Cardiorespiratory Service

We are proud of providing a caring and dedicated cardiorespiratory service with unbeatable, unique expertise and facilities in the South West.

Our patients have access to state of the art facilities such a top of the range CT scan, echocardiography, fluoroscopy, access to specialist, on-site cytologists and a state of the art ICU for the critical patient. Our Specialist cardiologists work alongside other Specialists in critical care, anaesthesia and internal medicine to ensure a multi-disciplinary approach that provides holistic care of the highest quality.

All cases of cardiac and or respiratory diseases can be referred. We also see tertiary referrals for Cardiology certificate and diploma holders.

New Heart Failure Research!

Welcome to the Cardiorespiratory Service

We hope you find the questions below useful. There is also a list of more general questions in our General Info for Owners pages.

My puppy has a heart murmur, what should I do?

If your puppy is older than 16 weeks, it should not have a heart murmur. Also a loud heart murmur is not normal. If this is the case you should present your puppy to a cardiologist.

You should not wait until your puppy is grown, as some congenital cardiac diseases can cause heart failure before your puppy is one year old. It might be possible to correct the disease and your puppy will have a normal life expectancy.

To find out what which cardiac disease might be present, we would scan the heart of your puppy. This enables us to assess the function of the heart and the cause of the heart murmur.

When we have found the cause of the heart murmur, we will discuss if treatment is needed and what are the best options for you.

How long will my pet need to stay with you?

Cardiac cases we usually see as day cases. That means you bring your pet in the morning and in the evenings we will discuss the results of our investigations with you and you can take your pet home. However, if your pet has a severe disease, we might need to hospitalise it for stabilisation. Our state of the art ICU unit allows 24 hours patient monitoring to provide best care for your pet.

If your pet has a lung disease, it might not be possible to schedule all investigations for one day. In these cases they might need to stay overnight. For hospitalisation every dog gets its own kennel and cats stay in our dedicated Feline Centre. Staff are present 24 hours in the hospital to care for your pet.

My pet is being referred for a 'Cardio work up,' what will you do to them?

Depending on your pet's particular problem, we will do a blood tests, measure their blood pressure, obtain an ECG and a heart scan and if there is a cough, breathing difficulties or we suspect heart failure, we might take an x-ray of the chest.

An ECG will tell us, if the heart rate and rhythm of your pet is normal. If we detect an irregular heart rate or rhythm, we might send your pet home with you with a 24 hours ECG (Holter monitor). This enables us to get a recording of the heart rate and rhythm when your pet is with you at home, when you take him/her for walks and when he/her is asleep.

A scan of the heart allows us to diagnose a cardiac disease, if present, and to assess the function of the heart.

If your pet coughs or has breathing difficulties, x-rays of the chest are the best way to find out how their lung's looks and what might be the cause of their problem.

The Cardiology Service

The cardiology service sees any cardiac case, whether it is a heart murmur, an arrhythmia, heart failure or a pericardial effusion. Advanced echocardiography, (including tissue Doppler imaging), 24 hours ECG (Holter monitoring), reveal device placement (long-term ECG recording for several months), intracardiac pressure measurements and angiography will be obtained as indicated.

Specialist interventional procedures as pacemaker implantation, balloon valvuloplasties of pulmonic stenosis and minimal invasive catheter occlusion of patent ductus arteriosus are available.

The close connection of several disciplines allows an interdisciplinary approach of complex cases. The state of the art ICU enables 24 hours monitoring of critical patients.

Outpatient Cardiology Refer a Case Advice (vets only)

Cardiac Diseases

Cardiac diseases are frequent in dogs and cats, and progression into heart failure is common. Achieving a diagnosis can be challenging, especially in cats, which frequently do not show typical clinical signs of their cardiac disease.

If you suspect cardiac disease or detect a heart murmur and/or an arrhythmia in a patient, we are happy to see them for a work-up to help you to achieve a diagnosis and develop a follow-up and treatment plan.

We have high quality echocardiographic machines, 24 hour ECGs and state of the art imaging facilities, enabling
us to diagnose not only common conditions but also more complex cardiac diseases.

Arrhythmias

Arrhythmias can be associated with cardiac diseases. They can be the cause of heart failure, syncopal events and sudden death in our patients.

By using 24 hour ECGs (Holter recorders) and reveal devices (long-term heart rhythm monitors), alongside our cardiac work ups we are able to detect intermittent arrhythmias and identify their significance.

The assessment of an arrhythmia, its significance and potential association with cardiac or systemic diseases, is very important to ensure the best possible treatment regime is selected.

