Chordae Tendinae Rupture

Greetings to all, In July 2021 we were told that our rescue Chihuahua Percy had a heart murmur. His notes say: 8th July 2021 - “grade 3 heart murmur” Shortly afterwards we changed insurance company from John Lewis to Bought by Many (now Many Pets) and later found that he wasn’t covered for his heart issue. The heart murmur was mentioned again: 26th January 2022 - “grade 4 heart murmur”   28th February 2022 – “Checked heart, still grade 4/6 HM” 11th July 2022  - upper resp noise. HR 132 grade 4/6 HM, normal rhythm referred noise in lungs abdo palp       mild hepatomegaly I was offered Pimobendan (Cardisure) to see if it would help. I commenced a course of half of a 1.25mg tablet, twice daily.   On the evening of Sunday 21st July, Percy was breathing badly and I had to take him to the emergency vets. The vet there diagnosed Chordae Tendineae Rupture. Percy was put to sleep. I requested an individual cremation. There was no post-mortem. At least, not that I am aware of. The emergency vet stated in his notes: PE: QAR - severe dyspnoea (restrictive patern) - RR 90 - lung sounds: crackles bialterally (more prominent ventrally) - struggling to auscultate the heart - femoral pulses very weak - MM pale - CRT 3S - cold Provided oxygen Placed IV-CATH Concerns: - chordea tendinae rupture   I submitted and insurance claim and was told that they had contacted my usual vets for their opinion as to whether there was a link between the heart murmur and the heart failure. “The claim has been discussed with our claims team and we sought further advise from the vets regarding the Cordinae Tendinea Rupture that Percy sadly passed away from, hence the delay in reply as we wanted to make sure we had all the information needed to assess the claim. The vets have advised us that the Cordinae Tendinea Rupture is connected to Percy's heart murmur that Percy was diagnosed with in 08.07.2021. As this is linked to a health issue that occurred pre-policy inception we are unable to cover this claim.”     My question is:   How can we be sure that the heart murmur was linked to the CRT without a PM?   I’m not a doctor or any other kind of medical professional, so if I sound a bit thick…   I just want to be sure that the insurance company (Many Pets) are correct in their refusal.   I have not had sight of the vets report from my own vets that the insurance company requested to make their decision.   Thank you in advance for your constructive advice.   Mark  

Dear Mark I'm extremely sorry to hear that you lost Percy to heart disease.  It's always traumatic losing a loved one, and when insurance issues are involved it must make it harder.  My understanding is that heart murmurs are a sound, not a diagnosis;  they are the sound of a heart valve closing incompletely or inefficiently and can have an array of different causes; the heart sound can be affected by anything that affects the flow of blood through the heart valves / chambers and thereby the sound that the valve makes when it snaps shut.  Cordae tendinae are fibrous bands of tissue attaching to the heart valve and in the event of their weakening or rupture, a heart murmur might indeed be heard.  Not every heart murmur originates in the cordae tendinae, but if a murmur was heard and not looked into, and slowly progressed in sound, and later the patient passed away because of cordae tendinae rupture, I can see that it might be difficult for your vet to argue that the two things were unrelated.  Generally, it is in vets' interest that insurance companies pay out for bills, but we are duty bound as professionals to be as truthful / objective as we can.

Please note that these are general comments only; that I do not have enough information about this case to have a clinical opinion.  Usually insurance decisions are a combination of the details of the policy and your vets answers to objective questions that they have no choice but to answer honestly.