HEART TESTING SCHEME
The following proposals have been made by Simon Swift who now lectures in
Cardiology at Liverpool University.
He considers that the Club MVD research has reached the stage when it is time
for a new Initiative. The Committee will be considering his proposals, but
would welcome the input and comments of members. Please let us have your
views.
Please forward your comments to:
Lesley Jupp
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Heart Testing Scheme
When the scheme was initially set up, there were few veterinary cardiologists
in the UK. in order to make the scheme as widely available as possible, it was
decided to allow any veterinary surgeon to complete the simple form declaring
whether the dog had a murmur or not.
There are now 17 Diplomates in Veterinary Cardiology and a further 74 with
the Certificate spread across the UK. The Veterinary Cardiovascular Society
(VCS) holds two lists of cardiologists who have been accredited to carry out
auscultation and echocardiography. These lists can be accessed via the
website. Other breeds such as boxers and Newfoundlands use these lists for
their breed schemes.
The UK Cavalier King Charles Spaniel scheme was set up about 15 years ago.
Since then, the Swedish breeding advice added that breeding dogs should be
over 5 or their parents over 5 years old and free of a murmur. Despite this,
there has been little evidence in progression or decrease in the incidence of
the disease.
Proposed New Scheme
We should continue to assess dogs on an annual basis until they are 5 years
old to detect any dogs that develop a murmur prematurely. This could be
performed by a Cardiologist or the local veterinary surgeon. These will be
quiet murmurs, so ideally, a Cardiologist should perform the examination to
increase the chances of detection. However, there will be a cost involved.
The examination at 5 years old should become a major examination as this is
the time at which we decide whether the dog and its progeny should be used
for breeding. This should be carried out by a cardiologist, preferably from the
VCS list, and should include:
1. Auscultation
2. Echocardiography
It has been well established that echocardiography is more sensitive at
detecting early mitral valve disease than auscultation alone. The thickness of
the valve and any prolapse can be assessed and colour flow Doppler
echocardiography can be used to look for small jets of mitral regurgitation
that have not yet reached the human audible range.
This would also make our breeding criteria more appropriate. At the moment,
we exclude all dogs with a murmur but may be including many dogs with flow
murmurs or other innocent causes of murmurs. This would explain why some
dogs develop murmurs, never go into failure but have their murmurs for
years. Using echocardiography we can be much more precise about the actual
cause of a murmur in an individual dog.
The examination will NOT involve sedation. There will be a cost (probably
about £100 plus VAT) and some fur may be shaved off the chest. If they pass,
their names should be published on a clear list that should be actively
promoted by the Club.
Issues
There are 3 areas that are likely to raise concerns for the breeders; namely
cost, location and unexpected failures.
1. Cost - while this is significantly more than the costs that have been
applied to date, it is not unreasonable. The exact cost will depend on the
clinic involved. As this is a single major examination, there will be no
ongoing charges after 5 years and comparisons with MRI can be made.
2. Location -the distribution of veterinary cardiologists is not even
throughout the UK. but now there should be sufficient that no breeder
has to travel excessive distances.
3. Failures - there should be an established appeals procedure where a
'breeder does not accept the result. In that situation, and initially it may
be quite common as the dogs will not hav~ murmurs, a second
echocardiographic examination can be performed by a cardiologist from
the VCS accredited list.
Once dogs are over 5 arid murmur free, there is little benefit to the scheme to
continue to auscultate these dogs. However, it would be interesting to follow
these dogs and see at what point these dogs develop a murmur if they ever
do.
Conclusion
I would urge the Club to adopt this scheme. When I first became involved, the
Club was innovative in it's thinking and indicated it wanted to address the
issues of mitral valve disease within the breed. However, since setting up the
scheme, little progress has been made and the Club gives little indication of
wanting to carry that enthusiasm forward. Clubs in Europe and America have
adopted echocardiography as the gold standard and left the UK behind. As a
result many cardiologists across the world have little confidence in the UK
scheme: It is time to change.
In the US many breeders say their heart rates have improved from following the protocol and this has been stated by cardiologists there too.
Can I also combine this Post with a Personal message to all on the List who I will have insulted in the past with my thoughtless views and say how sorry I am to have made them.
Particularly to,Margaret Carter ,Carol Fowler, Jemima Harrison ,Dr C Rusbridge, and Penny Knowler.If there is any-body else Iv'e missed out please accept my Apologies.
I sure regret having said what I have said in the Past.
If I could back in Time ,at the beginning of the SM Problem Making it's appearance ,I said things that I ,at that time believed, but then several things happened to make me realize how wrong I was in my views.
Next the Letter from the UK CKCS Club Chairman appeared ,a lady I have admired for many years ,It was Mrs Jupp who about 20 years ago got to grips with the MVD Problem in the Breed,I don't know if she was ever given credit for it ,how she battled on.
Bet( Hargreaves)