Changes

== Treatment ==

== Treatment ==

===Stage B===

===Stage B===

There is no evidence that any therapy slows the progression of asymptomatic disease.  

There is no therapy demonstrated to be beneficial in dogs with stage B1 disease.

 

The results of the EPIC study demonstrated that administration of Pimobendan to dogs with stage B2 disease resulted in prolongation of the asymptomatic phase of disease by approximately 15 months. Dogs receiving Pimobendan were around 33% less likely to go into congestive heart failure or suffer a cardiac death than those not receiving the drug. Pimobendan appears safe and well-tolerated.

 

Based on findings of the EPIC study, dogs with typical mitral valve murmurs of grade III/VI or higher should be investigated to look for evidence of cardiomegaly. If cardiomegaly is apparent, then the dog may benefit from starting Pimobendan, as opposed to the 'watch and wait' approach that was previously recommended.

 

===Stage C===

===Stage C===

Medical management is intended to alleviate clinical signs and prolong life.  

Medical management is intended to alleviate clinical signs and prolong life.