26th March 2012, 01:39 PM
Hello, I haven't been here in a while but I was hoping someone could help with a question I have. Last year I took in a retired stud dog (he is now 8 1/2 yrs old). He was diagnosed by my vet with a grade 3-4 heart murmur which we confirmed with a cardiologist at a heart clinic that came out for a dog show. We do not have a vet cardiologist in my state and I would have to travel 6+ hours to the nearest one.
My question is, my boy has been coughing recently and nearly fainted one day coming up the stairs so I fear his murmur is progressing. The heart clinic will be coming out again in May and offers echo scans. I wonder if I should get this done at the heart clinic or should I request an xray by my vet? I am not sure how I should go about finding if his heart condition has progressed. He is due for his annual vet checkup this month so I have not yet talked to my vet. I thought maybe I should have the echo done and take the results to my vet and then decide a treatment plan.
TIA for your suggestions!
26th March 2012, 02:40 PM
I would have your vet examine your dog's heart now and determine the current grade of mitral valve backflow. I also would take advantage of the echo in May. If that cardiologist is one of the closest to you, I would have your vet contact the cardiologist to consult on what should be done, so that when he comes in May for the health clinic, he already will be familiar with your dog.
Make sure that you pre-register for the May clinic, so that you don't miss out on the echo. Also, some cardiologists will travel to local vet offices. One of our cardiologists comes to the Orlando area at least once a month, from Gainesville, Florida. So, even though the closest cardiologist is 6+ hours away, there is no harm in asking if he visits local vet offices by appointment.
I would not leave the treatment decision-making to a non-specialist vet. If no cardiologist is going to be conveniently available, see if there is a board certified internal medicine vet closer to you.
26th March 2012, 02:49 PM
If your dog is showing possible symptoms of heart failure, you should get a workup including chest x-rays, full blood chemistry, and an echocardiogram as soon as possible. (I actually get chest x-rays before there are any symptoms of heart failure, as this gives a baseline cardiac size which is used for comparison purposes as the heart disease progresses. I get these baseline x-rays when a dog has a grade II or III murmur, before any symptoms, or even for an older dog who doesn't have a murmur.) Chest x-rays are pretty inexpensive. These tests (chest x-rays and echo) will indicate what stage of heart disease is present (this is different from grade of murmur; grade of murmur is really just a clue as it is merely the sound heard when listening with a stethoscope; grade of murmur may or may not correlate with stage of disease). If there are symptoms, he should already be on meds. The blood chemistry is important when starting heart meds as you want to make sure there are no other problems going on with major organs, etc., and then blood chemistry done after starting meds will make sure there are no side effects from medication.
Where do you live? (I think you are in the US.) If there is no cardiologist in your state, I'd look for a board certified internist. This specialist is perfectly able to diagnose and treat heart disease, particularly degenerative valve disease. You can search here:
Look for "small animal internal medicine."
There may be other specialty clinics in your area.
Chest x-rays are a good tool to use for monitoring increase in heart size, whether or not heart is constricting/pushing against main airway (which can cause a cough even without fluid in the lungs), the presence of fluid in the lungs, etc. Be aware, though, that a GP vet might not be good at interpreting heart size, esp. with a Cavalier which has a somewhat different cardiac profile from many breeds. I get chest x-rays done at my regular vet and then take them with me for my specialist consultation. I like to do monitoring x-rays every six months or so in the moderate stages of heart disease.
Nothing, however, gives as much information as an echocardiogram. This shows condition of the valves, amount of regurgitation (blood flowing the wrong way as a result of defective valves), exact chamber sizes (versus x-rays which aren't as precise), a measurement of contractility (the pumping strength of the heart muscle), and it can also indicate the presence of pulmonary hypertension (high blood pressure in the vasculature of the lungs). An echo can usually be done less often than chest x-rays. Keep in mind that an echo is only as good as the person performing and interpreting the test. Some GP vets now do echos, but their lack of training and experience makes the test less useful than when performed by a specialist such as a board certified internal medicine specialist or a cardiologist. I believe that an echo done by a specialist is key to fine-tuning the most effective drug treatment plan - one that will give the most control of symptoms and the best chance at longevity.
If you use a specialist, he/she will likely do a diagnosis and treatment plan and then work with your regular vet for monitoring and dispensing of meds. This way you don't have to visit the specialist as often, particularly if there is a distance to travel. I wouldn't particularly recommend getting an echo at the upcoming heart clinic unless the cardiologist doing the echo is willing to follow up and work with your GP vet. The person doing the echo is really the person who should do the treatment plan so just taking the results to your vet won't give you the best outcome.
If you give me your location, I'd be happy to do a little investigation about what specialists might be within a reasonable driving distance.
26th March 2012, 05:50 PM
Thank you both for the info....Pat I sent you a pm on my location. I live in a rural area so my options are limited but I am willing to do the best for my pet.
26th March 2012, 06:12 PM
I answered your PM - there is one board certified internist in your state but I don't know how far away you are. Or if you live in a city near your state's border, there may be someone nearby over the state line.