View Full Version : Ebony had her scan
20th October 2009, 03:47 PM
As some of you might remember my Ebony was diagnosed with a heart murmur grade 2 by her vet about two month ago while she was having her annual check up. My friend then took me to the Cavalier Club Health Screening Day to see the cardiologist there. He said that she has an unusual murmur, that the murmur is in one of her upper valves and that it isnít MVD. I had Ebony scanned last week and afterwards the cardiologist was very good in explaining things to me. Ebony has MVD but very very mild. He said that my vet must be very good to have heard the murmur as he had to look at the scan several times to find it. He showed the scan to me and it was so minimal you nearly missed it. He said that Ebony needs to come back in 2 to 3 years time and that she could live to a good old age. I ask him how the other cardiologist got it so wrong and he said that that person is a cardiologist but not a specialist. I didnít want to push him further on this. So does anyone on here know the difference? I thought a cardiologist is a specialist.
I am sad for Ebony and when the vet first told me I nearly died on the spot. Suppose all I can do now is keep an eye on it and do the best I can for Ebony. Just hoping and praying that it doesnít progress or at least takes itís time to progress
20th October 2009, 04:26 PM
I had Chaos screened at the Cavalier Club Screening day when she was about nine months old and the Cardiologist said she had a heart murmer but that it was not MVD and said she should be scanned. I took her to my vet for a referral and she said she could not hear it at all but sent us for a scan. I was also very worried. After the scan the Cardiologist said he also had difficulty in hearing it as it was so minor and that it was nothing to worry about as it was just a normal noise for her, some puppies apparently do have a slight noise.
Since then no other vet has mentioned her having a murmer thank heavens as I have enough to worry about with the SM.
20th October 2009, 04:45 PM
when frida was 1 year old the vet. 'found' an atypical murmur, and refered us to an ultrasound cardio specialist.
the waiting time was too long for me, so i scanned her myself, and could see nothing wrong. the grayscale image, the color doppler and the spectral doppler trace of all valves were all perfectly normal.
this was later confirmed at the clinic, and nobody else has been able to hear this 'murmur'.
god knows what some peolpe sometimes hear.....
by the sound of it you seem to have not much to worry about, the MVD being so minor.:) i hope it stays like this for a long, long time.
20th October 2009, 06:32 PM
I'm glad that you posted about this, because nothing that you've said about Ebony's murmur before today has made ANY sense to me! I did not comment earlier because I didn't have enough information to make an intelligent response but I was pretty certain that you had been misinformed.
I know how specialists in the US are credentialed, but I know nothing about the UK, so I checked it out. I learned that there are various levels of veterinary cardiology credentials in the UK (very different from US):
Royal College of Veterinary Surgeons (RCVS) Certificate Holder
This is the first level of qualification. It shows that the holder is "a competent clinician who has proved his/her experience and expertise in cardiology by examination". They will have needed to show at least two years experience during which at least 10% of their work will have involved the treatment of cardiovascular cases. Look for the letters CertSAC (Small Animal Cardiology) or CertVC (Veterinary Cardiology) after your vet's name.
RCVS Diploma Holder
This is the second level of qualification. The letters DVC after your vet's name denote this level of qualification. The holder is a competent clinician who has proved their experience and expertise by examination in veterinary cardiology. The diploma holder will have devoted their whole time to the study and practice of veterinary cardiology, in order to meet the requirements and to gain the substantial experience needed.
RCVS Specialist in Cardiology
RCVS Recognised Specialist status is not easily achieved. To be included on the List of Recognised Specialists, an individual must have achieved a postgraduate qualification at least at Diploma level, and must additionally satisfy the RCVS that they make an active contribution to their specialty, have national and international acclaim and publish widely in their field. A Recognised Specialist must also be available for referral by other veterinary colleagues. A Recognised Specialist must reapply for recognition every five years to maintain their name on the List.
Further information about veterinarians holding advanced qualifications is available from the Royal College of Veterinary Surgeons website: www.rcvs.org.uk.
http://www.heartydog.co.uk/doctor/en/index.shtml (above info is from this site)
Which of these three levels was the person who "diagnosed" Ebony's murmur? In the US, we have board certified cardiologists credentialed by the ACVIM and there are no "levels" - you either are or you aren't. Of course anyone can make a mistake on any given day, but this is a bit alarming to me. You might want to report your experience to the club who sponsored this heart screening. If this SAME person misdiagnosed both Chaos and Ebony, it would really be good to bring this to the attention of the group that sponsored the screening day.
On the positive side - GREAT that you have a good general vet who can hear very soft murmurs!! And GREAT that you have access to a top level cardiologist! And the news about Ebony is really very good - I would have no worries for now.
