Innocent cardiac murmurs are often found in asymptomatic puppies at the age of 7–10 weeks. To what extent these soft murmurs are recognized by first opinion veterinary practitioners is unknown.

Between October 2015 and June 2016, 354 client-owned clinically healthy puppies of 11 different breeds with an age of 45–76 days were auscultated by a veterinary cardiology specialist and a final year veterinary student. The same dogs had been auscultated by various veterinary practitioner too, when they were 34–69 days old. Several practitioners of 43 different practices performed the auscultation, in average 9 days earlier than the cardiologist and the student. The student had undergone a 3-hour practical training in cardiac auscultation before starting the study.

The findings of the cardiologist, student, and practitioners were compared for agreement. The practitioners' judgements about the presence or absence of a murmur were looked up in the puppies' passport.

Of the 330 puppies that were auscultated by both the cardiologist and a practitioner, the cardiologist detected a murmur in 97 puppies. All murmurs were systolic and had a maximal intensity of 1 or 2 out of 6. The agreement between the findings of the cardiologist and the veterinary practitioners was poor (κ=0.008) and significantly different (p<0.001). Cardiac murmur was heard by the practitioners in only 1 of the 97 puppies with a murmur. A total of 255 puppies were auscultated by both the cardiologist and the student. A fair agreement (κ=0.401) and a significant difference (p=0.046) was found.

A weakness of the study is that the practitioners performed the auscultation on a different day and under various circumstances. However, because physiologic anemia is known to contribute to the genesis of innocent murmurs, the prevalence of innocent murmurs at the first veterinary health check should have been the same or higher than at the second time point.

We conclude that soft (innocent) cardiac murmurs in puppies at the age of 6–10 weeks are seldom recognized by first opinion veterinarians. Soft murmurs that are detected by practitioners are probably louder and therefore they are possibly not innocent, but are caused by congenital cardiac anomalies. Based on the better agreement between the findings of the cardiologist and the student, compared to the findings of the cardiologist and the practitioners we conclude that training has much higher effect on the recognition of soft cardiac murmurs than experience, even if the training is short.

Disclosures

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