Mitral Valve Disease in Maltese: Signs, Diagnosis & Care

[Mitral Valve Disease](https://seniorpet.org/knowledge/cavalier-king-charles-spaniel-mitral-valve-disease "Mitral Valve Disease Guide") in Maltese: Signs, Diagnosis & Care ========================================================

Mitral valve disease (MVD), also called myxomatous mitral valve degeneration (MMVD), is the most common heart valve problem in small-breed dogs. Maltese — a small, long‑lived toy breed — are at increased risk for MVD as they enter their senior years. At 8–9 years old (senior for Maltese; expected lifespan 12–15 years), many Maltese begin to show early valve changes or murmurs. This article explains how MVD typically appears in Maltese, how veterinarians diagnose and stage it, and practical, breed‑specific management strategies you can use to preserve [quality of life](https://seniorpet.org/knowledge/siamese-cat-quality-of-life "Quality of Life Assessment"). It also reviews how other conditions that commonly affect Maltese (luxating patella, [dental disease](https://seniorpet.org/knowledge/siamese-cat-dental-disease "Dental Disease in Senior Pets"), collapsed trachea, cataracts, portosystemic shunt, and white shaker syndrome) interact with cardiac disease.

Why Maltese are worth watching ------------------------------ Maltese are a toy breed with a predisposition to degenerative mitral valve disease because small breeds show earlier onset and higher lifetime prevalence of myxomatous valve changes than many medium or large breeds. MVD is typically progressive: valve leaflets thicken and fail to coapt, causing mitral regurgitation, left‑sided volume overload and, over time, heart enlargement and congestive heart failure (CHF) (ACVIM consensus; EPIC study findings). Early detection in Maltese — when they are clinically normal or only have a murmur — can change the timing and type of treatment that preserves function and comfort.

Typical signs in a senior Maltese --------------------------------- Early MVD may be silent except for a heart murmur heard during routine exams. In Maltese, watch for:

• New left‑apical systolic murmur (often the first sign)
• Reduced stamina, slower play or reluctance to climb stairs
• Cough — but be cautious: collapsed trachea and dental disease also commonly cause cough in Maltese
• Mild tachypnea at rest or faster recovery after exercise
• Exercise intolerance and reduced tolerance for grooming sessions or vet visits
• Advanced disease: respiratory distress, increased respiratory rate at rest, fainting (syncope), or abdominal distension from right‑sided congestion (less common early)

Remember: a Maltese with a chronic cough might have tracheal collapse, periodontal disease, or MVD — or a combination. Differentiation requires veterinary evaluation.

How veterinarians diagnose and stage MVD --------------------------------------- Diagnosis combines auscultation, imaging and sometimes blood tests. The internationally used ACVIM staging system (A–D) guides monitoring and treatment decisions (see table below).

Common diagnostic steps

• Physical exam with careful auscultation and pulse assessment
• Thoracic radiographs (X‑rays) to assess heart size and pulmonary changes
• Echocardiography (cardiac ultrasound) — gold standard for valve morphology and the degree of regurgitation
• Doppler assessment to estimate severity of regurgitant jets and pulmonary pressures
• Biomarkers: NT‑proBNP (helps detect heart enlargement / cardiac strain) and cardiac troponin I (for myocardial injury) can support decisions when imaging is equivocal
• Routine bloodwork and bile acid testing if hepatic disease or portosystemic shunt is suspected before anesthesia

Table: ACVIM staging and common management steps (breed‑focused for Maltese) ---------------------------------------------------------------------------

| Stage | Findings (Maltese) | Typical monitoring | Typical treatments / actions | |---|---:|---|---| | A (at risk) | No murmur, breed predisposition (senior Maltese 8–9 yrs) | Annual cardiac auscultation, baseline physical & dental exam | No cardiac drugs; optimize dental care, weight, exercise | | B1 (asymptomatic, murmur, no cardiomegaly) | Soft left apical murmur; normal VHS/echo | Recheck every 6–12 months; consider NT‑proBNP if murmur new | No pimobendan yet; address comorbidities (tracheal collapse, dental disease) | | B2 (asymptomatic with cardiomegaly) | Murmur + radiographic/echo heart enlargement | Recheck 3–6 months; echo every 6–12 months | Start pimobendan (per EPIC trial), consider ACE inhibitor and spironolactone if advised | | C (past or current CHF) | Clinical signs of CHF (cough, tachypnea; radiographic pulmonary edema) | Frequent rechecks (weeks–months) | Furosemide, pimobendan, ACE inhibitor/spironolactone; oxygen/diuretics as needed | | D (refractory CHF) | Advanced CHF needing higher intervention | Palliative and specialist care | Advanced diuretic regimens, hospitalization, palliative measures |

