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You are currently examining Phoebe
Phoebe’s murmur is likely due to asymptomatic DCM; how would you like to proceed?
X-ray is a valid choice
However an X-ray is not a priority for Phoebe, as it cannot definitively diagnose or rule out DCM.8
Thoracic radiography can identify generalised cardiomegaly, including enlargement of the left atrium and ventricle, however it cannot be used to diagnose the cause of Phoebe’s murmur, or discriminate between MVD and DCM.
X-rays are indicated to establish a diagnosis of CHF. However, Phoebe is not showing any symptoms suggestive of CHF or possible pulmonary disease.
Phoebe’s murmur is likely due to asymptomatic DCM; how would you like to proceed?
This is the best choice
A cardiac ultrasound should be performed to confirm a diagnosis of DCM and exclude other heart diseases.8
Phoebe’s heart murmur is most likely to be due to DCM, but could be due to other acquired or congenital heart diseases.
Echocardiographic findings of DCM include a dilated, rounded left ventricle and impaired systolic function.8,9
Using cardiac ultrasound to screen for asymptomatic DCM
Nuala Summerfield
- American, European and RCVS Recognised Specialist in Veterinary Cardiology. Founder and Director, Virtual Veterinary Specialists.
Phoebe’s murmur is likely due to asymptomatic DCM; how would you like to proceed?
Holter monitoring is a valid choice
Arrhythmias are common in dogs with DCM but normal heart rhythm does not rule out DCM.7
Holter monitoring over 24 hours is the gold standard screening tool for arrhythmias, but cannot diagnose the cause of Phoebe’s murmur.7 Most arrhythmias in DCM are intermittent, with high day-to-day variability. Holter monitoring is more beneficial than a 5 minute ECG.7
Greater than 300 ventricular premature complexes (VPCs) in 24 hours, or two subsequent recordings within a year showing 50–300 VPCs in 24 hours, is diagnostic of asymptomatic DCM in Dobermanns regardless of the echo findings.8
Phoebe’s murmur is likely due to asymptomatic DCM; how would you like to proceed?
ECG is a valid choice
However an ECG is not a priority for Phoebe, as no arrhythmias were identified during her physical examination.
Arrhythmias are common in dogs with DCM but a normal ECG does not rule this out. Most arrhythmias are intermittent, with high day-to-day variability. So, Holter monitoring would be more beneficial than a 5 minute ECG.7
Holter monitoring over 24 hours is the gold standard screening tool for arrhythmias. Greater than 300 ventricular premature complexes (VPCs) in 24 hours, or two subsequent recordings within a year showing 50–300 VPCs in 24 hours, is diagnostic of asymptomatic DCM regardless of the echocardiographic findings.8
Phoebe’s murmur is likely due to asymptomatic DCM; how would you like to proceed?
NT-proBNP is a valid choice
The cardiac biomarker NT-proBNP is a useful screening tool to help decide if a dog should undergo a cardiac ultrasound, however, it can not be used alone to diagnose DCM.
NT-proBNP offers a measure of chronic, abnormal stretch or strain on the myocardium.7
If NT-proBNP levels are elevated, echocardiography should be recommended.
Phoebe’s murmur is likely due to asymptomatic DCM; how would you like to proceed?
Incorrect
Phoebe is at risk and showing signs of underlying heart disease. Further investigation is recommended.
A grade 2/6 murmur was identified during physical examination.
As a 5 year old Dobermann, Phoebe is at high risk of developing DCM. Screening for DCM is recommended in Dobermanns from 3 years old, on a yearly basis.8