What is a Heart Murmur?

by admin on March 1st, 2018

Category: News, Tags:

Hearing your vet announce that “your pet has a heart murmur” can be very daunting. However, the significance of a murmur very much depends upon the situation. Just as a fever can be something or nothing, a murmur may be similar – it may be insignificant, but it could also be a symptom of a disease that requires treatment. So, first of all, what is a heart murmur?

Simply put, a murmur is a sound produced by a squirt of blood inside the heart when it pumps. There are many causes of a murmur.

There are three sections in this information sheet:

  • Murmurs explained
  • FAQs about murmurs
  • List of the common causes of murmurs in dogs and cats

1. Murmurs explained

Murmurs due to regurgitation
Each of the four valves in the heart act as non-return valves, permitting blood flow in one direction (forwards). If a valve becomes faulty and no longer prevents backflow, then there is a resultant backward squirt of blood through the gaps in the valve with each heartbeat. This backward squirt of flow through an incompetent valve results in an abnormal heart sound called a heart murmur. A murmur thus sounds like a ‘squirting’ or ‘gushing’ sound during each heartbeat. The most common cause of an incompetent valve in older dogs is Mitral Valve Disease, or Endocardiosis, as it is also known.

Murmurs due to narrowed valves
If a heart valve is abnormally narrowed, usually due to a congenital defect (eg. Aortic Stenosis or Pulmonic Stenosis) then blood flow pumped out through the narrowed valve is pinched, resulting in an abnormal squirt of flow, ie. a murmur. This can be likened to putting a thumb over the end of a hose pipe to make the water squirt, rather than pour.

Murmurs due to ‘holes in the heart’
A murmur can also occur through a hole in the heart – the murmur is caused by the squirt of blood going through the hole. A hole between the left ventricle and right ventricle results in a squirt of blood being pushed through the hole when the heart ventricles pump (this is called a Ventricular Septal Defect (VSD)). A hole between the aorta and pulmonary artery (the two major arteries leaving the heart) results in blood squirting through the hole (this is called a Patent Ductus Arteriosus (PDA)).

Puppy murmurs
In puppies less than 6 months of age, in addition to murmurs produced by congenital defects, puppies can have innocent or benign murmurs – often called a puppy murmur. These occur due the fast flow of blood in such a small heart. As the puppy and its heart grow and mature, then the murmur gradually disappears. It is virtually impossible for a vet to discern the difference between a puppy murmur and a congenital defect. If a murmur persists beyond 6 months of age, it is more likely to be a congenital defect.

Murmurs associated with illness
A murmur can also be produced when a dog is anaemic and the blood thin. In this situation, thinner blood (less viscous) results in a faster speed of flow and thus a murmur. A similar situation can occur when a dog is ill for other reasons, such as during a fever.

2. FAQs about heart murmurs in cats and dogs

What is the significance of a murmur?
This depends upon what the cause of the murmur is from the list above, whether the defect causing the murmur is classified as: mild, moderate or severe, and whether it is resulting in heart enlargement or not.

Is the loudness of a murmur significant?
Not always. It depends upon what the cause of the murmur is from the list above. Some murmurs are innocent and of no clinical significance, whereas others are associated with defects. Many defects can be mild and have no effect on the heart and animals can live a full and normal life with them, whereas other defects affect the heart and may need some form of treatment.

Do all these murmurs sound different for each defect?
No, in fact they virtually all sound the same. The squirt (murmur) is heard when the heart beats, so the murmur is brief. The only defect that produces a slightly different sound is a PDA – the murmur is continuous rather than intermittent or brief.
Listening with a stethoscope is not easy and many vets find this difficult. As humans, we all have differing skills and abilities, so there is a lot of variation. It is likely that a veterinary cardiologist will hear murmurs better, because they have had a lot more practice and experience, as well as additional training.

