Incidental Heart Murmurs Flashcards
criteria for physiologic murmurs in puppies
- soft - grade I or II
- six months - does not exceed past 6 months
- solitary - no other clinical signs
- systolic
- may go away with changes in posture
when to investigate murmurs in puppies
- loud murmurs (grade III+)
- diastolic or continuous murmurs
- persists past 6 months of age
- breeds with known heritable heart disease
criteria for physiologic murmurs in kittens
- grade I or II
- musical
- systolic
- does not persist past 7 months
when to investigate murmurs in kittens
- clinical signs present
- other auscultation abnormalities
- persists past 6 months of age
- moderate to loud (grade III+)
- diastolic or continuous
what diagnostics to pursue for kitten/puppy murmurs
- echocardiogram
- thoracic radiographs
- NT-proBNP
- ECG
- PCV/HCT
when to take thoracic radiographs for murmurs in kittens and puppies
respiratory signs
OR
owner unable to do echo
pursue echo if cardiomegaly, pulmonary overcirculation, CHF
DDX for left basilar systolic murmurs in young adult dogs
- SAS - large breeds
- PS - small breeds
- physiologic murmur
- ASD
when should echo be used for screening in healthy dogs
breeding purposes
ONLY test that is informative in asymptomatic/healthy dogs
DDX for LAS murmurs in old small dogs
myxomatous mitral valve disease
diagnostics for LAS murmur in old small dog
- thoracic radiographs
- if no cardiomegaly –> stage B1 and does not require treatment - systemic BP
- want to reduce systemic hypertension to slow disease progression
do NOT need to do an echo due to high likelihood of MMVD diagnosis
how often should BP be checked in an MMVD dog
every 6 months
DDX for LAS murmur in adult large breed dogs
dilated cardiomyopathy > MMVD
diagnostics for LAS murmur in adult large breed dog
echocardiogram + ECG
ONLY need thoracic radiographs if checking for CHF
ECG Holter - used to check for DCM associated ventricular arrhythmias
DDX for systolic murmurs in adult cats
- stress
- HCM
equally likely to be physiologic as it is to be pathologic
how does a physiologic murmur occur in cats
- stress –> RVOT obstruction
- RVOTO increases sympathetic tone
- increased contractility
- RV collapses on itself
when is a murmur more likely to be pathologic in a cat
if concurrent gallop sounds or arrhythmias
if clinical signs present
preliminary diagnostics for a systolic murmur in an adult cat
BP
fT4
NT-proBNP
taurine levels
when is NT-proBNP useful
screening test to determine which cats should get an echo
more useful cardiac biomarker than troponin I but can NOT be used diagnose a specific disease
definitive diagnostics for murmur in cat
echocardiogram
