Don’t take a wait-and-see approach to heart murmurs

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dvm360dvm360 December 2021
Volume 52

A veterinarian shares discrepancies between the basic versus platinum approach when treating pets with heart murmurs to ensure the best care is provided.

KseniyA / stock.adobe.com

KseniyA / stock.adobe.com

In my experience, a heart murmur is typically diagnosed in a seemingly healthy pet during a wellness visit. Based upon records I have reviewed of patients brought to me for a second opinion, there are typical scenarios revealed by the pet owner and medical notes. The first scenario is when a murmur was diagnosed with no further evaluation or treatment offered or done. Instead, the owner is told that a wait-and-see approach is all that is required because the pet is asymptomatic. The second scenario is that the pet is placed on 1 or more medications with no diagnostic evaluation to determine if any of the medications are even needed. A third scenario, related to the second, is that refills of the initially prescribed medications continue with no further evaluation of the pet until its annual visit, and even then the evaluation is typically an examination and administration of vaccines. I believe these approaches are wrong and miss an opportunity to work up a case where early diagnosis and necessary treatment may be lifesaving—and failing to do so likely constitutes malpractice.

In my experience, heart murmurs in dogs (except congenital murmurs in puppies) are caused by valvular heart disease. Cardiomyopathy rarely is the cause of the murmur. However, in feline patients with murmurs, some type of cardiomyopathy is typically diagnosed. In many cases the diagnosis of cardiac disease is caught very early in the process, the pet is asymptomatic, and conventional medical therapy may not be needed (cardiac herbs or nutritional supplements may suffice.) In other cases, a murmur is present and the diagnostic testing is totally normal. Regardless, a comprehensive work-up is needed to determine the severity of the findings from the pet’s physical examination.

Basic, typical approach

Exam: $50

ECG: $50

Oral medications: $50-$150

Total: $150-$250

Platinum approach

Exam: $50

Blood testing (in hospital or sent out): $250-$350

Fecal testing: $40

Urinalysis: $40

Radiographs: $200-$300

ECG: $50

Echocardiogram: $500

Oral medications: $50-$150

Total: $1180-$1480

Note: A progress exam and needed lab tests are done 1 to 3 months after the visit, depending on the case, and every 3 to 6 months thereafter to allow for refilling medications.

The basic approach ignores the fact that many pets with heart murmurs are asymptomatic and have mild valvular disease that doesn’t require medical treatment. By prescribing medications for these patients, unnecessary treatment and follow-up visits are needed. It also overlooks the fact that some pets may need medication and prognostic information is not available due to the lack of testing.

The platinum approach recognizes that a heart murmur is typically associated with some type of cardiac abnormality even if heart failure is not present. Getting a diagnostic baseline of testing allows proper diagnosis, prognosis, and treatment. It determines future follow-up visits best suited to the patient’s stage of cardiac disease. An ECG might show a cardiac arrythmia or, rarely, cardiac chamber enlargement. Radiographs can reveal cardiac elevation, pulmonary edema, pleural effusion, or other lung pathology. Blood, urine, and fecal tests provide a minimum database, determine the presence of other diseases such anemia or hypo- or hyperthyroidism that might be the cause of the murmur, and provide a baseline useful for monitoring renal or hepatic adverse effects if cardiac medications are prescribed.

Shawn P. Messonnier, DVM, owns Paws & Claws Holistic Animal Hospital in Plano, Texas, and serves on the dvm360® Editorial Advisory Board. He has written multiple books on marketing as well as holistic veterinary medicine.

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