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In Discussion With Cardiology

13 January 2020

The cardiology team has recently expanded, and we have welcomed Rachel Blake, a European Veterinary Specialist in Small Animal Cardiology.

Meet Our Cardiology Team

Rachel Blake MVB DipECVIM-CA (Cardiology) MScR AFHEA MRCVS EBVS® European Veterinary Specialist in Small Animal Cardiology

Rachel graduated from University College Dublin in 2012 after which she completed an internship and subsequently a cardiology residency at The University of Edinburgh. She joined the Cardiology team at Pride Veterinary Centre and gained the European Diploma in Veterinary Cardiology in 2019

Julie Todd BVMS CertVR CertVC MRCVS

Julie graduated from Glasgow Veterinary School and has worked in small animal practices since then. She joined the team at Scarsdale Vets in 2000 (subsequently Pride Veterinary Centre) and has since gained the RCVS Certificate in Veterinary Cardiology, having gained the Certificate in Veterinary Radiology in 1996. Since the opening of Pride Veterinary Centre in 2011, Julie has worked to build up the cardiology caseload for the hospital.

Emma Murphy RVN BA(Hons)

Emma joined the practice in 2009 first as an auxiliary nurse, then as a student nurse. She qualified in 2013. Previously Emma has worked in animal shelters in the UK and USA, and has worked with horses as well as small animals. Emma is currently working towards a VTS (Veterinary Technician Specialty) in cardiology, having worked within the Cardiology team at Pride Veterinary Centre

What Does A Typical Day In Cardiology Look Like?

If patients have been in the hospital overnight then these will be checked in the morning before consultations start. The day begins with consulting, which includes appointments with new referrals and rechecks of on-going patients.

The majority of patients will be seen for a consultation, admitted for investigations and sent home later that day.

In a typical new referral consultation, the animal’s history will be reviewed, clinical signs discussed including how well the animal is exercising and whether there have been any concerns with respiration. In most cases blood pressure is checked with a Doppler machine (we use the tail which the team find most tolerate best). This is often performed as the first diagnostic test, when the animal is least stressed. Echocardiography is then performed on the majority of cases.

This can usually be done without sedation so the animal is often returned to their owner within a couple of hours.

If respiratory signs are a concern, the team may take chest x-rays. In most cases these are taken with no, or minimal sedation.

An ECG will be run if there are concerns about an arrhythmia. In dogs where there is a severe arrhythmia, or if the team are investigating a case of collapse, a 24-hour Holter (ambulatory ECG) monitor will be attached. The dog will then be sent home for the owner to record the dog’s activity.

After the investigations for cardiology patients have been completed, the rest of the day is spent doing heart scans for other disciplines, writing letters to referring vets, reporting results and giving telephone advice to clients and vets. Emergency cases are also seen throughout the day where possible.

Cardiology nurse Emma also runs blood pressure clinics. She will take the blood pressure with the owner present, and spends time to calm the animal first, to obtain as accurate a result as possible.

What Other Disciplines Do Cardiology Work With?

The cardiology team work with the majority of the other disciplines within Pride Veterinary Centre as well as with first opinion vets. If a case is in the hospital with another medical or surgical condition but has a heart murmur or arrhythmia, then the cardiology team will investigate this if it is thought to be clinically relevant or before sedation or general anaesthesia. The team work with the medicine department most often. Their most commonly shared patients are cats with hyperthyroidism, who have an assessment for cardiac disease before they are accepted for radioactive iodine therapy. Cases presenting for investigation of collapsing episodes can be difficult to categorise so they are often jointly investigated with the neurology team.

The cardiology team sometimes share more unusual cases with other departments – a recent example is a dog that was initially referred to surgery with acute abdominal pain but was found to have ascites due to a pericardial effusion associated with a right-atrial haemangiosarcoma.

Working in a multi-disciplinary team allows cardiology cases with concurrent disease to be investigated and treated under one roof, and also provides the cardiology team with a more varied and interesting case load.

What Type Of Cases Do Cardiology See Commonly?

The most common routine cases are asymptomatic heart murmurs whereby an animal’s vet has picked up a heart murmur at a booster vaccination/ health check that the owner wasn’t aware of. Often these are older animals with a progressive murmur and a heart scan will help determine whether medication should be given. The cardiology team also investigate murmurs detected in puppies and kittens using echocardiography to determine if congenital heart disease is present and if potentially life-saving intervention is necessary.

The most common emergency seen by the cardiology team is congestive heart failure, often referred because of respiratory difficulties, although in some cases symptoms are more subtle. A large proportion of the caseload is made of rechecks of congestive heart failure patients who require frequent tweaking of medications to ensure optimal control of their symptoms.

Other common emergencies include pericardial effusions in dogs, arterial thromboembolism in cats and both tachyarrhythmias and bradyarrhythmias.

Keeping patients calm is very important for the cardiology team. This is partly because they are one of the disciplines that do not heavily sedate animals for procedures, but also because the condition of patients with severe heart disease can be worsened with extra anxiety. This means they work hard to keep the environment calm and quiet for all their patients which in turn keep stress levels to a minimum.

Emma said: “We get to know our patients very well as a lot of them come back regularly. This means we know who is anxious and the best way to keep that particular pet calm. It’s nice to be able to adapt what we do to the needs of the pet.”

What Would You Like Referring Clinicians To Know About Cardiology At Pride Veterinary Centre?

Rachel said: “We would like people to know that they shouldn’t be afraid to contact us for advice. We know cardiology can be complicated sometimes, so we are very happy to work with vets by sharing advice with them over the phone.”

Julie said: “I enjoy seeing the long-standing cases and getting to know the pet and the owner. Educating the owner in how to measure resting respiratory rate at home is very helpful, as it is very different to the examination in the hospital. Many of our clients become very closely attuned to their pet's condition and are able to detect changes early, so we can work together to fine-tune medication and often give the animal a good quality of life for far longer than is initially predicted.”

A Particularly Rewarding Case

One stand-out case was a cat with a heart murmur and sudden onset blindness who was referred to Ophthalmology and Cardiology. He had retinal detachment, hypertension and severe hypertrophic cardiomyopathy with a very large left atrium. With medication he regained some vision and was able to live very happily at home.

His owner was a lovely lady, who the team came to know well, and was very dedicated in monitoring and treating him. The cat did not go into heart failure for over two years. When he did, he responded well to treatment, and did not die of his heart disease. Sadly he had to be euthanised eight months later, at the age of eighteen, due to a mouth tumour. It just shows how unpredictable heart disease can be, particularly in cats, and that animals can live happily for a long time with the correct treatment regime for them.

 

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