Disease Guide ·Heart Murmur ·2026

Heart Murmur in Dogs — symptoms, vet costs & insurance

A heart murmur is an abnormal sound during heartbeat — diagnosis costs $500-$2,000, and ongoing medication runs $50-$200/month. Not all heart murmurs mean disease. Puppies can have innocent murmurs they outgrow. In adult dogs, murmurs are graded I through VI and may signal valve disease, cardiomyopathy, or other heart conditions. Here's what diagnosis and treatment actually costs.

By Marcel Janik · Reviewed by veterinary data
Heart Murmur — vet costs and insurance
Heart Murmur — real vet costs and insurance guide.
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Key Facts & Real Vet Costs

What Causes Heart Murmurs

A heart murmur is turbulent blood flow through the heart that your vet hears with a stethoscope. Common causes include mitral valve disease (the most frequent in small breeds), dilated cardiomyopathy, congenital heart defects, and heartworm disease. Some puppies have innocent murmurs with no underlying disease — these usually disappear by 4-5 months of age. Graded I through VI by intensity

Symptoms — What to Watch For

Many dogs with heart murmurs show no symptoms at all, especially with low-grade murmurs. As heart disease progresses: coughing (especially at night or after exercise), exercise intolerance or tiring quickly, rapid or labored breathing, fainting or collapsing, swollen belly from fluid buildup, bluish gums. Low-grade murmurs may have no visible symptoms

Diagnosis — $500-$2,000

Vet exam ($50-$100) detects the murmur with a stethoscope. Echocardiogram ($300-$600) is the key test — an ultrasound of the heart that shows structure and blood flow. Chest X-rays ($200-$400) check heart size and lung condition. Blood work ($100-$300) and ECG ($100-$250) round out the workup. A veterinary cardiologist may charge more. Average $500-$2,000

Treatment — $50-$200/Month Ongoing

Innocent puppy murmurs need no treatment. For heart disease, medications include ACE inhibitors, diuretics (furosemide), and pimobendan — typically $50-$200/month combined. Severe cases may need specialist visits every 3-6 months. Heart surgery is rare but possible for certain conditions — $5,000-$20,000 at specialty centers. Average $50-$200/month for medication

Total Cost — $500-$2,000+ Diagnosis

Initial workup plus ongoing meds. Annual monitoring adds $300-$600/year. Surgery cases reach $5,000-$20,000.

Small Breeds — Higher Risk

Cavalier King Charles Spaniels, Dachshunds, Chihuahuas, and Miniature Poodles are most prone to mitral valve disease.

Prognosis — Varies Widely

Innocent murmurs resolve on their own. Managed valve disease dogs can live years with medication. Prognosis depends on the cause.

Prevention

Regular vet checkups to catch murmurs early. Heartworm prevention. Maintain healthy weight. Annual exams are key.

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The Real Cost

Initial workup plus ongoing meds.

Diagnosis$500-$2,000 Treatment$50-$200/Month Total Cost$500-$2,000
$500typical cost
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Insurance Traps Cardiac conditions are expensive long-term — here's how insurance handles heart murmurs and heart disease.
Red flag · Waiting period

Cardiac Coverage Basics

Most pet insurance policies cover heart conditions including echocardiograms, medications, and specialist visits as long as the murmur wasn't detected before enrollment. Cardiac workups are expensive — this is where insurance provides real value. Standard 14-day illness waiting period applies to heart-related claims.

Red flag · Pre-existing

The Pre-Existing Murmur Problem

If a vet noted a heart murmur at any visit before your policy started, all heart-related claims will likely be denied as pre-existing. This is a major issue with breeds predisposed to heart disease. Get insurance while your dog is young and healthy — even a Grade I murmur on record can disqualify cardiac coverage.

Red flag · Chronic condition

Ongoing Medication Coverage

Heart medications cost $50-$200/month — that's $600-$2,400 per year for life. Most policies cover prescription medications, but check whether your plan has per-condition caps that could limit long-term cardiac medication coverage. Some plans cover medications but not the recurring specialist echocardiograms needed for monitoring.

Red flag · Exclusion

Breed-Specific Exclusions

Some insurers add breed-specific exclusions for conditions known to affect certain breeds. Cavalier King Charles Spaniels, for example, may face cardiac exclusions or higher premiums. Read your policy carefully — not all insurers do this, but it's more common with breeds that have high rates of heart disease.

Heart Murmur and pet insurance guide

🇺🇸 US Pet Insurance Guide

Enroll before the first symptom appears

Our guide shows exactly what to check in the fine print — before your first claim gets denied.

