Members' NAVLE study guide

Canine MMVD: ACVIM Stages & EPIC Criteria

3,448 words 13 min read 3 figures Reviewed November 12, 2026

Myxomatous mitral valve disease (MMVD), also called degenerative valve disease or endocardiosis, is the most common heart disease of dogs. The valve thickens and leaks slowly over years, so most affected dogs have a murmur long before, if ever, they develop heart failure.

Key facts

Valvular heart disease (MMVD) at a glance
  • Species and system: dog; cardiovascular (mitral valve, also the tricuspid valve in at least 30%).
  • Frequency: about 75% of heart disease seen in North American practices; up to 85% of small-breed dogs have valve lesions by 13 years.
  • Typical patient: older small-breed dog (under 20 kg); Cavalier King Charles Spaniels affected young; males about 1.5 times more often.
  • Classic presentation: left apical systolic murmur in a dog without signs, later rising respiratory rate, dyspnea and cough from left-sided CHF.
  • Staging: ACVIM 2019 stages A, B1, B2, C, D; pimobendan starts at B2.
  • Not zoonotic, not reportable.

What's inside

14 sections in the full guide
  1. Key facts
  2. How the NAVLE tests this
  3. Cause and pathophysiology
  4. Clinical signs
  5. Staging (ACVIM 2019)
  6. Diagnosis
  7. Differential diagnoses
  8. Treatment and management
  9. Complications
  10. Prevention, control and public health
  11. Prognosis
  12. Quick review
  13. Test yourself
  14. References
The full guide also has 6 tables, 3 figures, 3 self-test questions and 15 references, available to NAVLE members.

Read the full study guide

The full guide is part of every NAVLE plan, with diagnosis and treatment tables, figures, a quick review and self-test questions. Start a free trial to try the question bank, or log in if you are already a member.

Read the free overview article A shorter, free article on Valvular heart disease (MMVD) on the NavleExam blog.

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Canine · Cardiovascular