(References: ACVIM consensus guidelines on MMVD; EPIC trial results showing benefit of pimobendan in B2 dogs)

Differentiating cough and respiratory signs in Maltese ----------------------------------------------------- Because Maltese frequently get collapsed trachea and dental disease, it’s essential not to assume a cough equals heart failure. Practical diagnostic distinctions:

• Tracheal collapse: “honking” cough made worse by neck pressure; typically worse with excitement or pulling on the neck. Use fluoroscopy or radiographs, and treat with harness use, cough suppressants, and surgery in severe cases.
• Dental disease: halitosis, visible tartar, gingival recession; treat with professional dental cleaning and [home care](https://seniorpet.org/knowledge/pillar/home-care-guide "Senior Pet Home Care Guide"). Severe periodontal disease can seed bacteria into the bloodstream and increase risk of endocarditis.
• MVD-related cough: often occurs later, with exercise intolerance and radiographs showing cardiogenic pulmonary edema.

Breed‑specific comorbidities that affect MVD care ------------------------------------------------ When managing MVD in Maltese, consider these common breed conditions and how each interacts with [heart disease](https://seniorpet.org/knowledge/cavalier-king-charles-spaniel-mitral-valve-disease "Heart Disease in Senior Pets"):

• Dental disease: Toy breeds like Maltese commonly have early and severe periodontal disease. Chronic oral inflammation increases the risk of transient bacteremia; in dogs with advanced valvular disease (stages B2–D), dental procedures require careful planning, pre‑anesthetic assessment and possibly prophylactic antibiotics at your veterinarian’s discretion. Rigorous home dental care and professional cleanings reduce systemic inflammatory load and some risk to the heart.
• Collapsed trachea: Can mimic or worsen cardiac cough and complicate anesthesia. Use harnesses, avoid neck collars, and coordinate respiratory therapy with cardiac management. Because both conditions can produce cough and breathing difficulties, imaging and echo are often needed.
• Luxating patella: Exercise recommendations need balancing — maintain low‑impact activity to preserve muscle mass and cardiac conditioning while avoiding high‑impact jumps that stress patella joints. Physical therapy and weight control help both knee and heart health.
• Cataracts: Vision loss can reduce a dog’s ability to exercise safely; sudden decreased mobility should prompt evaluation for concurrent cardiac issues. Cataract surgery requires pre‑operative cardiac assessment in MVD patients.
• Portosystemic shunt (PSS): Although typically a younger‑dog condition, mild/congenital shunts may be present in some Maltese. Hepatic disease alters drug metabolism (important for cardiac drugs), and pre‑anesthetic bile acids testing is recommended before procedures.
• White shaker syndrome: A steroid‑responsive tremor disorder seen in small white breeds (including Maltese). The need for corticosteroids to control tremor must be balanced against potential side effects (polyphagia, weight gain, immune suppression) that could complicate CHF management; coordinate dosing with your veterinarian and cardiologist.

Treatment options and practical care guidance -------------------------------------------- Every Maltese with suspected or confirmed MVD needs individualized care, but the following are practical, evidence‑based steps owners can take.

Medical therapy — what is typically used

• Pimobendan: Indicated for stage B2 (asymptomatic with cardiomegaly) per the EPIC trial; shown to delay onset of CHF and improve survival in dogs with cardiomegaly due to MVD (Journal of Veterinary Internal Medicine, EPIC Study Group, 2016). Typical dosing ranges for small dogs are around 0.25–0.3 mg/kg orally every 12 hours; follow your veterinarian’s dose and formulation.
• Diuretics (furosemide): Mainstay for relieving pulmonary edema in CHF; dosing individualized and adjusted by signs, weight, and electrolytes.
• ACE inhibitors (enalapril, benazepril): Often used in symptomatic patients; evidence for benefit in preclinical dogs is less consistent, but ACE inhibitors are commonly included in CHF protocols.
• Spironolactone: An aldosterone antagonist used as adjunctive therapy in CHF and sometimes earlier for cardioprotective effects.
• Cough management: For tracheal collapse or noncardiac cough, antitussives (e.g., hydrocodone) and environment changes (humidifiers, reduce irritants) are helpful. In cardiac cough due to pulmonary edema, diuretics are indicated rather than cough suppressants alone.

Monitoring schedule recommended for senior Maltese

• 8–9 years old with no murmur (Stage A): Annual physical exam with auscultation; baseline dental exam and dental cleaning as indicated.
• New murmur detected (Stage B1): Recheck every 6 months with auscultation and body weight; consider baseline radiographs and NT‑proBNP if murmur persists.
• Cardiomegaly detected (Stage B2): Cardiology consult or echocardiogram; begin medical therapy (pimobendan) as indicated; recheck every 3–6 months.
• Symptomatic (Stage C): Frequent rechecks initially (every 1–4 weeks after therapy changes), then every 1–3 months once stable.