Insurance Guide
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Common Questions Real answers about costs, treatment, and insurance coverage.
0What is a heart murmur in dogs?
A heart murmur is an abnormal whooshing or swishing sound that a vet hears when listening to your dog's heart with a stethoscope. It's caused by turbulent blood flow through the heart. Murmurs aren't a disease themselves — they're a sign of something else. That something can range from completely harmless (innocent puppy murmurs) to serious heart disease (valve degeneration or cardiomyopathy).
1How are heart murmurs graded in dogs?
Heart murmurs are graded on a scale of I to VI based on how loud they are. Grade I is barely audible — only detectable with careful listening. Grade II-III are soft to moderately loud. Grade IV-V are loud and easily heard, sometimes with a vibration you can feel on the chest wall. Grade VI is the loudest — audible even with the stethoscope slightly off the chest. Higher grade doesn't always mean worse disease, but it does warrant investigation.
2Do puppies outgrow heart murmurs?
Some do. Innocent or physiological murmurs are common in puppies and usually disappear by 4-5 months of age as the heart matures. These are typically Grade I-II, soft, and your vet may describe them as 'innocent' or 'flow murmurs.' However, not all puppy murmurs are innocent — congenital heart defects can also cause murmurs that won't resolve. Your vet should monitor the murmur at each puppy visit.
3How much does an echocardiogram cost for a dog?
A cardiac ultrasound (echocardiogram) for a dog typically costs $300-$600 at a general practice and $400-$800 at a veterinary cardiology specialist. This is the most important diagnostic test for heart murmurs — it shows heart chamber size, valve function, blood flow patterns, and heart muscle thickness. Most dogs need sedation, which adds $50-$100. If your vet refers you to a cardiologist, expect to pay on the higher end.
4What medications are used for heart disease in dogs?
The most common heart medications for dogs include pimobendan (Vetmedin) which strengthens heart contractions, furosemide (Lasix) which removes excess fluid, enalapril or benazepril (ACE inhibitors) which reduce blood pressure, and spironolactone which works alongside other diuretics. The specific combination depends on the type and severity of heart disease. Monthly medication costs typically run $50-$200 depending on your dog's size and the drugs needed.
5Can a dog live a normal life with a heart murmur?
Many dogs live completely normal lives with heart murmurs — especially those with innocent murmurs or low-grade murmurs from mild valve disease. With proper medication, dogs with heart disease can often maintain good quality of life for years. The key is early detection, consistent medication, regular monitoring with echocardiograms, and knowing the signs of heart failure progression so you can adjust treatment.
6What are the signs of heart failure in dogs?
Signs that a heart murmur has progressed to heart failure include persistent coughing (especially at night), rapid or labored breathing even at rest, extreme reluctance to exercise, fainting or collapsing episodes, swollen abdomen from fluid accumulation, bluish or pale gums, and sudden weight loss or loss of appetite. If you notice any of these signs, see your vet urgently — heart failure requires immediate treatment adjustment.
7Does pet insurance cover heart murmur treatment?
Most pet insurance policies cover heart murmur diagnosis (echocardiogram, X-rays, ECG) and ongoing treatment (medications, specialist visits) as standard illness coverage. The catch is pre-existing conditions — if a murmur was detected before enrollment, all heart-related claims may be denied. Long-term medication coverage varies by plan. Some have annual or per-condition caps that may not cover years of cardiac medication.

Breeds Most Affected by Heart Murmurs

Cavalier King Charles Spaniel Related
Cavalier King Charles Spaniel
Cavalier King Charles Spaniel
Dachshund Related
Dachshund
Dachshund
Chihuahua Related
Chihuahua
Chihuahua

Sources

  1. Keene BW, Atkins CE, Bonagura JD, et al. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. J Vet Intern Med. 2019;33(3):1127-40.
  2. Pedersen HD, Häggström J, Falk T, et al. Auscultation in mild mitral regurgitation in dogs: observer variation, effect of physical maneuvers, and agreement with color Doppler echocardiography and phonocardiography. J Vet Intern Med. 1999;13(1):56-64.
Marcel Janik, founder of RealVetCost

I'm a dog owner who got burned

My mother-in-law took her German boxer to the veterinary emergency room — $1,200 in tests, no answers. A different vet solved it in minutes with $8 pills.

That moment stuck with me. When you’re scared for your dog, you’ll pay anything. Some vets take advantage of that. I started digging into vet costs and pet insurance. The policies were confusing, the exclusions buried, the pricing impossible to compare. So I built the resource I wish existed. Real costs, real exclusions, plain speak. I’m not here to sell you a policy. I’m here so you don’t get blindsided.

Marcel Janik Senior UX/UI designer