Heart Disease
  • Heart disease in veterinary medicine
    • Heart disease from birth (congenital heart disease) is pretty uncommon, occurring in less than 2% of all dogs, and less commonly in cats.
    • Heart disease happens frequently in animals, though the disease we see most frequently (valve disease) is different than in humans (coronary artery disease).
      • About 10% of dogs seen by a family veterinarian will have heart disease, and of those, 75% will have valve disease.
        • 40% of small breed dogs will eventually develop some degree of valve disease.
        • Large breed dogs get a large and flabby heart (dilated cardiomyopathy), and as many as 60% of certain breeds may be affected in their lifetime.
      • About 15% of cats develop murmurs (abnormal heart sounds).
        • About 1/3 of these cats will have heart muscle diseases, where their hearts are either thickened, or scarred, or both.
      • About 15% of cats can have heart disease without a murmur (“silent” heart disease)
  • My family veterinarian heard an abnormal heart sound or rhythm
    • Your family veterinarian can find abnormalities in your pet before you can see signs
      • They may hear murmurs (abnormal heart sounds) or abnormalities in the heart rhythm (irregular or fast or slow).
    • These findings can be either significant or not yet an issue for your pet
      • Of course, early detection and appropriate treatment can make a positive impact for your pet.

    The best care for your pet is to be seen by a board certified veterinary cardiologist after being seen by your family veterinarian.

  • Other signs your pet might show with heart disease
    • You may see signs in your pet to prompt you to take your pet to your family veterinarian
      • In dogs
        • You may see exercise intolerance, coughing, breathing hard or fast, fainting, or abdominal swelling.
      • In cats
        • You may see hiding behaviors, decrease in eating, breathing hard or fast, front leg lameness or suddenly paralyzed rear legs.

    You should see your family veterinarian if you see any of these signs.

    The best care for your pet is to be seen by a board certified veterinary cardiologist after being seen by your family veterinarian.

Appropriate Care
  • Seeing a cardiologist in person will help your pet
    Collaboration between your family veterinarian and a board certified veterinary cardiologist can increase the survival of your pet in congestive heart failure by 75%, according to a recent report!
    • Board certified veterinary cardiologists have extensive and advanced training
      • We have four years of advanced training after veterinary school
      • We pass two years of additional testing
      • We attend continuing education in advanced cardiology to keep up with the newest information
    • Seeing a board certified cardiologist in person provides better care for your pet
      • We get to meet YOU, and get a sense for what is appropriate for YOU and your pet
      • You get to meet us, so you can be confident your pet is in good hands
      • We get to ask the subtle questions in the history that makes all the difference
      • We get to perform a thorough physical examination with you as a calming influence
      • You are present during the echocardiogram (heart ultrasound)
        • As a calming influence on your pet
        • We can show and explain to you what is going on with your pet
      • You get to get your questions answered on the spot, compassionately and clearly
  • Choice Cardiology is different

    We do ALL of these:

    • Experienced
      • We have the most experience in Colorado
      • We have been providing heart care for pets for over 20 years
      • We have seen the most cases (well over 20,000 for Dr. Loyer)
    • Present
      • We do not perform mobile services, because we don’t think that serves clients and pets best
        • You get first-hand information directly from the cardiologist
      • You are present during the echocardiogram (heart ultrasound)
        • As a calming influence on your pet
        • We can show and explain to you what is going on with your pet
    • Appropriate
      • We do all aspects of patient care for the heart, and not just mobile ultrasound
        • We do not just recommend recheck echocardiograms (heart ultrasounds) to follow cases
      • We “get” that we have to do the right thing for you, your pet, and your finances
        • We want you to be able to care for your pet for their lifetime
        • We work in collaboration with your family veterinarian
    • Reputation
      • Having been in the Colorado and Denver metro veterinary communities for over 20 years now, we have established an excellent reputation with our peers
        • To maintain that reputation, we have been:
          • Skillful- we perform excellent medicine
          • Ethical- we have and do treat people and pets right
          • Personable- we genuinely like our referring veterinarians, our clients, and our pet patients!
    • Progressive
      •  We wrote THE veterinary ultrasound software for accurate analysis of the echocardiogram
        • We have about EVERY normal value and range at our fingertips, and we use them!
        • We can and do perform a more complete echocardiographic examination
        • Others use “about” values and don’t record normal values
          • They certainly can’t look up in texts every specific value in the time allotted to perform the ultrasound.
      • We try to embrace change, and find better ways, and to continue to be cost/benefit effective.
    • Value
      • Your initial visit will, in most cases, require the echocardiogram (heart ultrasound)
      • You will get discounted fees for recheck examinations and many of the procedures we may have to repeat
  • We wrote THE veterinary ultrasound software for accurate analysis of the echocardiogram
    The College of Veterinary Cardiology has published and continues to publish many reports on the normal echocardiographic values for animals, because they think those values are important
    •  We wrote THE veterinary ultrasound software for accurate analysis of the echocardiogram
      • We have about EVERY normal value and range at our fingertips, and we use them!
        • We have values for breeds (if those studies have been performed)
        • We have the values that let us analyze subtle or complex problems
      • We can and do perform a more complete echocardiographic examination
      • Our reports are complete yet concise, and easily readable for followup purposes
    • Others use “about” values and don’t record normal values
      • Animals come in many species, breeds and sizes
      • Others certainly can’t look up in texts every specific value in the time allotted to perform the ultrasound

