When our regular veterinarian examined Majerle shortly after we picked her up from the emergency clinic, she said her lungs sounded clear and her heart, despite the murmur, was beating strongly.  She recommended an echocardiogram and EKG to determine precisely what the cause of her problems is.   The travelling cardiologist spends his mornings in our part of town, so we were able to have the procedures done that day.  When we picked up Majerle that afternoon, the vet said she had some good news.  The cardiologist diagnosed a ruptured chordae tendonae, which she described as a "torn heart string".  The chordae tendonae is a piece of tissue that controls one of the valves in the heart.  Apparently, when it ruptured it put Majerle into a state of cardiac emergency, at which time the emergency clinic vets put her into the oxygen cage and administered drugs (including nitroglycerin) to counter the problem.  It didn't sound good to me, but the vet explained that the cardiologist felt that Majerle's problems could be controlled with proper medication.  She was prescribed enalapril, a blood pressure medication, to help normalize her enlarged heart a bit, and lasix to control fluid buildup, and was sent home Monday afternoon.

Majerle seemed happy to be home, but also very tired.  She ate her dinner of canned food with gusto and got her evening lasix tablet.  When we went to bed, Majerle was very insistent on snuggling up against me.  She always lays close enough to me to touch me with a paw or her back, but this night she plastered her entire back against my side.  Although she slept soundly, I felt her rapid breathing all night long, and was so concerned I barely slept.  Hubby didn't sleep well either; every time Majerle moved or even twitched in her sleep, we both woke up and felt her chest to make sure she was breathing OK.

The following morning, I gave Majerle her first dose of enalapril.  She took the pill-filled treat quite eagerly then went back to sleep.  An hour or so later, I tried giving her the morning lasix pill (I try to keep the lasix doses 12 hours apart, and had given her the evening dose a bit late) but she wasn't interested in the treat.  She got up, moved to my pillow and plopped down on her side, then urinated.  I was already concerned about her breathing, but this turn of events REALLY concerned me as Majerle wasn't the kind of dog that would pee while laying on her side.  I carried her outside while Hubby stripped the bed (thankfully we have a waterproof mattress pad, placed there because occasionally one of the dogs doesn't quite make it off the bed when they have to go potty).  Majerle was shaking like a leaf and looked completely miserable.  I was now in major worry mode, and called the vet who asked to see her ASAP.  It seems that the enalapril can cause the blood pressure to drop too much, but after a quick trip to the clinic it turned out there was no such problem.  Majerle's lungs were still clear and her heart was still strong.  The vet thought perhaps the stress of the past couple days was finally affecting the dog, and sent us home with the admonition to keep a close eye on her.

I suddenly had the idea that perhaps the reaction was to taking the medication on an empty stomach.  I did some quick web research that indicated it was OK to take enalapril with food.  The following morning I gave Majerle a light breakfast before giving her the meds, and we didn't have any problems.

It's been 5 days since the initial emergency, and things seem to be going quite well.  Majerle is coughing more than she ever has; she's going in tomorrow morning for a blood test to check her kidney function to make sure the enalapril isn't causing problems, and I will bring up the coughing to the vet.  Other than the coughing, Majerle has been more alert and active than she's been in a long time.  I've read some pretty scary things about enalapril (particularly that it can cause kidney failure) but she is responding so well that, if her blood tests remain normal, I'll do more research to determine how comfortable I am with her remaining on it.