LIFESTYLE I VET TALK
Heart murmurs in pets One of the most common causes of a heart murmur is an abnormal heart valve. These can be either congenital or acquired. A heart murmur is detected with a stethoscope usually during a routine clinical examination. The actual ‘murmur’ is an abnormal heart sound which is usually caused by turbulent (rather than smooth) blood flow. Congenital murmurs are referred to as ‘innocent’ murmurs if the problem corrects itself (benign). Usually innocent murmurs are less intense (softer). Up to 30% of puppies and kittens can have an innocent murmur. Heart murmurs are graded by intensity (loudness) from grades 1-6, with a grade 1 being the softest and grade 6 being the loudest. Unfortunately, the grade of the murmur does not always correlate with the severity of heart disease, but can be used in patient records to describe the murmur, which helps determine progression of disease with each examination.
What is the prognosis for pets with heart murmurs? Not all murmurs progress to congestive heart failure. Many older pets have heart murmurs due to mitral valve deterioration, but this does not always mean your pet will live a shorter life span. It depends whether the heart can compensate sufficiently without medication. What are the signs of congestive heart failure in pets? • Exercise intolerance • Coughing • Increased respiratory rate • Pale gums What diagnostic tests are available? Congenital heart murmurs If you have a new puppy or kitten and your vet detects a heart murmur that persists as your pet grows, then it is essential that further testing
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is done to ensure that the abnormality causing the heart murmur is not life threatening. Some examples of lifethreatening heart murmurs include aortic stenosis; patent ductus arteriosus (PDA); and ventricular septal defect (VSD). Testing involves chest x-rays and cardiac ultrasound, usually by a specialist veterinary cardiologist or veterinary ultrasonographer. Acquired heart murmurs For adult cats and dogs that develop a heart murmur, your vet will be able to guide you with the best diagnostic recommendations depending on the severity of the murmur. DOGS - Generally, if a heart murmur is detected for the first time and is a grade 1 or 2, then imaging may not be required immediately, however more frequent veterinary exams will be recommended to see how quickly the murmur progresses. If the murmur is a grade 3/6 or higher, then chest x-rays and a cardiac ultrasound should be carried out to determine the cause. When a chest x-ray is taken, your vet can determine whether the heart is abnormally large and if there is any fluid accumulating on the lungs (pulmonary oedema). CATS - Require diagnostic testing immediately if a heart murmur is detected. While some of the murmurs are harmless, some cats even with a low intensity murmur can have serious heart disease (eg. hypertrophic cardiomyopathy). This may result in blood clots forming which may lodge in an artery, cutting off blood supply to various parts of the body. My recommendation
for cats with a murmur is the following: • Blood testing • Chest x-rays • Cardiac ultrasound
What treatment is available?
Congestive heart failure is initially treated with injectable diuretics (frusemide) to rapidly remove fluid congesting the lungs as well as oxygen supplementation. This emergency treatment can be life-saving. Once your pet is stable, usually your vet will prescribe a combination of diuretics and cardiac drugs. How can I effectively monitor my pet?
The best way to monitor your pet’s heart disease is to record a sleeping respiratory rate 2-3 times per week. Ideally the respiratory rate per minute should be < 25 breaths. If it gets to 30 breaths or above, it is important to see your vet. There is now a phone app called Heart2Heart which allows the pet owner to record respiratory rate easily. Coughing may occur if there is a significant amount of fluid building up on the lungs. However, coughing is not always the result of fluid and there are many respiratory disorders that can cause concurrent disease in older patients. How can I help my pet with congestive heart failure?
• Short easy walks • Avoid hot weather • Low stress environment • Regular vet exams • Healthy weight • Low salt diet • Avoid prednisolone • Medications are for life, so ensure you do not miss giving your pet a dose Dr Gretta Howard. Veterinarian Twitter: @ DrGrettaVet
