https://www.vetsurgeon.org/f/clinical-questions/2367/irish-setter-heart-problem Hi All, I have a 9 y.o female neutered irish setter. She has been in left and right failure subsequent to mitral valve regurgitation for 3 days. There was also tricuspid regurg present on colour doppler. The dog had a systolic murmur for some timeen-USTelligent Community 10https://www.vetsurgeon.org/thread/4277?ContentTypeID=1Sat, 09 May 2009 15:50:46 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:dd0587e8-ac62-4ed9-b847-553a63d1fee5Rajat<p>Hi Danny</p> <p>Its been a while since your post but in case things haven&#39;t improved... I&#39;d suggest using Digoxin rather than Diltiazem to control AF, unlikely to get control with Diltiazem. </p> <p>How is the dogs systolic function? Do you feel she has primary endocardiosis as the problem? What grade is her murmur/s and how have they changed? Always had a murmur or did she present with one? Just wondering if she DCM vs endocardiosis, often tough to tell, but the murmur grade and length of having a murmur can give it away in addn to the echo.</p> <p>&nbsp;</p> <p>If she has true pulmonary hypertension ( I&#39;d start worrying at TR jets&gt; 3m/s or PG &gt;30 mmHg) despite treating your CHF you could consider Sildenafil. I wouldn&#39;t at this stage unless it was really bad and you felt it was her primary problem... sounds like AF is the main worry and once under control your other medications should work well. Consider adding Spironoloiactone and hydrchlorothiazide for ascites. Works better than frusemide.</p> <p>So a short answer overall - try Digoxin and stop the Diltiazem!</p> <p>&nbsp;</p> <p>Cheers</p> <p>Raj</p><div style="clear:both;"></div>