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Thread: Referral to Cardiologist

  1. #1
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    Default Referral to Cardiologist

    We took Sally to the vet for her booster yesterday and the vet has suggested a referral to a cardiologist for a heart scan. We knew Sally has a murmur so were quite relieved the vet offered to refer us. I was just wondering what this will involve now? Will she be anaesthetised? What is likely to be diagnosed other than MVD? The vet mentioned that a lot of cardiac conditions can be helped with medication and sometimes Surgery. What surgery would this be? I feel sorry for Sally she's such a happy energetic dog who never seems to get tired! I only want whats best for her and to give her a happy, healthy life. Any advice would be great especially from others who have been through this.
    Sally (Blenheim) 01/02/07
    Lois (Tricolour) 25/09/08

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    There is not enough info here to give you a good answer.

    Sally is only 2 - when was her murmur first heard? What grade murmur does the vet think? Has the murmur progressed? Does vet suspect murmur is due to MVD or to some other cardiac problem - such as a congenital malformation (such as PDA or pulmonic stenosis)? It sounds as if your vet isn't sure what is going on.

    I presume Sally is not in heart failure - medications aren't given until dog is in heart failure or until there are significant changes in heart size/functioning. If her problem is endocardiosis (MVD) and she is only 2 years old, it is unlikely that medication would be started anytime soon. If she has some congenital malformation, surgery is an option in many cases. Surgery isn't really an option for MVD - although they are doing valve repair/replacement at Colorado State Univ (Chris Orton) but generally not for MVD but for valve dysplasia - a congenital valvular problem.

    http://www.newsinfo.colostate.edu/in...m_id=495769710

    An echocardiogram (ultrasound of the heart or heart scan) does not require anesthesia. Have you had x-rays done yet to look for changes in heart size? That's usually a first step. (That also does not require anesthesia.)

    You might do well to have a consult with a cardiologist since you really aren't sure what you are dealing with at this point. Cardio may or may not recommend further testing other than auscultation and history/physical.

    Pat
    Pat B
    Atlanta, GA

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    Thanks for your reply Pat. The vet we saw on Friday hasn't seen Sally before as we have just registered at this new vet since moving house. We are waiting for Sally's notes to be transferred from previous vet. Sally is not showing any symptoms of heart failure at present and seems fit and healthy. The vet mentioned it could be a congenital abnormality but she obviously wasn't sure so she is referring us to cardiologist. I asked her if she could grade the murmur but she said it wouldn't mean much as it wouldn't indicate the size of the hole and that a scan would confirm everything. The vet was really pushing for us to have the scan as she said there would be treatments available to prolong life and give her a better quality of life for longer. I have rang the vets this morning to say we want to go ahead with the referral and I am waiting for the vet to ring me back with more information. It seems we will be referred to the University of Liverpool or somewhere in Chester.
    Sally (Blenheim) 01/02/07
    Lois (Tricolour) 25/09/08

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    Hmmmm.......is this a young, inexperienced vet or an older, experienced vet? If she mentioned a "hole in the heart" she is talking about VSD - ventricular septal defect - which is a congenital (present at birth) abnormality where there is a hole between the ventricles. Cavaliers are not known for VSD - there is another birth defect called PDA - patent ductus arteriosis, which is hereditary for Cavaliers (though not terribly common).

    Cardiologists and experienced GP vets can hear a heart murmur and have a very good idea what cardiac disease is causing the murmur. They can do this diagnosis by the timing, PMI and intensity of the murmur. Timing is when the murmur is heard - during systole, diastole or continuous. PMI is point of maximum intensity - the location where the murmur is loudest. Intensity is the grade (how loud) of the murmur - usually I to VI (Roman numerals are used). There are other heart sounds such as gallops, clicks and split heart sounds. Now a young, inexperienced vet might hear a murmur and have absolutely no clue and would thus want to refer you to a cardiologist.

    Did your old vet tell you that he/she heard a murmur? What did he/she say about it? If old vet suspected a congenital heart defect, they would have mentioned it and explained it, right? Is your new vet familiar with Cavaliers? If not, she might think that any 2 year old dog with a murmur must have a congenital heart defect because it is too young for an MVD murmur. But we all know that a 2 year old Cavalier can very well have an early MVD murmur. If your new vet doesn't know this, and you go to a cardiologist who confirms this is an MVD murmur, you may want to think about whether or not you want this new vet to treat Sally. On the other hand if Sally truly has a congenital defect and your old vet never told you of this possibility, maybe the old vet was the one who was not so good!

    I looked around and found is a good website that explains congenital heart problems in easy to understand language:

    http://www.heartydog.co.uk/diseases/en/congenital.shtml

    Please keep us posted!

    Pat
    Pat B
    Atlanta, GA

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    If you are referred to the cardiologist at the University of Liverpool, that will be Simon Swift who does all the cardiac clinics for the Cavalier Club and is a leading researcher in MVD in Cavaliers. The ordinary stethescopes used by general vets aren't sensitive enough to do more than pick up that a murmur is there; a cardiologist will have a specalist stethescope and be able to tell you much more about the intensity of the murmur, or whether there is something there other than MVD. But as Pat says, they will be able to sort out a lot of possibilities without the need for anaesthetic. Chester probably means the Chestergates Hospital, which is a superb facility; Geoff Skerritt there is a world-class neurologist and researcher in Syringomyelia, but they deal with all sorts of conditions. So if you do go to either of these, you will be getting a really good second opinion.

    All the best

    Kate, Oliver and Aled

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    Go for the echo - it was totally worth it to me and set my mind at ease. I had my boy checked at a cavalier gathering and the cardio couldn't conclusively diagnose him. We had the echo and everything checked out fine and it is just a functional murmur (no defects, mitral valve looked good, nothing oversized)

    The cardio was glad I agreed to do the echo because now we have a baseline if things should change. My boy wasnt yet a year old when all of this happened and I was in a panic. I was so glad to get the results and not have the constant worry.

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    Well Sally is at Liverpool University's Hospital for small animals at the moment having all her tests done. They took a full history from us and listened with a stethoscope. The cardiologist said there was a murmur but a very quiet one and was difficult to hear. They are doing an ECHO, ECG, bloods and xray today. She will be ready to collect this evening and they will let us know the plan when we collect her. Up to now the hospital have been great and the vets really want to listen to what we are saying. I hope they are treating Sally well. Thankyou everyone for your advice
    Sally (Blenheim) 01/02/07
    Lois (Tricolour) 25/09/08

  8. #8
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    Well all the bloods were normal and the Xray was normal. This is the report which is obviously not normal:

    We examined Sally at the small animal teaching hospital on the 27th of April 2009 to ascertain the effect of her heart murmur. To this aim blood was taken and the results were unremarkable. An Electrocardiogram was performed and was normal, blood pressure was also normal (140mmHg). Ultrasound investigation of her heart revealed a slightly thickened valve between the left atrium and left ventricle, which was also slightly prolapsing. This is without haemodynamic significance at the moment, but might progress. The pulmonic valve was also leaking, which is also not of significance at the moment. During the scan she had occasional premature complexes, which is not normal. An xray revealed a normal size of her heart, there was no evidence of distended pulmonary vessels or heart failure.

    There is no treatment needed at the moment just to continue with good amount of exercise and to keep her trim. They will review again in 2 years or before if deterioates. Feel so sorry for her as she's only 2yrs old. She is showing no symptoms and is so happy and active.
    Sally (Blenheim) 01/02/07
    Lois (Tricolour) 25/09/08

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