1. When do I need to give heartworm preventative to my dog?

• Risk of heartworm infestation is correlated with lifestyle and signalment.
• Heartworm is transmitted by mosquitos
• If you live in the Northeast part of the USA you only need to give heartworm preventative from June 1 through November 1, since maturation of the heartworm larvae requires average daily temp. > 64º F (18 ºC) for any one-month period. There is therefore NO need to give heartworm chemoprophylaxis year-round

2. Do all old dogs with a heart murmur need to be on heart medication?

• No, the presence of a heart murmur, does not automatically warrant treatment
• In old dogs a heart murmur is most often due to age-related changes of the valves within the heart
• These changes can make the valves leaky and thereby cause turbulence in the blood flow and the heart murmur
• A heart murmur does not necessarily mean that significant heart disease is present
• If the heart is of normal size and no symptoms are observed, treatment is most often not warranted

3. What is a heart murmur?

• A heart murmur is a sound caused by turbulence in blood flow
• A murmur can occur if the valves in the heart are leaking, either due to age changes, or in young animals due to developmental defects of the valves or due to abnormal shunting of blood
• Heart murmurs are graded on a scale of 1 to 6 or 1 to 5
• Soft murmur (up to 3/5) may be physiologic and benign
• High grade murmurs are considered abnormal
• Even if a high grade murmur is present in an old dog, treatment is not always indicated

4. My dog has been diagnosed with chronic valve disease. What is that?

• Chronic Valve Disease (CVD) or endocardiosis is a disease secondary to thickening of the heart valves
• CVD often affects the valve between the left atrium and left ventricle, causing “backflow” or regurgitation of blood across that valve and therefore a heart murmur

5. Do pets get pacemakers?

• Yes, pets do have pacemakers implanted routinely
• A pacemaker is indicated in cases where the conduction system in the heart is diseased and thereby causing an abnormally low heart rate
• Often these pets show signs such as weakness or fainting (syncope)

6. What is pericardial effusion, and why does it occur?

• Pericardial effusion is build up of fluid in the sack surrounding the heart
• If a large amount of pericardial effusion is present this can compress the heart and prevent it from filling and working properly. When this occurs,  cardiac tamponade is said to be present
• Pericardial effusion can be caused by heart tumors
• Common types of heart tumors are hemangiosarcomas, which often involve the right atrium, and chemodectomas, which usually surround the aorta and are called heart base tumors
• At times no obvious reason is found for the pericardial effusion, in which case the etiology is classified as idiopathic
• If a significant amount of pericardial effusion is present, the heart sounds are muffled, and on chest radiographs the heart silhouette will be globoid.

7. Which drugs are most often used to treat congestive heart failure in small animal?

• Commonly used drugs are diuretics, angiotension converting enzyme inhibitors and digoxin
• Diuretics are used to decrease fluid in lungs, chest cavity and/or abdomen when congestive heart failure is present
• Furosemide is the most frequently used diuretic
• An angiotensin converting enzyme inhibitor (ACEI) has many effects including decreasing the myocardial workload
• Digoxin is one of the oldest heart medications. It has a positive effect on the heart’s ability to contract and at the same time it decreases the heart rate, which is often increased in animals with severe heart disease and/or failure.

8. What are typical signs of heart disease and possible congestive heart failure?

• Typical signs of congestive heart failure are increases in the resting respiratory rate (breaths per minute) and respiratory effort, which is due to accumulation of fluid in the lungs (left sided congestive heart failure) or chest cavity (right sided heart failure)
• Often the heart rate will be elevated and sinus arrhythmia will not be present, due to elevated adrenergic tone
• Cough will often be present, especially at night, and if a significant amount of fluid is build up in the lungs significant breathing difficulties will be seen
• The animal is likely to be intolerant to exercise
• An animal with heart disease does not have to be in congestive heart failure. If the heart disease is severe enough and the heart reaches a point where compensation is no longer possible, congestive heart failure develops.
• Left sided heart failure causes fluid accumulation in the lungs, whereas right sided failure causes fluid build up in the abdomen and/or chest cavity.

