ToTo is a 10 year old Yorkshire Terrier from New York, NY. ToTo had a totally clean bill of health until a low grade murmur was detected in July of 2016. X-rays and echocardiogram at the time did not conclude treatment, just a follow up one year later. During pre-check for teeth cleaning three weeks ago, March 2017, blood work came back with slightly elevated enzymes in the liver; and x-ray showed a much more enlarged heart than last summer. The vet was not comfortable with putting him under until another echo was done, which concluded he had progressed to a grade 4. The vet prescribed Denosyl to protect his liver as well as Enalapril. Three days later ToTo’s heart rate increased to 180/min and resting breaths were 60/min. He was rushed to the emergency vet. X-rays showed fluid in lungs and ToTo was put on Lasix. The next morning, he went back to the emergency vet after a difficult overnight with many side effects. The vet confirmed a murmur of not just a level 4, but a level 6. At that point, the vet recommended seeing a cardiologist. Dr. Karmer saw ToTo and suggested adding Vetmedin to the daily meds. Currently, he is on Vetmedin, Enalapril, and Lasix. Toto had a successful surgery at the Bozon Clinic in France on January 29, 2018 and is resting and recovering at home in NYC.