January 2012 PacPacific Tide Volume 1, Issue 1 An informational monthly newsletter

Pacific Veterinary Specialists & Emergency Service ~ 1980 41 st Avenue, Capitola, CA 95010 Specialty 831-476-2584 ~Emergency 831-476-0667

Pacific Veterinary Specialists Monterey, 2 Harris Court Suite A-1, Monterey, CA 93940 Monterey Office 831-717-4834 or Capitola 831-476-2584

Author of the month: Feline Heart Murmurs – “Important” or Not?

Interpreting feline never more than mildly elevated. as only echocardiography can heart murmurs can be frustrating! Physiologic heart murmurs may determine whether a heart Murmurs are very common in cats also be heard in the presence of murmur is of pathologic and it goes without saying that the anemia (PCV typically <18% in significance. An presence of a heart murmur serves cats), fever, and other systemic echocardiogram provides the as a warning sign that underlying illnesses due to an increased owner with information on Mandi cardiac disease may be present. velocity of normal, laminar blood whether cardiac disease is The problem arises that feline flow through the heart and a present and if so, what kind and heart murmurs do not always hyperdynamic state. how severe it is. Definitive Kleman , DVM, equate to the presence of cardiac therapy may be recommended disease. Murmurs may be Hyperthyroidism can cause both based on the results of DACVIM innocent or physiologic or may be physiologic and pathologic heart echocardiography. Thoracic pathologic (due to mild, moderate murmurs in cats. Early in the radiographs may be taken if or severe HCM, restrictive or disease process, both the elevated cardiac disease is verified by

(Cardiology) unclassified cardiomyopathy, sympathetic tone and echocardiography, but thyrotoxicosis, arrhythmogenic hyperdynamic state contribute to radiographs are not necessary right ventricular cardiomyopathy, Dr. Kleman received her a physiologic murmur. These for physiologic murmurs. dilated cardiomyopathy, or murmurs frequently resolve Bloodwork and further workup DVM from the University of congenital heart disease). following effective treatment of may follow (e.g. T4, blood Florida followed by an the hyperthyroidism. Longer pressure, ECG). Additionally, care should be taken internship at the University standing hyperthyroidism to not apply too much pressure induces pathologic changes to the Why not just take chest of Pennsylvania and a over the sternum with your heart, including left ventricular radiographs? Chest radiographs stethoscope. This pressure may will indicate whether the cat cardiology residency at the hypertrophy, systolic anterior deviate blood flow through the motion of the mitral valve, and has moderate to severe cardiac University of Florida. In small cat heart to cause a non- left atrial dilation. Heart disease (mild disease is very pathologic heart murmur. addition to life-saving murmurs are common in these difficult to differentiate from Referred airway sounds can also cats due to the structural and normal) but will not tell you interventional procedures, mimic a heart murmur in cats. Cats functional cardiac changes and what type of cardiac disease is are notorious for taking short in she is interested in complex the murmur may or may not present. Chest radiographs in and out breaths that coincide with resolve following treatment. asymptomatic cats infrequently arrhythmia the rate of the heart beat thereby provide enough information to mimicking murmurs. Applying diagnosis/management and Can auscultation really differentiate mild cardiac gentle pressure to the nares may differentiate benign physiologic disease from a physiologic novel approaches to chronic alter the patient’s respiratory murmurs from pathologic murmur. The presence of a congestive heart failure. pattern to allow respirations to be murmurs associated with cardiac heart murmur serves as a differentiated from the heart beats. warning sign that underlying Most importantly, Dr. disease? Unfortunately, the answer is no. Our ears are not cardiac disease may be present Kleman is passionate about Innocent or physiologic murmurs able to tell the difference between and an echocardiogram in account for a large percentage of indicated. If echocardiography helping to provide happy a pathologic murmur and a feline murmurs and are frequently physiologic murmur in a cat. is not accessible due to finances and fulfilling lives for dogs heard in cats with high heart rates Both physiologic and pathologic or availability, thoracic due to stress, pain, or excitement. and cats with heart disease. heart murmurs are commonly radiographs and/or NT-proBNP The actual cause of this type of dynamic In cats and this are good intermediate steps. Her philosophy balances the physiologic murmur is often a auscultatory finding is not helpful However, both of these tests dynamic right ventricular outflow importance of for differentiation. A dynamic have interpretation tract obstruction (DRVOTO). heart murmur means that the limitations/”grey” zones in cats communication, This long name indicates a murmur disappears or diminishes with mild to moderate cardiac compassion, and knowledge dynamic compression of the right in intensity when cats are relaxed disease. Additionally, both of ventricle during systole at high these tests are not necessary in while working closely with and increases in intensity when heart rates or inotropic excited or stressed. It is prudent cats with a normal the families and stimulation. There is no anatomic to recommend an echocardiogram echocardiogram and a abnormality and the velocity is whenever a murmur is ausculted physiologic murmur. veterinarians of her patients.

2Pacific TYPE Veterinary TITLE HERE Specialists & Emergency Specialty Services and Our Doctors Service Emergency 1980 41 st Avenue Internal Medicine Oncology Chris Robison, DVM Capitola, CA 95010 Kelly Akol, DVM, DACVIM Theresa Arteaga, DVM, Kim Delkener, DVM Merrianne Burtch, DVM, DACVIM(Oncology) Mark Saphir, DVM Phone DACVIM Jessica Kurek, DVM (831) 476-2584 Michelle Pressel, DVM, Cardiology

DACVIM Mandi Kleman, DVM, Behavior Emergency DACVIM(Cardiology) Jan Brennan, DVM (831) 476-0667 Surgery Radiology Lisa Metelman, MS, DVM, DACVS Larry Kerr, DVM, DACVR Alternative Therapies Fax Mark Lee, DVM, DACVR Darren Hawks, DVM (831) 476-8499 Tom LaHue, DVM, DACVS Michelle Laurensen, DVM, DACVR Critical Care Colleen Brady, DVM, E-mail [email protected] DACVECC Lillian Good, DVM, DACVECC Pacific Veterinary Specialists Monterey 2 Harris Court Suite A-1 Monterey, CA 93940 About Our Organization

Phone PVSES was founded to care. We offer staff is committed to (831) 717-4834 provide high quality, comprehensive providing

specialized services compassionate and Fax specialized medical (831) 717-4837 care to companion including endoscopy, thorough medical care animal patients. Our Doppler ultrasound, that meets the needs Emergency (Capitola) practice is dedicated to surgery, 24-hour ICU of the patient, client, (831) 476-0667 serving the veterinary care, and emergency and referring community as a and critical care. Our veterinarian. E-mail partner in total patient pvsmonterey @pacbell.net

Pacific Veterinary Specialists & Emergency Service 1980 41 st Avenue Capitola, CA 95010

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