Clinical Notes: Beyond Management: Advancing Veterinary Cardiology from Palliation to Cure

For many general practitioners, a cardiology referral is synonymous with lifelong medication and managing the progression of heart failure. However, at VSOS, our cardiology team, led by specialists with over a decade of dedicated experience, is shifting the narrative from chronic management to definitive intervention.

By partnering with our multidisciplinary team, you provide your clients access to "keyhole" procedures and advanced surgical repairs available in only a handful of clinics worldwide.

VSOS is globally equipped for these complex procedures; our team was trained by the world's leading specialists and is supported by the dedicated facilities, personnel, and equipment required to achieve world-class surgical outcomes. Furthermore, our team offers the security of extensive practical experience, having now successfully performed this procedure many times. 

Because Myxomatous Mitral Valve Disease (MMVD) is seen so frequently in practice, it is easy for cases to follow a familiar clinical pathway. However, early specialist input can help define exactly where a patient sits on the continuum of care. Referral is particularly valuable when:

• Clinical signs are evolving: The murmur is increasing in intensity, or there is concern regarding progression toward congestive heart failure.

• Owners seek clarity: Clients would benefit from clearer staging, a formal prognosis, or complex treatment planning.

• Management complexity increases: Medical management is becoming more difficult to balance, or there is a question around suitability for advanced intervention.

Atypical findings emerge: The signalment or clinical findings do not fit the usual pattern, suggesting another condition may be contributing

Medical therapy remains a vital component of managing dogs with mitral valve disease, with strong evidence supporting its role in improving quality of life. However, it is important to maintain a clear distinction for the owner:

• Support vs. Repair: Medication supports the patient and manages symptoms, but it does not physically correct the structural regurgitation.

Long-term Outlook: As the disease progresses, physical intervention such as surgical mitral valve repair is the only way to significantly reduce the leak and potentially allow the patient to come off heart medications entirely.

VSOS provides specialist-led cardiology within a broader, multidisciplinary hospital model. This team-centred approach, encompassing surgery, internal medicine, imaging, and emergency care, is a significant strength when managing complex cardiac cases.

For mitral valve patients, a referral to our team provides:

• Advanced Diagnostics: High-level echocardiographic assessment and ECG for precise rhythm evaluation.

• Comprehensive Staging: Clear diagnosis and medical management planning tailored to the individual.

• Advanced Intervention: Assessment for surgical repair under cardiopulmonary bypass, involving the placement of false cords and annuloplasty to physically tighten the valve annulus.

The referral process is designed to be a practical extension of your own clinic. We understand that your clients value clear answers and efficient service.

• Streamlined Consults: We begin with a review of your referral history, followed by diagnostics tailored to the patient.

• 90-Minute Turnaround: Because our cardiology imaging is assessed live, owners can often leave with a definitive diagnosis and plan within approximately 90 minutes.

• Immediate Decisions: This rapid pathway allows for earlier decision-making when the next clinical step is not yet obvious.

Not every murmur follows the expected pattern, and signalment remains a critical diagnostic clue. A soft murmur in a larger dog should not automatically be assumed to be routine MMVD.

A recent example involved a 5-year-old Springer Spaniel referred for a murmur. Our work-up identified:

• DCM Phenotype: A dilated, weakened left ventricle.

• Profound Bradycardia: ECG revealed sinus node dysfunction and a ventricular escape rhythm.

• Targeted Treatment: In this atypical case, the chronic bradycardia was the likely driver of the cardiac changes, making pacemaker implantation, rather than standard MVD medication, the appropriate pathway.

To assist your clinical decision-making, we have outlined the specific criteria that often trigger a transition from medical management to advanced interventional or surgical procedures

We know how much your clients rely on your guidance. Our goal is to provide you with a comprehensive specialist report and a definitive treatment plan within 90 minutes of the owner walking through our doors

Provide your clients with the gold standard in cardiac care. To refer a patient for a same-day echocardiogram and specialist assessment, click here or speak with our cardiology coordinator.

Let’s work together to move your patients from management to a better quality of life