What is the best way to diagnose a murmur?
Nearly always, an ultrasound scan (echocardiography) is the best way to diagnose a murmur. But sometimes additional tests are also required, such as chest x-rays, ECG or blood tests. Echocardiography is a difficult and skilled examination that is best performed by an experienced clinician.

3. List of the common causes of murmurs in dogs and cats

Defects can be congenital, meaning an animal has been born with the defect. Or there can be changes in the heart that develop in adult life, for example due to ageing degeneration of a valve.

Murmur due to Mitral Valve Regurgitation:

  • Mitral Valve Disease (MVD) is the most common cause of a murmur in adult dogs in older age
  • Mitral Valve Dysplasia is a congenital defect of the valve
  • Mitral Valve Regurgitation can occur secondary to heart enlargement of other causes in dogs
  • Mitral Valve Regurgitation can be secondary to cardiomyopathy in cats

Murmur due to Aortic Valve Stenosis:

  • Subaortic Stenosis and Valvular Aortic Stenosis is a congenital defect of the valve
  • Hypertrophic Cardiomyopathy in cats, often causes ‘Subaortic- like Stenosis’

Murmur due to Tricuspid Valve Regurgitation:

  • Tricuspid Valve Disease occurs in adult dogs in older age, most will also have MVD
  • Tricuspid Valve Dysplasia is a congenital defect of the valve
  • Tricuspid Valve Regurgitation can occur secondary to Pulmonary Hypertension
  • Tricuspid Valve Regurgitation can be secondary to heart enlargement of other causes
  • Tricuspid Valve Regurgitation, when mild, can be seen in some normal dogs

Murmur due to Pulmonic Valve Stenosis:

  • Valvular Pulmonic Stenosis is a congenital defect of the valve

Murmurs associated with holes in the heart:

  • Patent Ductus Arteriosus is a congenital defect resulting in abnormal flow between the aorta and pulmonary artery
  • Ventricular Septal Defect is a congenital defect in which there is a hole between the two ventricles

Innocent murmurs
These are murmurs due to abnormal flow within the heart and not due to a defect in the heart, ie. there is no congenital defect or degenerative disease. There are a number of causes, these are just some examples:

  • Puppy murmurs are innocent murmurs that usually disappear by 4-6 months of age
  • Anaemic murmurs are due to the blood being thin
  • Fever murmurs are due to turbulence in blood flow
  • Flow murmurs are seen in some athletically fit dogs, ie. a murmur with no defect present

Heart Valves

No Comments »

Special Offer – March – Wellness Screen Offer

by admin on March 1st, 2018

Category: Special Offers, Tags:

Wellness Screen Offer

No Comments »

Pet of the month – March – Poppy

by admin on March 1st, 2018

Category: Pet of the Month, Tags:

PoppyMeet our wonderful slimmer, Poppy. She started Sienna’s weight clinic at a whopping 17kg and now weighs 12.7kg. Her overall weight loss is absolutely enormous! Poppy and her owners have done so well to achieve her target weight!

Her quality of life has improved dramatically. She attends hydrotherapy once a week for her hip problems and now swims with jets on because she’s too good!

Congratulations Poppy!!

Canine obesity is in fact the most common nutritional disorder seen in dogs.  As with humans, it’s caused by an imbalance of taking in more energy than giving out. This can give rise to a persistent and potentially life threatening energy surplus.

How to know if your dog is overweight
Signs of canine obesity include owners struggling to see or feel their dog’s ribs, spine or waistline; abdominal sagging; a bigger, rounder face; a reluctance to go for walks or lagging behind; excessive panting; and the dog appearing tired and lazy. Grossly overweight dogs may even need assistance getting up and down, in and out of vehicles, and often refuse to move or play games.

Problems associated with obesity
Vets see these problems all too often, with obese pets posing greater risks from anaesthetic and surgical complications, heat or exercise intolerance, complications from cardio-respiratory disorders, hormone problems, skin disease, cancer, urogenital disorders, even early death. Canine obesity may even contribute to tracheal collapse and laryngeal paralysis too.

