MVD: Seeing the Heart Clearly, Treating at the Right Time

Mitral valve disease is one of the most common conditions in small dog practice, yet the timing of intervention remains one of the trickiest decisions for GPs. Starting medications too early has no proven benefit, and starting them too late risks missing the window of opportunity where treatment can meaningfully slow progression. Echocardiography bridges that gap. It answers the questions that auscultation can’t – how severely the mitral valve apparatus is degenerating, how the left atrium is responding, and whether the patient has entered the stage where evidence-based medications like pimobendan genuinely change outcomes.

While murmurs raise suspicion, they don’t indicate severity. Many dogs remain in the ACVIM B1 category for years with no structural heart changes, and treating them early doesn’t help. Others silently transition into B2, with left atrial enlargement that warrants medical therapy, client education and monitoring. Echocardiography makes that staging visible and removes the guesswork. For breeds like Cavaliers, Chihuahuas, and Poodles, as well as other small dogs predisposed to this condition, knowing when the transition occurs is essential.

If you’re ever sitting in that uncomfortable space of “I think it’s time, but I’m not sure,” echo is the tool that gives you the clear, confident next step.

Echocardiography reveals the actual structural changes driving mitral valve disease, including valve thickening, regurgitant jets, chamber dilation, and the early consequences of chronic volume overload. These are the parameters that shape ACVIM staging and guide treatment decisions. In MVD, two elements matter most: the degree of mitral regurgitation and the size of the left atrium. When the left atrium begins to enlarge – a hallmark of the shift from B1 to B2 – the evidence supports starting pimobendan to delay progression and prolong symptom-free time.

Echo findings also help anticipate when other therapies, such as diuretics, ACE inhibitors, or additional monitoring, may be needed in the future. They provide a baseline for future comparisons, offer clarity on follow-up intervals, and provide objective measurements to share with cardiologists or internal medicine specialists when collaborative input is needed. The information can also dramatically improve client compliance. Seeing chamber enlargement on screen is far more compelling than hearing “the murmur has changed.”

Most dogs tolerate echocardiography extremely well with gentle handling; sedation is rarely needed, except in cases where the patient is highly anxious or reactive. The study is safe, non-invasive, and immediately informative, which is why it’s considered a “bread and butter” indication for ultrasound in small animal medicine.

Mitral valve disease often leaves vets sitting between “it might be time” and “I don’t want to start too early.” Our role is to give you the clarity that bridges that gap. We perform in-clinic echocardiography, allowing you to stage disease accurately, confirm when a dog has progressed from B1 to B2, and guide treatment timing without sending patients offsite. The findings are shared with you in real-time, allowing you to shape the medication plan, set monitoring intervals, and have clearer conversations with owners. It’s a collaborative approach to managing MVD that enables you to lead the case with confidence.

If you’d like to arrange an echocardiogram or discuss a case where timing is uncertain, we’re always happy to help.