Practical at‑home care for Maltese with MVD

• Use a well‑fitting harness, not a neck collar, to protect a collapsing trachea and reduce cough triggers.
• Keep your Maltese lean — excess weight increases cardiac workload and stresses patella joints.
• Maintain daily low‑impact exercise (short walks, gentle play) to preserve muscle and cardiovascular conditioning; avoid strenuous exercise during hot or humid weather.
• Control oral health: daily brushing, dental chews recommended by your veterinarian, and professional cleanings with pre‑anesthesia cardiac assessment.
• Monitor respiratory rate and effort at home: resting respiratory rate >30–40 breaths per minute or consistent coughing, open‑mouth breathing, or lethargy requires urgent veterinary evaluation.
• Medication adherence: give cardiac medications exactly as prescribed; avoid doubling doses if a dose is missed — call your vet.
• Prepare for emergencies: keep your vet and emergency clinic phone numbers handy; know the fastest route to urgent care.

Anesthesia and procedures — special considerations ------------------------------------------------- Maltese frequently need dental cleanings, cataract surgery, or orthopaedic procedures for luxating patella. Pre‑anesthetic cardiac assessment is critical for any dog with a murmur or known MVD. Steps to reduce risks:

• Pre‑anesthetic bloodwork and, for symptomatic or B2 dogs, thoracic radiographs and echocardiography.
• Consider NT‑proBNP and bile acids testing (if PSS suspected) before anesthesia.
• Work with your general veterinarian plus a veterinary cardiologist or experienced anesthetist to modify sedatives and intraoperative monitoring. Drugs that cause large hemodynamic changes should be avoided or adjusted.
• For dental procedures: use strict sterile technique, brief anesthesia time, and careful analgesia. Discuss antibiotic prophylaxis with your veterinarian for higher‑risk cardiac patients — current guidance is individualized use rather than routine prophylaxis.

When to contact your veterinarian — warning signs ----------------------------------------------- Contact your veterinarian or emergency clinic right away if your Maltese with MVD shows any of the following:

• Rapid or persistent respiratory rate >40 breaths per minute at rest
• Open‑mouth breathing, blue/pale gums, or fainting
• Marked decrease in appetite, sudden weakness or collapse
• New/worsening cough, especially if accompanied by exercise intolerance
• Signs of severe tremor or neurologic changes (possible white shaker syndrome or hepatic encephalopathy in PSS)

Prognosis and quality of life ---------------------------- MVD progression is variable. Many Maltese with early (B1) disease live comfortably for years with monitoring and attention to comorbidities. Pimobendan has been shown to delay onset of CHF in dogs with cardiomegaly (EPIC trial), and appropriate CHF therapy often provides good quality of life for months to years. Controlling dental disease, avoiding respiratory irritants, and managing luxating patella help maintain activity levels and wellbeing. End‑of‑life decisions should focus on quality of life: appetite, ability to move, breathing comfort, and enjoyment of normal routines.

References and further reading ------------------------------

• ACVIM Consensus Statement on the Diagnosis and Treatment of Myxomatous Mitral Valve Disease in Dogs (ACVIM, relevant updates).
• EPIC Study Group (2016). "Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly." Journal of Veterinary Internal Medicine.
• Publications on NT‑proBNP and cardiac biomarkers for canine heart disease (see Journal of Veterinary Internal Medicine reviews).
• Articles and reviews on collapsed trachea, periodontal disease, luxating patella, and white shaker syndrome in toy breeds (veterinary textbooks and specialty journals).

Work closely with your veterinarian and a cardiologist if your Maltese has a murmur or respiratory signs. Early detection, breed‑specific preventive measures (especially dental care), and careful coordination of treatment for concurrent conditions can keep your Maltese comfortable and active well into their senior years.

Appendix — Practical checklist for owners of senior Maltese (8–9 years) -----------------------------------------------------------------------

• Annual vet exam with heart auscultation; sooner if new cough or reduced stamina.
• Baseline thoracic radiographs and NT‑proBNP if murmur is heard.
• Echocardiogram if murmur is moderate/strong or radiographs suggest cardiomegaly.
• Schedule professional dental cleaning and begin daily toothbrushing.
• Replace neck collar with a harness; train to avoid pulling on leash.
• Monitor resting respiratory rate daily at home; keep a log for vet visits.
• Discuss anesthesia plan with your vet before elective surgeries (dental, cataract, orthopedics).
• Coordinate care among your GP vet, cardiologist, ophthalmologist, and surgeon as needed.

If you’d like, provide details about your Maltese’s murmur grade, recent radiographs or echo report (if available), medications, and other health issues — I can help interpret those findings and suggest a tailored monitoring plan.