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Blood sampling carried out by Harry van Engelen (photo © Viktor Szatmari)
* This paper first appeared in the Journal of Veterinary Internal Medicine 2015;29:1524–1528 (DOI: 10.1111/jvim.13632)
Background: The aims of this study were to establish the prevalence of innocent cardiac murmurs in clinically healthy puppies, to investigate a possible correlation between the presence of an innocent murmur and haematocrit, and to describe the auscultation characteristics of innocent murmurs.
Hypothesis: Lower haematocrit contributes to the genesis of innocent murmurs.
Animals: Five hundred and eighty-four client-owned clinically healthy puppies, between 20 and 108 days old.
Methods: Two cross-sectional surveys with a 1-year (n = 389 pups) pilot and a half-year (n = 195 pups) principal study periods. Cardiac auscultation was performed by a single, board-certified cardiologist. Haematocrit was measured with an automatized haematology analyser. Echocardiography was performed only on puppies with a cardiac murmur in the principal study.
Results: In the pilot study, 15% of the dogs had a murmur. Innocent murmur was diagnosed in 28% of the 195 dogs in the principal study. Innocent murmurs were systolic, mostly with a musical character and with a maximal intensity of 2 of 6, and mostly with the point of maximal intensity in the left cardiac base. The haematocrit was significantly lower in the group with a murmur compared to the group without (P = 0.023).
Conclusions and Clinical Importance: Innocent murmur was a common finding in puppies at the age when the first veterinary controls usually take place. Physiologic anaemia contributes to the genesis of innocent murmurs in puppies. Rising haematocrit in growing puppies can explain the spontaneous disappearance of innocent murmurs with aging. Haematocrit did not differentiate innocent murmurs from abnormal murmurs.
Key words: Anaemia; Congenital; Dogs; Physiologic; Screening.
DVM PhD DipECVIM-CA (cardiology)
Department of Clinical Sciences of Companion Animals
Faculty of Veterinary Medicine
3584 CM Utrecht
Viktor Szatmári was born in Hungary and studied veterinary medicine at the University of Veterinary Science in Budapest, where he qualified in 1995. He then worked as a clinician and researcher at the Small Animal Clinic of the Department & Clinic of Internal Medicine of the same University. His research topic was diagnostic Doppler ultrasonography of the canine abdominal blood vessels. In 1999, he moved to the Netherlands, where he worked on the same topic at the Division of Diagnostic Imaging of the Faculty of Veterinary Medicine, Utrecht University. In 2004, he defended his PhD thesis with the title of Ultrasonography of portosystemic shunting in dogs; Doppler studies before, during and after surgery. Between 2003 and 2006 he followed a residency training programme in Companion Animal Internal Medicine and Cardiology of the ECVIM-CA at the Department of Clinical Sciences of Companion Animals of the Faculty of Veterinary Medicine, Utrecht University. In 2007, he became a Diplomate of the ECVIM-CA (Cardiology) and Faculty Staff Member and the Head of the `Thorax` Unit (Cardiovascular & Pulmonary Medicine) at the Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University. Since 2008, he has been the programme director of the ECVIM-CA (Cardiology) residency training program at the same institution. Twice a week he receives referral cases – dogs and cats with cardio-pulmonary disorders – and once a week he performs interventions, such as transcatheter embolization of patent ductus arteriosus, balloon valvuloplasty, pacemaker implantation and bronchoscopy. Besides his busy clinical activities he teaches veterinary students, and gives many continuing education courses and lectures for veterinarians in clinical cardiology and pulmonology, echocardiography and abdominal ultrasonography.
Volume 26(2), Summer 2016
Heart murmurs in pups:
when should I be worried?
Innocent Cardiac Murmur in Puppies: Prevalence, Correlation with Haematocrit and Auscultation Characteristics
by Viktor Szatmári, Martin W. van Leeuwen and Erik Teske
Physiologic anaemia contributes to the genesis of innocent murmurs in puppies. Rising haematocrit in growing puppies can explain the spontaneous disappearance of ...
... Read more
Prevalence of innocent murmurs
Physiologic murmur can be expected in
15–25% in clinically healthy puppies
brought for the first veterinary control.
What does it sound like?
Cardiac auscultation is routinely performed on each pup on the first and subsequent veterinary health checks, to detect murmurs. Although a cardiac murmur may be indicative of a congenital cardiac anomaly, a murmur may be present with no underlying heart disease, usually called an innocent murmur.
Click on the recording to hear an
innocent cardiac murmur in a
healthy 2-month-old Cairn
(with thanks to Viktor Szatmári).
Background: The aims of this study were to establish the prevalence of innocent cardiac murmurs in clinically healthy puppies, to investigate a possible correlation between the presence of an innocent murmur and haematocrit, and to describe the auscultation characteristics of innocent murmurs. ...
... Read more