In canine heart failure due to mitral valve disease, which of the following represents a typical combination therapy?

• A. Furosemide, Enalapril, Pimobendan
• B. Furosemide, Enalapril, Digoxin
• C. Furosemide, Enalapril, Pimobendan
• D. Spironolactone, Enalapril, Pimobendan

Answer: (C)

In mitral valve disease with heart failure, the goal is to relieve fluid buildup, reduce the heart’s workload, and support its pumping ability. A loop diuretic like furosemide rapidly lowers pulmonary congestion and edema, which improves breathing and reduces preload. An ACE inhibitor such as enalapril helps dilate blood vessels, decreases afterload, and dampens the renin-angiotensin-aldosterone system, which can slow remodeling and further stress on the heart. Pimobendan adds positive inotropy (improving the heart’s contractile strength) and vasodilation, which enhances forward flow and reduces the workload on the heart.

Together, these three address symptom relief, hemodynamic improvement, and disease progression in many dogs with CHF due to MMVD. Digoxin is less commonly used as a routine first-line addition in this scenario, and spironolactone may be added in some cases but is not part of the classic trio.