Definitely see a cardiologist. The pup MIGHT have an innocent murmur that it outgrows, but in my limited experience, that kind is usually a low grade murmur. Pup may need a doppler at the cardiologist's. That can rule out things for you, or give you lifesaving information for the pup. I know a Lab pup diagnosed with TVD that was given 3 months to live who was still going strong at 9 years. Then again, there are others who don't fare so well and have limited, short lives. We see different things in rescue.
Do be aware that it is a listen in time. I have had Cavaliers I bred diagnosed by a noted cardiologist with a significant murmur, which, given adult age, usually means mitral valve disease in that breed. The dogs went back to the same cardiologist and others--no one could find a murmur again on those dogs. The one just cleared again at almost 8 years, so who knows what that was all about. The dogs were not used in a breeding program, but were performance dogs. I do find that in the Cavaliers, we have transient murmurs more likely after a rabies vaccine, for what it is worth anecdotally.
In what part of the country are you, OP? There are several heart clinics coming up over the next couple months, some with dopplers.
Does a heart murmer always mean TVD?
Vet said it was a 3 out of 6 in a 12 week old pup.
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We have produced many innocent heart murmurs over the years. Usually a grade 1 or 2, once a general vet gave grade 3. All of these were gone by 16 weeks, never to return.
I wouldn't spend the time or money for a cardiologist at 12 weeks old. If murmur is still there at 16 weeks old, yes, then I'd start to run the whole gammit. Just how we've done it here. If it's a real issue for concern, it will still be present at 16 weeks.
Between 8-12 weeks old the pups blood supply increases, often giving a benign flow murmur. You may be just at the end of this normal growth phase. Also, generalist vets tend to rate murmurs too high - higher than if a cardiologist were listening.
Is the pup eating normally with good appetite or does he/she stop to rest while eating? Does pup have normal puppy energy or is he/she doing an excessive amount of resting? The clinical presentation of pup is also a huge indicator of if it's time to seek out a cardiology consultation.
Sure, there are other heart defects. A cardiologist may be able to tell from the location and sound of the murmur if it is TVD or something else.
The one that checked my TVD pup listened then said it was highly unlikely to be anything else but TVD, did we still want an echo? Well, we had the echo done anyway so the breeder would have confirmation of the diagnosis.
My general vet was not able to determine the exact problem just by listening. Have a cardiologist consultation to find out what you are dealing with. If you are near South Carolina go see Dr. Baumwart. That is who we went to, before he moved to SC.
Murmurs can be caused by any number of defects and can also be "innocent murmurs" that go away with age. Why worry and get gray hairs over it? You need a correct diagnosis and only a Cardiologist can do so. They may be able to do so with only an asculatation, which is a minimal fee (in our area $45 or so). If it is serious, regardless of cause, you may have to intervene surgically, or make an even tougher decision.
Make the appointment and make your decisions based upon what the cardiologist tells you.
As the Stage 3 murmur can be caused by a no. of different reasons including TVD, seeing a cardiologist as already stated would be the best, most knowledgable vet to work with. A cardio has many sized stethescopes and a 2d color echo Doppler.
I personally feel, most cardiologists will recommend a Doppler immediately after auscultation. Try to find a clinic near you or a little further, it's worth the ride for a proper diagnosis. I hope it's something minor and you'll be able to let out at sigh of relief.