HEART MURMURS IN DOGS

Brian A. Scansen, DVM, MS, DACVIM (Cardiology)

Ohio State University*

DOG WITH HEART MURMUR

Young or never previously auscultated

Systolic Diastolic Continuous

Left apex Left base Right

Mitral valve Subaortic Tricuspid valve

dysplasia or stenosis or dysplasia or  iastolic murmurs are
D Patent ductus
regurgitation pulmonary regurgitation; uncommon arteriosus is most likely
stenosis or ventricular septal h C onsiderations include h E
 chocardiography is
functional defect aortic or pulmonary valve helpful to confirm
murmur or insufficiency; mitral or
atypical VSD tricuspid stenoses are
even rarer
h C onfirm with
echocardiography

In general, if the murmur Soft (grade I-II/VI),

is grade III/VI or higher,
semilunar valve stenosis is
likely
h I t is helpful to evaluate
pulse quality, as the pulse
in severe subaortic stenosis
is weak; it is normal in pul-
monary stenosis or func-
tional murmurs
h C  onfirm with
echocardiography
ejection-type murmurs
at the left base may be
functional or represent
mild semilunar valve
stenosis
DIAGNOSTICS
Diagnostic tests to help separate these differentials
include radiography, ECG, or echocardiography
h E
 chocardiography is most likely to provide a definitive
diagnosis for congenital heart disease; radiography or
ECG can be supportive

*Byline reflects author affiliation on

original publication. On publication
of this collection, the author’s
VSD = ventricular septal defect current affiliation is Colorado State
University.

16 cliniciansbrief.com
 DIAGNOSTIC/MANAGEMENT TREE h CARDIOLOGY h PEER REVIEWED

Middle aged and older

<15 kg >15 kg Any size with

fever, lameness,
new murmur

Systolic Diastolic Systolic Diastolic

DIAGNOSIS
Consider
endocarditis as a
differential;
 ortic insufficiency or
A  ortic insufficiency or
A
echocardiography
pulmonary insufficiency pulmonary insufficiency
required to confirm
most likely most likely
h C auses are rare; h C auses are rare;
infectious endocarditis, infectious endocarditis,
congenital malforma- congenital malforma-
tion, or severe degenera- tion, or severe degenera-
tion are considerations tion are considerations

Left base Left apex Right Left base Left apex Right

If grade III/VI or Mitral valve Tricuspid regurgita- If grade III/VI or Dilated cardiomyop- Tricuspid regurgitation is
less and with no degeneration (eg, tion is the most likely less and with no athy or mitral valve the most likely differential
clinical signs, a endocardiosis) differential clinical signs, a degeneration h C onsider degenerative

functional murmur is the most likely h C onsider degener- functional mur- (eg, endocardiosis) tricuspid valve disease
is possible differential ative tricuspid mur is possible are both possible and/or pulmonary
h F or any grade, h T horacic radio- valve disease (eg, h F or any grade, h C onsider echo- hypertension
consider undiag- graphy or echo- endocardiosis) consider undi- cardiography to h A heartworm antigen

nosed congeni- cardiography and/or pulmonary agnosed con- differentiate test should be evaluated
tal heart disease can help evalu- hypertension genital heart h T horacic radio- h C onsider previously
h A heartworm anti-
such as subaor- ate overall disease such graphs may also undiagnosed VSD if
gen test should be
tic or pulmonary heart size and as subaortic or be pursued to a left basilar systolic
evaluated
stenosis or VSD evidence of h C onsider previ-
pulmonary ste- evaluate overall murmur is also present
h C onfirm with congestive nosis or VSD heart size and h C onfirm with
ously undiagnosed
echocardio- heart failure VSD if a left basilar
h C onfirm with any evidence of echocardiography
graphy h C onfirm with
systolic murmur is echocardio- congestion
echocardio- also present graphy
graphy h C onfirm with

echocardiography

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