FAQ for Clients

The ideal way to figure out the severity and treatment options for any pet with heart disease is to see a board-certified veterinary cardiologist in person. Board-certified specialists have four additional years of advanced training after veterinary school and pass two consecutive years of testing with the American College of Veterinary Internal Medicine to demonstrate their advanced expertise in cardiology.

Taking your pet to a cardiologist allows a hands on thorough cardiac examination of your pet along with the expert actually performing an echocardiogram– a non- invasive ultrasound of the heart that is done with the family present. The board-certified veterinary cardiologist will explain the results to you during the course of your visit. Based on their findings, the cardiologist will determine exactly what type of therapy will best treat your pet.

Frequent wellness visits with your primary care veterinarian are the key to giving your pet a long, healthy life. In most cases, your veterinarian will hear an abnormal heart sound during a routine examination. They may describe hearing a murmur or a rhythm problem well before the pet shows any outward signs. For cats, there is a blood test (NT-proBNP) that has been life-saving to find disease in cats not yet showing symptoms. Once the abnormal sound is identified or the blood test result is positive, an evaluation with a board-certified veterinary cardiologist provides the best care for your pet. Pets with advanced heart disease may show outward symptoms. Dogs may cough, have trouble breathing, faint, show weakness and exercise intolerance, or have abdominal distension. Cats with advanced disease may hide more and be lethargic, have an increased respiratory rate and effort, faint or have sudden onset of painful forelimb lameness or hind limb paralysis. If your pet shows any of these symptoms, they should be seen by your veterinarian right away.

Dogs and cats both hide outward signs of heart disease and typically do not appear sick until they are in a crisis situation. Emergency visits with pets can be traumatic for both the patient and family, so the “wait and see” approach is not recommended for dogs or cats with heart murmurs.

CVCA provides comprehensive cardiac care for pets in Maryland, Virginia and Kentucky. We are the largest cardiology practice in the United States and treat more than 24,000 dogs and cats each year. CVCA has nineteen board-certified veterinary cardiologists and five residents in our training program and a team of compassionate professionals who understand the importance of your pet to your family. We serve as an extension of your primary care veterinarian’s practice to accurately diagnose and treat heart disease, improving both the quantity and quality of your companion’s life. In fact, we recently found that pets live 75% longer when both a CVCA cardiologist and a primary care veterinarian collaborate to manage cases of pets with congestive heart failure. A pet owner can rest assured they are getting the very best care for their pet when they see CVCA. Based on ongoing survey results, over 99% of our clients would refer their friends or family to us.

An early indicator of heart disease is an abnormal heart sound heard when the heart is listened to with a stethoscope. Murmurs, gallops and an arrhythmia may all indicate underlying heart disease that may benefit from treatment. This is why it is so important for your pet to have annual exams with your primary care veterinarian who may pick up heart disease before it becomes symptomatic or life-threatening. Unfortunately, not all patients with heart disease have abnormal heart sounds. This is especially true of cats. Dogs – Potential symptoms of heart disease:

• Coughing
• Trouble breathing
• Fainting
• Weakness
• Exercise intolerance
• Abdominal distension

Cats – Potential symptoms of heart disease:

• Hiding
• Lethargy
• Increased respiratory rate and effort
• Fainting
• Sudden onset of painful forelimb lameness or hind limb paralysis

If any of these symptoms are noted in your pet, they should be evaluated by your veterinarian right away.

Some patients are very easy to medicate and others prove very challenging. Helpful tips:

• Many medications can be crushed and put in a small portion of canned or other delectable foods. Please check with the staff to determine if the medication you are giving is one that can be crushed.
• Treats called Greenies™ or Pill Pockets™ can hide pills.
• After medicating your pet, encourage them to drink or eat (if the medication does not need to be given on an empty stomach) to prevent the medication from getting stuck in the throat and causing irritation.

Medicating cats:

• Hold the top of the head by placing your thumb on one side of the upper jaw and your fingers on the other. Tilt the head up to the ceiling so the mouth opens and, using your other hand, place the pill as far back in the mouth as possible. Holding the pill with your thumb and forefinger and using your third finger to push down on the lower front teeth may help open the mouth further if needed.
• Alternatively, for more feisty cats, you can hold them by the scruff of the neck, tilt the head back and point the nose to the ceiling and pop the pill in their mouth. Once the pill is in, close the mouth and rub the neck to encourage swallowing.
• It is important to get the pill as far back on the tongue as possible. This helps make sure it is swallowed and reduces how much the cat can taste the pill.
• You can use a pill popper to put the pill in the mouth to avoid getting your fingers bitten. Time is of the essence. The quicker you can get the pill in, the less your cat will fight you and the more success you will have.

Medicating dogs:

• Most dogs will eat medications readily in treats.
• If your dog will not willingly take a treat with medication, hold your dog’s head from the top with one hand. In dogs with longer noses, hold the upper jaw with the thumb on one side and the fingers on the other. In shorter nosed dogs, hold the head like a cat. Tilt the head upwards, then while holding the pill with your thumb and index finger, with your 3rd finger placed on the lower front teeth, push the jaw down to open the mouth. Drop the pill as far back on the tongue as possible. Immediately close the mouth and blow on the nose to encourage swallowing. If the pill is too far forward, the pill can be easily spat out.

