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Clinical assessment of patients with suspected heart disease
  1. Jelena Ristic

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Is this cardiac disease?

The first major hurdle is deciding whether a dog's clinical signs are, in fact, due to cardiac disease. Keeping an open mind during the consultation and clinical examination is important and can often provide many vital clues. It should be remembered that it is unusual to have clinically significant  cardiac disease without an auscultable abnormality (ie, a murmur or arrhythmia). Furthermore, heart disease is not the same as heart failure: heart disease simply implies the presence of a cardiac abnormality, such as a murmur, but not necessarily any clinical signs; heart failure occurs when the heart can no longer supply blood to the body effectively and is associated with signs such as weakness and pulmonary congestion (see box, right). Heart disease can be present for years without causing any clinical signs.

Before embarking on the clinical assessment of a case, it is important to consider the causes of heart disease in the dog (see table, below right). This article concentrates on acquired cardiac conditions as these are far more common than congenital abnormalities in the general practice setting.

Diagram showing the clinical features of heart failure

Assessment of information  for the individual case

Clues from the signalment

There are certain generalisations that  can help to determine the likelihood of a  particular disease. For example:

  • Congenital disease is more likely in  puppies;

  • Small breeds are more likely to have chronic valvular heart disease (CVHD);

  • Large breeds (>15 kg) are more likely to have dilated cardiomyopathy (DCM);

  • Pericardial effusion is more common in large breeds.

Clues from the history

An owner may report certain signs that lead the clinician to suspect cardiac disease. These can be divided into three broad  categories:

  • Exercise intolerance. This is seen in many cardiac conditions due to forward failure. Collapse is an extreme sign  seen in cases where cardiac output is markedly reduced.

  • Respiratory signs. Coughing is perhaps the most common sign …

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