Valvular damage is often seen with cadiomyopathy, and I would not rule out
the possibility of primary CMP with valvular disease as a result.
 
Enacard and lasix are two of the three commonly used drugs for CMP - all
that you are missing is digitalis (usually prescribed as digoxin).  Digoxin
strengthens the contraction of a failing heart muscle.
 
I think that if there hasn't been sufficient response to the current
therapy, that you may want to re-evaluate this animal and add digitalis
to the current course of therapy.
 
The long term prognosis for clinical valvular disease is about the same
as it is for CMP - not good.  We really can't ever improve the situation -
with appropriately dosed medication, all we can do is slow down the
progression of the signs.
 
With kindest regards,
Bruce Williams, dVM
[Posted in FML issue 3398]