# Self-Reported Management of Incidentally Detected Heart Murmurs in Puppies: A Survey among Veterinarians

## TL;DR

Veterinarians find it difficult to distinguish innocent from pathologic heart murmurs in puppies, despite recognizing the importance of further testing for accurate diagnosis.

## Contribution

This study provides new insights into the challenges veterinarians face in managing heart murmurs in puppies and their referral practices.

## Key findings

- Only 9% of veterinarians find differentiating innocent from pathologic murmurs in puppies easy.
- Most veterinarians do not immediately refer puppies with pathologic murmurs to a cardiology specialist.
- Veterinarians acknowledge the difficulty in distinguishing murmurs and the importance of echocardiography for loud murmurs.

## Abstract

Screening puppies carefully for heart murmurs during the first veterinary health visit is essential to disclose hidden congenital heart diseases. However, murmurs in puppies can also be innocent. Ideally, puppies with a possible congenital heart disease should not be sold to a new owner by their breeders. Our study aimed to investigate how easy veterinarians find differentiating innocent from pathologic murmurs, and how they manage puppies with a pathological murmur. We sent a questionnaire to veterinary practices in the Netherlands and Belgium, and analyzed 452 responses. Though 88% of the respondents find detecting a heart murmur easy, only 9% find differentiating innocent from pathologic murmurs in puppies easy. Only 80% of veterinarians recommend immediate referral of puppies with a pathologic heart murmur. Most respondents recognize that normal growth and lack of clinical signs do not rule out congenital heart disease. Though there are several centers with a veterinary cardiology specialist employed in the surveyed countries, only 43% of the respondents recommended the referral of a puppy to a veterinary cardiology specialist for murmur investigation. In conclusion, most veterinarians understand the importance of an echocardiography of puppies with loud murmurs, but they acknowledge the difficulty in distinguishing innocent from pathological murmurs.

Background: Heart murmurs in puppies can be innocent or pathologic; the latter is almost always related to a congenital heart disease. Differentiating between these murmurs can be challenging for practicing veterinarians, but this differentiation is essential to ensure the best prognosis for puppies having a congenital heart disease. Our study aimed to reveal how veterinarians manage puppies with a heart murmur. Methods: A web-based questionnaire was sent to Dutch and Belgian veterinary practices. Results: Data from 452 respondents were analyzed. Though 88% of the respondents find detecting a heart murmur easy, only 9% find differentiating innocent murmurs from pathologic murmurs in puppies easy. Of the respondents, only 80% recommend immediate additional examination when detecting a loud heart murmur during the first veterinary health check at 6 weeks of age. Most of the respondents are aware that normal growth and the absence of clinical signs do not exclude severe congenital heart disease. Of the respondents, 31% were uncertain whether early surgical intervention could lead to improved outcomes. Conclusions: Veterinarians are aware of the importance of echocardiography for puppies with a loud heart murmur, and recognize their limitations when differentiating an innocent from a pathological heart murmur in a puppy.