Common canine problems suffered as a result of obesity include diabetes (where the pancreas fails to secrete enough insulin in order to regulate blood glucose levels); heart disease (caused by high cholesterol levels); as well as arthritis directly affecting mobility, making it even harder for your pet to lose weight.

Until fairly recently, fatty tissue was thought to be just a relatively lifeless energy store and insulator; but we now know it secretes hormones affecting appetite, inflammation, insulin sensitivity and bodily function, as well as influencing water balance and blood pressure leading to kidney disease and high blood pressure.

Ways to prevent obesity

If your dog is overweight then carefully start changing his feeding habits; increasing exercise (e.g. more or longer walks, or take up a canine activity such as agility or flyball); looking at the type of food and his intake; creating a feeding plan.

One of the very best ways is to make regular visits to your vet nurse for weight loss advice and to have free weight checks and record your success.

Come and join our weight clinics today! There is a small £5 joining fee after which you and your pet receive a weight management booklet with tips on keeping your pet at a healthy weight, body condition score chart, measuring cup, calorie chart of common treats, food diary and leaflets on foods available to help your pet lose weight.

This is followed by regular free of charge check-up appointments to ensure your pet reaches his/her optimal weight.

Phone today to book an appointment with our weight management nurse Sienna!


No Comments »

Lens Luxation

by admin on February 1st, 2018

Category: News, Tags:

What is the lens?

The lens is a large transparent structure within the eye lying just behind the black part of the eye (the pupil). The lens helps to focus light onto the back of the eye. It is normally held in place by tiny threads all around its edge.

What happens in lens luxation?
In patients suffering from lens luxation (dislocation), the lens shifts out of position and moves either into the front or into the back of the eye. If the lens becomes trapped in the front of the eye, it can cause water-logging of the window of the eye (seen as blueing of the front of the eye) and an increase in pressure within the eye (glaucoma). If it falls into the back of the eye, the lens can damage the sensitive tissue at the back of the eye (the retina) and cause it to loosen (retinal detachment). This can also lead to glaucoma. In both cases, the eye is usually painful, and blindness develops unless early appropriate treatment is given.

What causes lens luxation?
Many cases of lens luxation are hereditary and caused by a weakness in the threads holding the lens in place. This condition is called primary lens luxation and is common in the Jack Russell and other terriers. It is also occasionally seen in other breeds and crossbreeds.

Some cases of lens luxation are due to other eye diseases such as cataracts, inflammation within the eye or chronically increased intraocular pressure (glaucoma). These diseases cause damage to the threads that hold the lens in place and as a result it eventually comes loose.

What are the signs of lens luxation?
In most cases of primary lens luxation, the disease develops very rapidly. In the very early stages the eye may just look slightly red and sore. These signs may be misinterpreted as simple conjunctivitis but are in fact the beginning of a potentially blinding disease. Later the patient is often depressed and reluctant to exercise.

The eye usually appears red and painful, often with a bluish tinge over the cornea. As the pressure in the eye goes up, the optic nerve at the back of the eye (which takes messages from the back of the eye to the brain) becomes damaged and blindness results.

How is lens luxation diagnosed?
Once the lens completely dislocates it is relatively straightforward to see that it is out of position in most patients. In addition, examination by an ophthalmic specialist using specialised equipment may enable a diagnosis of lens luxation to be made well before the lens actually dislocates out of position.

Is treatment possible?
Lens luxation is a serious, blinding painful condition. Although medical management of primary lens luxation is an option, in most cases surgical removal of the lens is likely to give the best chance of preserving vision. Lens removal may also be indicated if the lens has luxated as the result of other eye conditions, but each of these cases must be assessed on their individual merits.

