For Emergencies:
Following on from the last Cardiology blog, I thought it would be good to tell the story about Frank and his very loud murmur.
Frank is a 2 ½ year old Olde English Bulldog. A grade 1-2/6 murmur on the right side was heard when he was about 1 year old but he had no obvious clinical issues and apart from some orthopaedic problems he was a happy dog. This had increased to a grade 3 last month and was referred to us for an assessment.
Happy Frank
When I saw Frank he was a bright and happy dog. His owners felt he had no issues with exercising or breathing. On listening to his heart he had a grade 2 murmur on the left side but a grade 6 on the right, at mid level. There was a definite thrill palapated when I put my hand over it. This was obviously a very loud murmur and a bit of a concern in such a young dog. It certainly would not be considered a non-pathological murmur. We decided along with the owner, to perform an echocardiogram on Frank to discover the cause of the murmur and decide if further treatment was required.
On the echo, we could see that there was a problem with Frank’s intraventricular septum, right at the top, just below the entrance to the Aorta. With the colour flow placed over this area you could see a clear flow going from the left to the right (see video).
On a closer look at this (see pic 1) we diagnosed a perimembraneous Ventricular Septal Defect (VSD). What made it more interesting was the presence of some pseudoanuerysmal tissue causing a flap over the right side of the lesion leading to a partial closure.(Red arrow on pic 2) So a hole which was 7.45mm on the left side of the heart became a hole of 4.8mm on the right side. We classify VSDs as small, medium and large based on their diameter compared to aortic diameter. This extra tissue allowed us to classify the VSD as small which was very important to Frank. A small VSD rarely causes long term issues for dogs as the amount of flow through it is minimal and the heart can handle this without having to remodel much. It is also therefore, unlikely to reverse in flow leading to a Right to Left Shunt.
Frank’s ultrasounds
Frank’s owners were delighted with this result and what was a worrying time for them having a loud murmur heard in their dog, became much less worrying with Frank likely to live a full and happy life.
I thought it was worth sharing this story for a couple of reasons. Firstly that it was a positive outcome for Frank and it is nice to share positive stories from referral. Although I absolutely recommend further assessment for grade 6 murmur in an young dog, it shows that it is not always a serious problem. A echo and diagnosis can be very positive for an owner when you have a clear diagnosis. Especially in this case where it was good news. I also wanted to highlight the importance of a thorough auscultation of the heart – left and right side and cranial and caudal. Ensure you put your stethoscope right forward under the axilla to make sure you have listened to all areas of the heart. This is very important in large breed dogs.
As you can see Frank is a lovely lad and will hopefully go on to live a full life with his ‘hole in the heart’ causing him very little trouble.