    Here is what we are evaluating, and what we report     EchoVetReport

    Here is what others are evaluating, and what others report

  • Tests we perform at Choice Cardiology

    Also see Tests We Often Perform

    • Routine Tests
      • Echocardiogram (heart ultrasound)
        • This is a non-invasive test that allows us to “see inside the heart” to know precisely what is happening with your pets heart.
        • Typically, you will be present during the exam as a calming influence for your pet, and we can teach you about your pet’s condition as we perform the exam.
      • Blood Pressure
        • We use the Doppler system, the most accurate for dogs and cats
        • Important to optimize treatment of heart disease
      • ECG (EKG or electrocardiography)
        • Important for heart rhythm disturbances
      • Digital Radiography (X-Rays)
        • While the echocardiogram (heart ultrasound) shows us what is going on inside the heart…
          • Radiographs let us see the lungs to see if there is congestive heart failure, or other causes of cough
    • More Advanced Testing
      • Holter monitoring (24 hour electrocardiograms)
        • These are performed with your dog at home, to allow us to see the heart rhythm during all activities
      • Flouroscopy
        • This is a “moving X-Ray”
          • Visualize tracheal collapse and where it is ocurring
            • Place tracheal stents for those patients with trouble breathing with their tracheal collapse
          • Pacemaker implantation
          • Other cardiac catheterization procedures (angioplasty, ductal occlusions)
  • Can I can get the echocardiogram performed with my family veterinarian?

    The best care for your pet, your best opportunity to make good decisions, and to get an accurate diagnosis and treatment plan for your pet is to see a board certified cardiologist in person.

Your Appointment
  • Your appointment
    • We will make sure your information is correct in our system
      • You will need to fill out our online Client/Patient Intake Form
        • This is available to you online, so you can do this before your appointment and we can get you into our system, to maximize your time with us
    • The doctor will come in to expand the history and perform a physical examination
    • An echocardiogram (heart ultrasound) is performed on most of our patients with their initial examination
      • You typically will be present with your pet during the exam, as a calming influence and so we can teach you about your pet’s condition
    • Other tests we recommend and their costs will be discussed with you before we perform them
    • We will discuss your pet’s complete case with you, and answer your questions
    • We will give you a complete report for you to take home with you
    • We will fax over a copy of the report to your family veterinarian
  • You are present during the echocardiogram (heart ultrasound)
    • You are present during the echocardiogram (heart ultrasound), in almost all cases
      • We don’t take your pet into “the back room”
    • You are a calming influence for your pet and can see how non-invasive the test is
    • “A picture is worth a thousand words”
      • You get to see your pet’s condition just as we see it
      • We get to teach you as we perform the examination, so you understand your pet’s condition better
    • You see the value of this remarkable technology
      • You see us not only visualize the inside of the heart…
        • You also get to see all the different measurements we perform for accurate diagnosis
        • You see us input all those measurements into our software for precise diagnosis

    Every once in a while, we have a patient that does better without their parents. You typically tell us that because you know your pet.

  • You see what is going on with your pet and we give you a diagnosis “on the spot”
    • “A picture is worth a thousand words”
      • You get to see your pet’s condition just as we see it
      • We get to teach you as we perform the examination, so you understand your pet’s condition better
    • Other tests we recommend and their costs will be discussed with you before we perform them
    • We will discuss your pet’s complete case with you, and answer your questions
      • We are compassionate, and clear
      • We talk in language you can understand
        • We want you empowered to make good decisions for you and your pet
      • Our reports are concise medical records
      • We provide you with a wealth of information on our website, so you have easy access
  • After hours emergencies

    Our after hours emergencies and patient care are handled by Northside Emergency Pet Clinic