The surgical removal of a luxated lens is an operation that should only be carried out by an eye specialist as it requires special training and skills, the use of an operating microscope and microsurgical instrumentation. The surgery also requires the use of a special muscle-relaxant anaesthetic, as the eye must be held absolutely still in the right position during the operation. During the procedure the patient’s breathing is taken over by the anaesthetist. Again, specially trained staff are required to monitor this anaesthetic.

In surgery for lens luxation, the cornea, which forms the clear window at the front of the eye, is incised and the luxated lens is gently removed. The inside of the eye is coated with special gel during the procedure to help to protect its delicate structures. Some of the natural jelly at the back of the eye (the vitreous) also needs to be removed during the operation, and this is performed using highly specialised mechanised equipment. The wound is stitched with suture material finer than a hair. The stitches dissolve over a period of weeks after the surgery.

Following surgery, intensive medical treatment is required, and several re-examinations are necessary to give the best chance of a successful outcome.

Will my pet cope without a lens?
Most pets cope well without a lens but will need a while to adapt to the new vision. Most dogs without lenses are able to avoid bumping into objects, and many can still chase a ball.

Success chances and possible complications
The chance of a successful outcome depends in part upon the duration of the problem prior to presentation and also whether the lens is completely dislocated at the time of surgery. In early cases, the outcome of surgery can be very satisfactory, but in longstanding cases, the success chances are significantly reduced.

Unfortunately, blinding complications are seen in a significant percentage of cases – up to 30% or 40% depending upon the condition of the eye and duration of the problem by the time of surgery. These complications include persistence of glaucoma, bleeding into the eye and retinal detachment.

Even after successful surgery which has saved vision, it may be necessary to continue with long-term medication, especially to keep the pressure in the eye under control. This may in turn require patients to be returned for check-ups from time to time.

Does the condition affect both eyes?
Yes, unfortunately, primary lens luxation affects both eyes, although not necessarily at the same time. However, there will often be early signs of partial dislocation of the lens in the second eye at the time that the first eye is noticed to have a problem. Without treatment, the second lens will then usually dislocate within a few months of the first, and the natural progression of patients with this condition without surgery is to become blind in both eyes. Glaucoma then usually develops, and this not infrequently means that one or both eyes may need to be removed in order to relieve pain.

Is preventative treatment available for the second eye?
Yes, especially in cases of primary lens luxation. If the earliest signs of lens instability (subluxation) are detected at the time that the first eye is affected then the lens may be surgically removed. Early removal of unstable lenses carries the best chance of long-term success. In early cases, it may be possible to perform the surgery through a smaller incision using specialised equipment, and this, in turn, helps to give a better prognosis.

What happens if vision is irreversibly lost in an eye with a luxated lens?
Eyes that have lost vision irreversibly due to lens luxation are not suitable for lens removal. Because many eyes with lens luxation are painful, it may be necessary to consider removal of the eye under these circumstances.

What happens if an eye needs to be removed?
Eye removal is generally only recommended if the eye is painful and blind and the pain cannot be readily controlled with medication. The thought of an eye being removed may be alarming at first, but it is important to realise that this will generally make the patient feel much more comfortable and much happier very quickly. The hair is clipped at the site of the operation but soon grows back, and this then leaves hairy skin where the eye used to be. There is no hole left behind, and the result is cosmetically perfectly acceptable. And of course our patients don’t look at themselves in the mirror and worry about their appearance, they just feel more comfortable and get on with life!

Lens luxation

No Comments »

Special Offer – February – Neutering Offer

by admin on February 1st, 2018

Category: Special Offers, Tags:

Neutering Offer

No Comments »

Pet of the month – February – Ruby

by admin on February 1st, 2018

Category: Pet of the Month, Tags:

This month’s pet of the month is Ruby, who has been suffering from tracheal collapse for the last nine years. She has been fortunate in that her symptoms have been limited to a chronic cough and have not progressed to more serious respiratory difficulty or distress.