• Follow-up echocardiograms are important for long-term cardiac care. They provide us with the ability to assess for progression of disease. Our recheck schedule recommendations are designed to identify changes in heart size, heart function and intracardiac pressures that would prompt us to make medication recommendations in an effort to keep your pet symptom-free for as long as possible. The timeframe between follow-ups is specific to your pet and their condition.
• The earlier changes in the heart are detected and evaluated, the more effective treatment is.
• Many forms of cardiac disease in pets are progressive diseases and require the right balance of medications for your specific pet to keep the heart function as stable as possible. This balance changes over time with the progression of the disease and your pet’s tolerance to medications.
• Since many pets live 10-15 years, rechecking the heart every six months is similar to going to the doctor every three to four years for humans.
• The ideal medication balance is achieved through routine communication with you and your primary care veterinarian and follow up evaluation by CVCA.
• Clinical signs of heart disease that are obvious at home occur when the disease process has become advanced. At that point, treatment may consist of hospitalization, oxygen therapy and injectable medications.
• Monitoring of the diagnostic testing can help predict the future onset of clinical signs to allow for adjustments in the treatment plans.
• Symptoms of heart failure can be devastating and life-threatening. Preventing and or limiting these signs with adjustments in the treatment plans, based on reevaluations, can help limit the stress to the pet and their owners due to hospitalization for heart failure.

Yes, medications prolong both the quality and quantity of life of pets with cardiac disease. Ultimately, our goal is to provide your pet with both. While there are some congenital heart defects that can be treated surgically, the majority of cardiac disease is treated medically as surgery is not a feasible option. Most medications prescribed are available at your local pharmacy in generic form and pets take heart medications very well. If there are negative effects of the medications, the cardiologist would immediately adjust the treatment plan. In the majority of cases for our patients on tailored treatment plans, their families report a huge improvement in the quality of life and energy on their medications.

Cardiac medications are recommended for various reasons:

• To help stabilize your pet’s underlying cardiac disease and delay the onset of symptoms.
• To resolve or stabilize signs of heart failure.
• To treat an arrhythmia.

For some pets, all three types of medications are needed to provide optimal outcomes.

All medications have the potential to cause side effects and cardiac medications are no exception. The most common side effects are:

• Lethargy
• Decreased appetite
• Vomiting
• Diarrhea
• Effects on blood pressure
• Effects on kidney values
• Electrolyte imbalances

Follow-up care with your primary care veterinarian for an exam, blood tests and blood pressure monitoring as recommended are an important part of your pet’s cardiac care. If you are concerned about side effects that develop after starting a new medication or adjusting the dose of a current medication, please call so we may help adjust the medications to resolve the side effects.

There are few instances where surgery is recommended for pets with heart disease. Surgery or catheterization may be recommended in certain cases:

• Congenital heart defects:
• Pacemaker implantation for low heart rates (high-grade second degree or third degree [complete] atrioventricular [heart] block, sick sinus syndrome and atrial standstill), especially when symptoms of fainting are present and not improved by medications.
• Surgery is an option in many cases of recurrent pericardial effusion or fluid in the sac surrounding the heart.

Surgery is not a standard part of therapy for the most common diseases of aging in pets.

• Your pharmacy, as the majority of the medications used are the same as those used in people.
• Certain medications such as Vetmedin™ (pimobendan) are veterinary labeled drugs and are more readily available through your veterinarian or online veterinary pharmacies.
• Occasionally, for pets who are very difficult to medicate with tablets or require nonstandard doses of medications, the cardiologist might recommend having your pet’s medications compounded in a custom formulation through a compounding pharmacy that will ship the medications or have them available for local pick-up.

We will update your information in our computer system during check-in. In the exam room, a blood pressure reading may be performed by the doctor’s assistant, based on your pet’s age and current medications. The doctor will then come in and perform an examination on your pet. An echocardiogram (ultrasound of the heart) will likely be done on your pet. The echocardiogram is considered the “Gold Standard” of diagnostics and is how our cardiologists obtain the best information regarding your pet’s cardiac function. Typically, we encourage you to be present with your pet during the echocardiogram. This helps to keep your pet calm as well as allows you to see the results and discuss the interpretation right away. You will receive a detailed home care report to take with you. It will have all of the doctor’s findings and recommendations. A full report will be faxed over the same day to your primary care veterinarian and any other veterinarians who are involved in your pet’s care. Most appointments typically last an hour.

You will get a diagnosis during your appointment with ample time to discuss with the cardiologist treatment options that are best for your pet and your family.

At CVCA, a cardiologist is available 24/7 by phone to emergency and primary care veterinarians for assistance with pet care.

• Our full cardiac workup is affordable and offers your pet the best chance of accurate diagnosis to minimize ongoing and unexpected veterinary costs.
• The vast majority (85%) of our patients are diagnosed based on these procedures.
• About 15% of patients may also need an ECG to assess heart rhythm.
• For any further recommended diagnostics or treatment, an estimate will be reviewed with you. We will be sure to review diagnostic test results already completed by your primary care veterinarian.
• We accept Visa, MasterCard, Discover, American Express, Care Credit, Payment Banc, personal checks and cash. We also have an option for deferred interest extended payments.

It is very rare that we need to shave or sedate pets. Most pets are very calm when their family is by their side. We wet the fur down with alcohol and ultrasound gel to obtain our echocardiographic study.

Our client service representatives will help you find a time and a location that works for you. Urgent and same-day appointments are available as needed. Emergency care will be coordinated with you and your veterinarian.

You may follow your normal routine for medications and feeding that day unless it has been specifically arranged that your pet will need to be sedated. Pets do not typically need to be sedated for the echocardiogram.

Please bring:

• A list of all medications with strengths and dosages or pill vials with labels.
• Any medical records or chest x-rays that have not been sent electronically by your veterinarian.
• Your pet.

The best opportunity for an accurate diagnosis and treatment plan for your pet is to see a board-certified cardiologist in person.