Pacemaker Implantation

Radiograph after implantation of a pacemaker in a 12y old dog with third degree AV block

In cases of significant bradycardia (3rd degree atrioventricular block, high grade 2nd degree atrioventricular block, atrial standstill) and sick sinus syndrome causing weakness, exercise intolerance, syncope, or heart failure, pacemaker implantation will prolong the life of the animal whilst having a normal quality of life.

The pacemaker battery will be positioned at the dorsal neck, the lead will be placed and secured in the right ventricular apex via the jugular vein. After the procedure the animal will be hospitalised for a few days, because the risk of lead dislodgment is greatest within the first days after pacemaker implantation.

For the first 4 weeks after discharge, the owner will be ask to keep the dog as quiet as possible and to take him/her for lead walks only. After 4 weeks a revisit will be scheduled to interrogate the pacemaker to make sure that the settings are appropriate and the pacemaker will be programmed to a rate responsive mode, which enables the pacemaker to adapt the heart rate of the dog to its level of activity.

Further revisits will be scheduled every 6-12 months to interrogate the pacemaker and check the pacemaker settings.

Balloon Valvuloplasty

In cases of severe valvular pulmonic stenosis and clinical signs (weakness, exercise intolerance, syncope, heart failure), successful balloon valvuloplasty will enable the animal to have a normal quantity life and markedly improved quality of life. If left untreated, development of heart failure is likely.

Echocardiography will be obtained before the procedure to assess the size and severity of stenosis, cardiac function and to investigate for potential additional cardiac diseases.
For the procedure the jugular vein or femoral vein will be used as vascular access. During the procedure pressure measurements of the pulmonary artery and right ventricle will be obtained before and after the procedure to be able to assess the pressure reduction obtained.

Right sided angiography is used to assess the size of the pulmonic stenosis. This measurement will be used to choose the balloon used for balloon valvuloplasty. The balloon will be positioned over the pulmonic valve using fluoroscopic guidance and inflation of the balloon will result in reduction of the stenosis.

After the procedure the animal is hospitalised overnight for observation. Repeat echocardiography will be performed the following day and the dog will be discharged from the hospital.

Patent Ductus Arteriosus

Puppies that have a continuous heart base murmur are likely to have a patent ductus arteriosus (PDA). If this is left untreated, development of heart failure is likely. Therefore, closure of the PDA is highly recommended.

This can be performed via minimal invasive catheter procedure under fluoroscopic guidance. Specifically developed closure devices (Amplatz Canine Duct Occluder) for dogs can be delivered by catheters via the femoral artery. The advantage of this procedure is that there is no need for thoracotomy, complete closure of the PDA is almost always obtained and only a small suture will be present over the access side.

Echocardiography will be performed before the procedure to assess the size of the PDA, possible secondary changes, cardiac function and potentially additional cardiac diseases, and the day after the procedure, after which the dog will be discharged home.

Videos show an echocardiography before and after PDA occlusion.

Amplatzer occluder in situ

The Respiratory Service

Our patients have access to state of the art facilities such a top of the range CT scan, echocardiography, fluoroscopy, access to on-site cytologists and a state of the art ICU for the critical patient.

We aim to treat your dog or cat as we would like ours to be treated. All cases of respiratory diseases can be referred. We also see tertiary referrals for Cardiology certificate and diploma holders. Cases we regularly see include:

Cough/Sneezing.
Exercise intolerance.
Abnormal breathing/respiratory distress.
Nasal discharge.
Tracheal stents for tracheal collapse.
Balloon dilation and nasopharyngeal stenting for nasopharyngeal stenosis.

Respiratory Endoscopy

The specialists have a wide range of endoscopes of superb quality for performing rhinoscopy, nasopharyngoscopy, laryngoscopy and bronchoscopy in cats of dogs of any size.

Cytology results (e.g. bronchoalveolar lavage results) are often available within several hours as specialist cytologists are available on site.

Small Dog Coughing Clinic

CT showing bronchitis and bronchiectstasis

A dedicated clinic for investigation and treatment of chronic cough in small dogs.

The service has:

Dedicated respiratory clinicians.
Specialised imaging: CT scan, fluoroscopy, advanced echocardiography, bronchoscopy.
On-site clinical pathologists.
Interventional therapy such as tracheal stenting available when required.

Interventional Respiratory Radiology

We are able to offer specialist radiology procedures which will lead to a prompt and correct diagnosis or will allow us to give the best appropriate treatment.

Fluoroscopy is routinely used for the investigation of dynamic airway disease and procedures such as tracheal stent placement for tracheal collapse, ballooning or stenting for nasopharyngeal stenosis and foreign body removal.

Tracheal Collapse