    • There are emergency veterinarians and staff available for excellent after hours patient care
      • We provide continuing education so that your pet receives the very best of care
    • “Compassion Fatigue” is a huge problem currently in veterinary medicine
      • After all these years, we still love our work, in part because we have set good boundaries
        • If we don’t take time for family and play, we just won’t have what it takes to provide you and your pet with excellent, compassionate care
    • By a close collaboration with Northside
      • We can provide excellent after hours service for you and your pet
      • We can maintain good work/family balances for ourselves and our staff
  • Costs and payments
    • Our full heart workup is affordable
      • A blood pressure and an ECG (electrocardiogram) are included with your examination
      • Additional tests are only performed as needed
        • radiographs (x-rays) or a more advanced ECG (electrocardiogram)
    • We work to minimize ongoing care, and emergency visits needed by your pet
      • We will give you estimates before performing additional services
    • We take most credit cards, debit cards, cash and Care Credit
  • Questions your pet might have (eating, drinking, shaving, that dreaded temperature)
    • Relax! We will take great care of you
      • You can eat and drink before the appointment
        • Unless you are coming in for surgery, then you can’t have your morning food
      • We very rarely have to shave to do an echocardiogram (heart ultrasound)
        • We will use some alchohol (it dries quickly) and some non-toxic ultrasound gel
        • Your at-home buddies will probably wonder what you were up to, though
      • If you need a 24 hour Holter ECG (electrocardiogram)
        • Then, we will need to shave some patches. Sorry about that.
      • We really rarely have to use any sedation, unless you are really squirmy
    • Oh yeah. You will love us. We won’t take your temperature unless you are really sick, because we want you as relaxed as possible!
  • Bring your pills with you!
    • Bring your pills with you!
      • It really helps us help you!
        • Heart patients have to change their medications fairly frequently
        • Different manufacturers have different pill colors
          • The color of the pill doesn’t help us
    • At the very least, please write down what you are giving
      • Drug name
      • Size of tablet or capsule
      • Strength of an elixir (usually mg/ml or mg/cc)
      • How much you are giving (amount of tablets or elixir)
      • How often
Medications
  • Medications improve quality of life, and improve survival
    We only want your pet to be on those medications that will either make your pet feel better, or live longer.

    • We work hard not to over medicate your pet.
    • We will discuss the pros and cons of each medical approach we recommend, to empower you to make good decisions regarding your pet
  • How medications work in heart disease
    We can affect the heart in a multitude of ways

  • Giving medications
    Here are some tricks for you to give your pet medications

    giving medications tricks

  • Side effects of medications
    There are general side effects we see with heart medications, and we try to minimize these effects:

    • not eating well
    • vomiting or diarrhea
    • lethargy
    • kidney side effects

    We have always done direct care of our referred patients, so have extensive experience with the medications and handling their side effects. If your pet is experiencing adverse effects, we will want to know about that so we can help you

    For more information on each medication’s side effects, go to

    choicevs.com/diseases-and-other-info/medications

  • We help you get medications as inexpensively as possible
    • We often will give you a limited supply of medications your pet will be on
      • This is so we can see that your pet will handle the new medications
        • And you are not buying months worth of a medication your pet has side effects from
    • We then typically will give you prescriptions for your medications, with plenty of refills
    • We are always looking for alternatives that are cost effective for you
      • If we know suppliers for that medication that are particularly cost effective, we will share that information with you
    • We always have some clients that prefer to get medications from their family veterinarians or us
      • And that is fine
Other
  • Rechecks and your pets welfare
    We provide recheck examinations at a discount to you for the life of your pet!
  • Surgery is not common

    Surgery for heart patients is uncommon

    • Heart transplants are not performed in veterinary medicine
    • Valve repair or replacement has not had good success yet
      • This is still being investigated at certain academic institutions
    • Certain congenital diseases are very amenable to a surgical approach
      • Patent Ductus Arteriosus
        • an occluder device can be placed through a back leg artery using flouoroscopy
        • surgical repair has long been performed successfully
      • Pulmonic Stenosis
        • Select cases of pulmonic stenosis can have a balloon angioplasty procedure
          • This is performed through a peripheral vein
    • Pacemakers
      • We have placed many pacemakers, and are very experienced with this procedure
        • Pets feel so much better with a normal heart rate than a very slow heart rate
        • Clients are generally amazed at how much better their pet feels after a pacemaker
    • Tracheal Stents
      • With severe tracheal collapse causing breathing problems, sometimes a tracheal stent is a last resort
        • We place this through the mouth using flouoroscopy, with no incisions