Tracheal collapse is a progressive weakening of the tracheal cartilage, or “windpipe”, seen most commonly in middle-aged small breed dogs. As the trachea collapses it results in an obstruction to the passage of air. Certain breeds including Yorkshire Terriers, Bichon Frise and Pomeranians are more prone to this condition

How can I tell if my dog has tracheal collapse?

Tracheal collapse is characterised by a harsh “goose honking “cough that is often worsened by excitement. The disease is often worse in the summer months due to the heat. While the disease typically progresses over months or years, some dogs can present with a sudden onset difficulty breathing and require emergency therapy.  Dogs with tracheal collapse can often have other conditions including heart murmurs, pneumonia or problems with their larynx/palate.

How is tracheal collapse diagnosed?

Tracheal collapse is a dynamic process meaning that it can often be missed on normal chest radiograph (x-ray). Ideally, it is diagnosed using a combination of fluoroscopy – a video x-ray that allows visualisation of the trachea as the dog inhales and exhales – and bronchoscopy, where a camera is passed down the trachea to assess the degree of collapse and assess for other conditions, such as pneumonia.

How is tracheal collapse treated?

Medical management

The vast majority of dogs will respond to lifestyle changes (weight loss, being walked with a harness rather than a neck lead, avoidance of cigarette smoke or aerosols in the house) in combination with medications (corticosteroids, cough suppressants and antibiotics). Almost all dogs will have some improvement with the introduction of medication and up to 90% will be well controlled for 12-18 months.

Tracheal stenting

Tracheal stenting involves placing a metal (nitinol) mesh within the trachea under anaesthesia. The stent holds the trachea open and stops the airway obstruction. 90% of cases show a rapid improvement in clinical signs. It is important to know that dogs that have a tracheal stent placed will likely still require lifelong medications as outlined above.

What are the potential complications with tracheal stenting?

Tracheal stenting should only be performed by veterinary surgeons who have been properly trained in the technique. As the procedure requires fluoroscopy it is normally only performed at a referral practice. Many of the complications associated with stenting such as stent movement or fracture are more likely to occur if an incorrect size of stent has been placed. However, even when performed by appropriately trained personnel the complications seen with the technique can include inflammatory tissue growing through the stent and chronic infections. Up to 40% of cases that have a tracheal stent placed may require a second procedure at some point in their life. Following stent placement, most animals will be discharged within 24-28 hours.


No Comments »

Pet of the month – January – Max

by admin on December 6th, 2017

Category: Pet of the Month, Tags:

Pet of the month for January is Max, who often accompanies his owner on long runs over the Downs. Last month unbeknown to his owner Max sustained an injury at the base of his tongue, which was not witnessed. Neither was there any evidence of blood or oral discomfort.

Understandably Max went off his food and became listless. A swelling became palpable below his jaw and on examination, bruising was discovered under the tongue. The injury became septic and was flushed under anesthetic. Max is now doing very well and has finished all his antibiotics.

Although we cannot be sure how Max sustained this injury, a number of dogs love to carry a stick and some will actively find their own stick when exercising off the lead on a walk. The majority of the time, this is harmless fun but sometimes part of a stick can go further into the mouth than planned! Stick injuries in dogs can be serious.

Occasionally, a section of twig can get lodged across the hard palate (this is the roof of the mouth), between the upper molar teeth.  If a dog has run at speed to pick up a stick then he/she may in effect ‘run onto the stick’, and there is potential for sections of stick or twig to penetrate deeper into the mouth, neck or throat.

Although not applicable in Max’ situation, a good tactic to try and avoid your pets chasing and carrying sticks is to provide other toys for them to play with whilst on their walks, and definitely, as pet owners, we should avoid the temptation to actually throw a stick for our dogs!


No Comments »

Special Offer – January – Dental Offer

by admin on December 6th, 2017

Category: Special Offers, Tags:

Dental Offer

No Comments »

Cystitis in Cats

by admin on December 6th, 2017

Category: News, Tags:

What is special about cystitis in cats?
Unlike dogs and people, cystitis in cats is frequently caused by stress rather than by an infection.

