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]