💓 Matters of the Heart: My Second Week in Cardiology at VMCLI.

September 10, 2025, 8 AM - 4 PM.

Day two, week two, and it was a full day in cardiology!!!! I was paired with my AMAZING LVT, Emily - who I quickly realized is not only incredibly kind and welcoming, but also so knowledgeable that I found myself wanting to emulate her in my career. Additionally, she was a fantastic teacher!

Emily reviewed heart anatomy with me again, making sure I was familiar with the "normals" before explaining the "abnormals." It made me appreciate how important it is to really master the basics before diving into pathology.

Our first patient of the day was Randy Bobandy, a 6-month-old tuxedo neutered male kitten who presented for panting after vigorous play. Dr. Morganstern, the cardiologist, performed an echocardiogram and found that everything was perfectly normal. He explained to the owner that Randy Bobandy is simply a young, healthy cat who sometimes just plays too hard.

What struck me was that although we learn that a panting cat = immediate emergency, context matters. Every case is unique, and while panting can signal a problem, sometimes it's just a rambunctious kitten being...well, a rambunctious kitten. Luckily, the owner had insurance.

Our next patient was Summer, a 2-year-old spayed female Boxer. She came in for a repeat echocardiogram due to a history of syncope episodes - moments where she had fainted back in August. To monitor her heart rhythm more closely, Summer was fitted with a Holter monitor- a device the patient wears for 24 hours to record every heartbeat and rhythm. BUT ! Summer's mom reported no recent fainting spells! Emily then explained the difference between syncope and seizures. To the untrained eye, they can look similar, but there are key differences.

• Syncope is fainting caused by a sudden drop in blood flow to the brain. The patient may collapse, twitch briefly, but usually recovers quickly.

• Seizures, on the other hand, last longer, involve full-body convulsions, and are followed by a post-ictal period where the patient may seem disoriented, anxious, or act abnormally for minutes to hours afterward.

Boxers like Summer are predisposed to a condition called arrhythmogenic right ventricular cardiomyopathy (ARVC). In simple terms, this is a genetic disease where the heart muscle, especially the right ventricle, gradually gets replaced by fatty or fibrous tissue. This interrupts the heart's normal electrical signals, often leading to dangerous arrhythmias (abnormal rhythms) and sometimes sudden fainting episodes or, tragically, sudden death. That's why monitoring is so crucial in this breed.

Our third patient of the day was Daina, a 5-year-old spayed female Great Dane with a heart as big as her name. Daina was diagnosed with subaortic stenosis (SAS), a congenital heart condition. SAS happens when there's a narrowing just below the aortic valve, making it harder for blood to leave the heart. The good news? In most dogs, SAS reaches its peak by about a year of age and usually doesn't worsen over time. Dr. Morganstern performed an echo to check if there had been any progression. One key measurement he looked at was the LA:AO ratio - that's the size of the left atrium (LA) compared to the aortic root (AO). In healthy hearts, this ratio is usually under 1.6. If it's higher, that can indicate the left atrium is enlarged, often due to increased pressure or obstruction.

For Daina, the ratio stayed below 1.6, which meant her condition hadn't progressed. Dr. Morganstern reassured her mom that no medications were needed, and Daina was cleared to go home - tail wagging and all!

Our final cardiology patient of the day was Sophia, a sweet Cavalier King Charles Spaniel. Cavaliers are notorious for heart disease - especially mitral valve disease - so it wasn't surprising that she was a "B1" patient coming for her annual echo.

Unfortunately, Sophia's repeat echo showed progression. She had now moved from Stage B2 to Stage B2, which meant it was time to begin medication. Emily broke down the stages of heart disease and failure:

• Stage A: Patients are at risk (like breeds predisposed to disease) but show no signs or abnormalities.

• Stage B1: Structural heart disease may be present, but the heart hasn't enlarged. The LA:AO ratio is still under 1.6.

• Stage B2: The LA:AO ratio increased above 1.6, meaning the left atrium is enlarged. This is when medication begins - pimobendan specifically, which strengthens the heart's contraction and improves efficiency. Once started, it's lifelong.

• Stage C: This is heart failure. Patients may show coughing, exercise intolerance, or edema. At this stage, diuretics like furosemide and spironolactone are added, along with pimobendan. Emily explained that adding furosemide depends heavily on kidney values - since the kidneys are responsible for excreting the excess fluid, their function has to be monitored closely. Sironolactone, on the other hand, is a potassium-sparing diuretic, meaning it helps remove excess fluid without depleting potassium levels.

• Stage D: End-stage heart failure, when patients often require more aggressive, multi-drug therapy and frequent rechecks.

For Sophia, with the right medication started early, her quality of life can be preserved for much longer.

Today in cardiology reminded me that every patient tells a different story. From Randy Bobandy's harmless post-play panting, to Summer's fainting spells, to Daina's stable congenital condition, and Sophia's step into Stage B2 heart disease, each case had its own lesson.

I realized how important it is not just to know the science, but also to balance it with context, clear communication with the owner, and compassion for both patients and clients. Watching Dr. Morganstern, Emily, and their team work together reinforced for me that great veterinary medicine is equal parts knowledge, teamwork, and empathy.

Most of all, I walked away inspired - excited to keep learning and one day apply it in my own career!!! 💓