A referral is recommended by your primary veterinarian when they feel a patient would benefit from seeing another vet with more experience, qualifications and dedicated equipment within the field of cardiology. There are many reasons as to why your primary veterinarian may recommend a cardiology referral: Your pet may have presented with a symptom that could be due to heart disease: • Dogs can present with a cough, difficulty breathing, weakness, exercise intolerance, lethargy, abdominal swelling or fainting. • Cats may be more lethargic, have difficulty breathing or have faster breathing. They can also present with a history of hiding away in unusual places, fainting or have sudden onset limb paralysis. • Your pet may have no symptoms at all and be completely healthy but your vet may have heard an abnormal heart sound (such as a gallop or murmur) or an abnormal heart rhythm. • Your pet may require general anaesthesia for a procedure (such as a lump removal or dental) but has had an abnormal heart sound or rhythm heard during pre-anaesthetic checks. • Your pet may have had an elevated proBNP or Troponin blood test. Diagnosing heart disease can be challenging. An assessment by a cardiologist is the best way to determine whether disease is present and if it requires treatment.

On the day of your appointment your pet will be admitted to your vets for diagnostic investigations with Dr Emma-Louise Waller MRCVS (Emmie). This will typically include echocardiography (an ultrasound examination of the heart), 6 lead electrocardiography (ECG recording) and a blood pressure measurement; however, this can differ between cases depending on their individual requirements. Other tests will be performed as necessary (with your permission). Once the investigations have been completed, your practice will contact you to arrange a collection time when Emmie will meet you to discuss the diagnostic findings, detail any options for potential treatment and monitoring or further investigations as well as answering any questions you may have. This will typically take around 30 minutes. In the majority of cases, ongoing care and treatment will be managed by your own veterinary practice along with periodic reassessments with Emmie. Owner’s will receive a summary report within 3 working days of their appointment. Emmie will always be available for ongoing advice, questions or any other concerns you may have.

Given the nature of the conditions being investigated, diagnostics are all attempted with the patient awake. None of the tests are invasive and therefore full sedation is often not required. However, whilst the tests performed are not unpleasant or painful, patients are required to lie on their side during the scan which is unfamiliar and potentially a little worrying, particularly for cats. In light of this all cats are offered oral Gabapentin to be given at home prior to the appointment in order to help keep them calm and stress free during their visit. Nervous dogs can also be prescribed Gabapentin (usually given in combination with another medication called Trazodone) if required. Please ask your practice if you would like to request this for your pet. Very occasionally the aid of further sedation is needed, this is given via injection at the time of the appointment with the cardiologist. It is therefore requested that a small breakfast be given at 6-7am but food be withheld thereafter. Water can be available as normal. Please also give any medications as normal prior to the appointment.

Echocardiography requires good contact between the ultrasound probe and the patient's skin: 2-3 small squares (5-10cm) of fur will need to be clipped from just behind both elbows (and on the abdomen in dogs only) in order to obtain the best images.

Your primary care practice will be able to give you an estimate before your appointment, please contact them to provide one as well as the practice details regarding payment and insurance. Emmie will be able to more accurately discuss costs of treatment and ongoing care after examining your pet.

Mild heart murmurs are very common in puppies and kittens, these are often benign and disappear within the first few months of life. However some murmurs are due to congenital cardiac defects such as narrow vessels, holes in the heart or incorrectly formed valves. You will be recommended to have a full cardiac ultrasound with a veterinary cardiologist if your puppy or kitten has a particularly loud or concerning murmur, has a murmur that persists beyond the first few months of life, or has symptoms compatible with cardiac disease.

Typically, pets do not show outward symptoms until the later stages of heart disease. If heart disease is present, the best chance of making a difference is with early diagnosis and treatment. We therefore advise being seen as soon as possible. Unfortunately, not all cats with heart disease present with a murmur and therefore they can be even more challenging to diagnose. On the other hand, not all cats with murmurs have heart disease, and so the only way to know with certainty is to perform a cardiac ultrasound along with other diagnostic tests as indicated.