9. What are NOT typical signs of heart disease/heart failure?

• Chronic dry cough is NOT a typical sign of heart failure, but may be due to a primary respiratory problem. Chronic cough can however be seen in dogs with severe heart enlargement due to compression of the main stem bronchi, but this type of cough is due to manual compression on the airway and NOT congestion in the lungs.
• Panting is in general NOT a typical sign of heart disease. An animal with congestive heart failure has increased resting respiratory rate (breaths per minute) and effort, and in acute cases severe respiratory distress may be seen (open mouth breathing, extended neck, front leg turned outwards – all in order to compensate and improve breathing capability).

10. Is it likely that my pet has significant heart disease if no heart murmur is present?

• No, heart disease without a murmur is rare
• Especially in old dogs, the absence of a heart murmur would make it very unlikely that significant heart disease or heart failure is present
• Only in very few conditions (reverse shunts) can significant heart disease be present without an ausultable murmur, but in those instances the clinical symptoms should give the cardiologist a suspicion of the underlying disease

11. My pet had a persistent ductus arteriosus (PDA) diagnosed. What are the treatment options?

• A persistent ductus arteriosus is a congenital heart defect permitting communication between the systemic and pulmonary circulation.
• The communication between the systemic and pulmonary circulation is normal in the fetal life, but it should close once the animal is born
• A large PDA can (if untreated) cause left sided congestive heart failure, and be fatal
• Treatment options for PDA are either surgery or coil-occlusion via catheter
• PDA surgery involves opening of the chest cavity (NOT the actual heart) and placing a suture around the abnormal vessel connection between the aorta and the pulmonary artery. Coil-occlusion (or embolization) is a less invasive procedure performed via catheterization through which one or more small coil(s) is placed within the abnormal vascular connection - which precludes further flow along this pathway
• Treatment of a PDA (either via surgery or catheterization) is in general curative

12. What kind of work-up will be done if I bring my pet to see a cardiologist?

• The cardiologist will initially evaluate your pet by doing a physical examination, which will help establish what further diagnostic work-up is warranted in the individual case. Also the history given by you as the owner is essential in order to provide the best and most appropriate work-up of a given presenting complaint
• A physical exam done by a cardiologist includes an evaluation of the patient with focus on the cardiovascular system (heart and vessels), which in particular means careful auscultation of the heart (and lungs) to assess whether heart sounds are normal, whether an arrhythmia is present. If the heart rate is within the expected normal range and whether any abnormalities can be heard in the lungs. Also the peripheral pulses, colour of mucous membranes and signs of congestive heart failure are assessed (ascites, pleural effusion, edema, etc.)
• There are various further diagnostic tools that may be warranted, but not all may be needed in each case.
• ECG (electrocardiogram): this test evaluates electrical activity of the heart with heart rate (heart beats per minute) and heart rhythm assessment. An ECG can give valuable information about arrhythmias (abnormal heart rhythms) if such are heard on auscultation.
• Echocardiogram (ultrasound of the heart): this diagnostic gives an opportunity to evaluate the heart’s internal dimension, heart function and valves by using ultrasound beams that are reflected and transformed to a picture on a monitor. Doppler evaluation is a special part of the echocardiographic exam, which is done frequently in order to assess blood flow within the heart and measure flow velocities, possible shunts, etc.
• Chest radiographs (X-rays): this modality gives information on the lung pattern (in case congestion is present), size of lung vessels and the heart silhouette, but not ainformation about the heart function. No information about the actual heart function. Chamber enlargements can be detected on radiographs, but more precise measurement can be obtained on an echocardiogram.
• Holter-monitor: this is a 24 h continuous ECG recording that necessitates the dog wearing a small vest including a mini-computer, which detects and records every heartbeat over a period of 24 h. Once this recording is analysed, valuable information about arrhythmias and heart rate can be obtained, which may not have been detected when the patient was seen in the clinical settings. This diagnostic tool is typically used for patients with a history of syncope (fainting), or if significant arrhythmias are detected in the hospital.
• Event-monitor: this is different from the Holter-monitor in the sense that this device only records when asked. Specifically, this device stores the ECG from the episode of collapse, (when the owner activates the monitor at the time of the event). The advantage with this monitor is that if the syncopal events are infrequent the patient can wear this monitor for several days (since it’s not recording continuously) and thereby increase the chance of capturing a collapse episode on tape for evaluation.