20th October 2009, 08:08 PM
Thanks for that detail. I hadn't realised the three levels either! Maybe this explains some vets who are 'specialists' in hearts but not cardiologists? Or are they then cardiologists at just the first level? It is confusing.
As a general point - anyone with some cardio qualification is going to be far better than the vast majority of vets at hearing murmurs, especially early onset murmurs. But an actual scan is going to be far more accurate than listening. Listening is a skill, and you will get varied results between specialists because they are human -- they will all have different levels of expertise and experience. But the key thing is most cardios will pick up a murmur when vets will miss half of them at early onset -- so a vet is NOT a reliable source for diagnosing a murmur, especially an early murmur. That's why any puppy buyer should never accept vet heart certs for parents when looking for a puppy. You always want recent cardiologist certs. :thmbsup:
My dad was a medical professor at the University of California and Stanford University, a respiratory specialist -- one of the best in his field internationally for certain types of pulmonary disease (so I am very proud of him! :) )-- and told me that there could be great differences in what different pulmonary specialists would hear when listening to the lungs through a stethoscope. He told me about some who were just excellent and noted others could be very mediocre! A really good specialist will get a very accurate diagnosis simply by listening. Others will get the general diagnosis but not the specifics. But certain conditions may be better heard by one person than another because that's their specialty. At any rate, listening is simply the start -- most of the time, the listening indicates the specialised tests that may be needed.
I'm glad you got a mild diagnosis -- I'd say a lot of cavaliers would get the same at that age. The murmur may never worsen. If you know the breeder be sure to let them know as this would be early onset disease, though.
20th October 2009, 08:20 PM
Thank you for clearing this up. I feel a bit bad in mentioning the Cavalier Club Screening as they are doing wonderful work and itís free.
When Ebony was a pup my vet at the time said that she had a puppy murmur, and to keep an eye on it as they can grow out of it. My breeder took me to the Cavalier Club Day when Ebony was fife month old and the Cardiologist at that time (a well known one) got RCVS couldnít hear nothing and cleared Ebony. Now Ebony is 2 Ĺ years old the vet diagnosed her with this murmur. When I spoke to the cardiologist who done Ebonies scan he saw that I was a bit confused about the specialist status. I showed him the certificates from the Club Screening and he looked at the Cardios Names and he just said that the first Cardiologist who looked at Ebony is nearly a specialist and the second one is no way near that. But I think being a professional he didnít want to say any more. The guy who done Ebonyís scan is definitely a specialist in cardiology as it says after all his letters.
I still wonder if this had anything to do with her puppy murmur. When you looked at my friends scan (we went together and her dog got a grade 4 murmur) the cords are broken but with Ebonyís no cords are broken itís like a little kink at the end of the cord, very tiny thatís why he had a hard time finding it on the scan.
20th October 2009, 09:06 PM
She likely had an innocent flow puppy murmur that went away and then she later developed this current soft MVD murmur.
The easiest way for lay people to "see" endocardiosis (MVD) on an echocardiogram is when they use the color doppler function and, if there is any TINY leak in the valve, the color of the regurgitant jet (blood flowing the wrong way when the valve closes) is very obvious as the forward flowing (proper) blood and the backward flowing blood are two different colors. Sometimes you can see ruptured chords on a scan and sometimes not......and sometimes the chordae tendinae are in good condition but the valve leaflets are thickened, malformed, prolapsed, etc. and you can see that. Remember that vets "hear" a murmur (sound) but you can't "see" a murmur. You "see" a malformed valve and blood going the wrong way, which confirms that the murmur sound is indeed a symptom of MVD.
My own GP vet can hear murmurs very well and I never even consult my cardiologist to get a scan until the murmur is about a grade III and/or there is some heart enlargement on x-ray. (Exception would be if the murmur or heart enlargement very quickly progressed or if overt symptoms began.) So, again, HANG ON TO YOUR VET who can hear those low grade murmurs!
20th October 2009, 09:15 PM
One other little tidbit of info -
Endocardiosis (MVD) will show up on an echocardiogram (scan or ultrasound) long before anyone can hear a heart murmur. If you did scans on all of our "heart clear" Cavaliers, I guarantee that most would have early disease. This is why the cardiologists who designed the heart protocol decided not to require scans (but only auscultation) to clear dogs for breeding -- there would not be enough clear dogs to continue the breed if scans were required.
My own two current Cavaliers are clear for murmurs, but at ages 7 and 14 1/2, they most assuredly have some disease. This is why I get chest x-rays every six months for the oldest so that I can visually monitor heart size, and I'll get a baseline for the 7 year old in the next year or so even if he continues to be murmur free.
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