Your healthy dog or cat goes in for a routine visit, and your veterinarian finds a heart murmur. What do you do?
- Gold Standard: See a cardiologist. Check out the murmur. Get a diagnosis. Make sure it’s nothing serious.
- Reality Check: A cardiology referral is expensive, usually between $300 and $600. Many clients ask me: Is this necessary?
There is no simple answer. Your vet has to run a bunch of stuff through her head and give you a qualified recommendation on how to proceed without really knowing what’s going on inside that heart without a workup.
Here are a few things your vet will consider before referring you for a cardiac workup:
- How old is the pet?
- What is the breed?
- Is this a new murmur?
- Is this a “typical” murmur, or does it sound weird?
- Is this pet really healthy other than an “incidental” murmur?
- Are there any other signs of heart disease obvious during the physical exam?
If you and your vet decide that you have a healthy animal, not a breed at risk for heart disease such as a Cavalier King Charles Spaniel, and there are no signs of heart disease, it is your decision to hold off on a cardiac workup.
After this heart-to-heart discussion (pardon the pun), you should have reached your decision based on some important physical exam findings:
- The murmur seems to be a minor disorder.
- There are no serious cardiac stressors or other signs of disease.
- Your pet is clinically normal.
- You have no plans to breed the animal.
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A typical scenario of an incidental murmur goes something like this: A healthy dog or cat, 4 years old, comes in for a routine physical. Weight is the same, activity is the same and there are no noted changes. This animal has never had a heart murmur diagnosed.
The murmur sounds mild, and there is no evidence of any other changes throughout the chest cavity. The physical reveals a healthy, happy dog or cat with a newly diagnosed heart murmur.
Usually, a watchful waiting approach in this situation may be appropriate. You must realize, however, that a stethoscope on the chest in no way tells you or your vet what is actually going on inside that heart.
In this video, you can hear the difference between a normal dog’s heartbeat and one with a murmur:
Human vs. Veterinary Medicine
If a heart murmur is detected in a person, we are referred to a veterinary cardiologist. Most folks will have their heart murmur checked out. The physician clearly writes in the medical record that the murmur was detected and referral to a cardiologist was recommended.
In veterinary medicine, we have to do the same thing. Because so few people have pet insurance, many more people decline the cardiologist referral than do human patients. This is where our job as veterinarians becomes harder.
We need to make a recommendation that this heart murmur may or may not be a big deal, while at the same time tell folks it should be checked out. Yikes!
It sounds like we’re talking out of both ends of our you-know-what. Quite honestly, this is the case. If money was no issue and everything in life was free, I’d love for every one of my patients with a heart murmur to have a cardiologist check them out. Oh well, back to reality.
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The Cardiology Referral
If you choose to have a cardiac workup done for peace of mind, your pet will undergo some “non-invasive” diagnostic tests.
An EKG is no big deal, and an echocardiogram requires nothing more than a little fur shaved off the side of the chest cavity. If you have a particularly rambunctious pet, sedation may be required. This is rare.
The cardiology visit determines if the heart murmur signifies heart disease. Based on these findings, the cardiologist may recommend monitoring, medication, diet changes or exercise restriction. If you get great news that the murmur is not a worry at this time, you can go home and relax.
Here’s my take-home message: Don’t freak out if your vet hears a heart murmur. We can talk about it and have it checked out if necessary. Modern veterinary medicine is there to help you and give you peace of mind.
- Drut, A., Ribas, T., et al. (2015). Prevalence of physiologic heart murmurs in a population of 95 healthy young adult dogs. Small Animal Practice, 56(2). 112–118.