Whilst cystitis in female cats is painful and upsetting, it can actually turn into a life-threatening condition in tom cats if the urethra (the way out of the bladder) is blocked up by swelling, blood clots or crystals. Those cats are absolutely unable to pass urine, which leads to the bladder overfilling.  This in turn causes back-pressure which can ultimately lead to kidney failure and collapse. Any male cat that seems unable to pass urine should be seen by a veterinary surgeon immediately.

Why do cats get cystitis?
There are a number of possible causes of cystitis, but the majority of young cats which develop  cystitis do so as a result of stress. Sometimes an obvious reason for the underlying stress can be identified, such as the house being decorated or another cat or a dog moving in, but often it is difficult to recognise the actual cause of the stress. Once cats have developed this type of cystitis, they are very prone to having further bouts of it in the future and in some cases management of some variety is necessary to prevent further episodes.

A smaller proportion of cats, especially elderly individuals or those with chronic problems, such as kidney disease, develop cystitis due to infection, generally by bacteria.
There are several other reasons why cystitis may develop, and these include bladder stones, tumours or toxic cystitis. Such cases are uncommon, however.

What are the clinical signs of cystitis?
All types of cystitis have similar clinical signs, not all of which are necessarily observed in every case:

  • Frequent visits to the litter tray
  • Passing very small amounts of urine on the litter tray or even being unable to pass anything at all
  • Accidents in the house or urination in inappropriate places
  • Bloody urine
  • Painful urination – some cats cry when urinating
  • Some cats are restless or seem off colour

How is the disease diagnosed?
The clinical signs are very often already suggestive of cystitis. To rule out other causes and to identify which type of cystitis is affecting your cat, a general physical examination and also further tests, such as a urine analysis, are usually necessary. In some cases blood tests, radiographs/ultrasound examination or other tests may be required, too.

A male cat that is unable to urinate due to complete blockage of the bladder needs to be treated as an emergency.

How is cystitis in cats treated?
If stress-related cystitis is diagnosed, the treatment usually consists of pain relief, relaxation of the cramped bladder muscle and glucosamines, which seemed to soothe the sore inside layer of the bladder. We also strongly advise that cats which are prone to cystitis are fed only on wet food. This is an exception to the general rule, as we usually recommend feeding cats and dogs on dry food. However, we know that the overall water intake for the patient is better when wet food is given, and a slightly more dilute urine can help to prevent further episodes of cystitis. If possible, small amounts of water can be added to the wet food or the cat may be encouraged to drink by flavouring the drinking water with small amounts of something tasty e.g. salt-free chicken broth or tuna. Anything that increases the water intake in such cats is beneficial.

Male cats that are unable to pass urine often need much more intensive treatment. Usually such patients need an emergency general anaesthetic to allow us to unblock the bladder and achieve urine flow. In some cases, especially if the problem has been overlooked for a little while, intensive care may be necessary for several days and unfortunately not all cats with this condition manage to pull through.  The earlier the condition is treated, the better.

My cat has cystitis – what is the outlook?
While some cats only ever have one episode of cystitis in their life, once a cat has developed stress-related cystitis he or she is prone to develop further episodes when stressed. It is advisable always to feed such cats on wet food and encourage drinking as much as possible. It is also important to monitor such cats closely – this applies especially to tom cats as they are prone to becoming blocked.  In some cases ongoing management or medication is required.

Can dogs get this type of cystitis?
Dogs do not get the stress-related type of cystitis which we see in cats. They certainly can develop cystitis, but it is usually due to an infection or other underlying cause.  The signs of cystitis in dogs are similar to those in cats (see above), and if you become aware of such symptoms, you should seek veterinary advice at an early stage.


No Comments »

Special Offer – December – Arthritis Awareness Month

by admin on December 2nd, 2017

Category: Special Offers, Tags:

Arthritis Awareness

No Comments »