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I just purchased an 8 week old Maltese puppy and took it to my veterinarian for his first exam.  My veterinarian said the puppy has a heart murmur, and that I should consider taking the puppy back since he may not live long.  I have only had the puppy a few days but am already very attached and cannot imagine returning him.  What should I do?  Is the murmur something to worry about? 

A heart murmur in a puppy or a kitten may or may not be a serious problem.  A murmur is an abnormal sound that is heard when listening to the heart with a stethoscope.  Murmurs are due to atypical blood flow in the heart or the surrounding vessels, but they do not necessarily confirm the presence of heart disease.  Typically, the louder the murmur the more concern about the possibility of significant heart disease.

                Murmurs in puppies and kittens can be placed in two categories: first, murmurs that are a result of actual heart disease, also referred to as pathologic murmurs, and second, murmurs that are present with a normal heart, also referred to as innocent or flow murmurs.  Therefore, it is possible to have a mild murmur with a completely normal heart (innocent murmur).  The cause of innocent murmurs in both humans and animals is unknown but the prognosis with an innocent murmur is excellent.  Many innocent murmurs will also resolve as the patient ages.  Pathologic murmurs are of much more concern.  Unfortunately, differentiating between an innocent and a pathologic murmur can be difficult by just listening to the heart during a physical examination.  If a murmur is heard, then a special test called an echocardiogram is often necessary to determine if actual heart disease is present. 

            An echocardiogram is an ultrasound examination of the heart.    It is easily tolerated by the patient, and it is the most accurate test for the presence of heart disease.  In addition, the echocardiogram is very good at determining the severity of disease.  Your veterinarian may need to refer you to a specialist for the echocardiogram.     To answer your question, you have three options.  The first and very difficult option is to return the puppy.  The second option is to have an echocardiogram performed to assess whether there is significant heart disease present.  It may be helpful to review your sales agreement, because some pet stores and breeders will help you pay for the echocardiogram.  The third option is to have the puppy examined again in 1-2 months.  As discussed above, some innocent murmurs will resolve over time.  If the murmur resolves it is unlikely to be of concern in an otherwise normal animal.  The main concern with the third option is the possibility of the puppy having significant heart disease that was not detected early.  Whether a murmur is associated with a shortened life span is completely dependent on the presence or absence of heart disease, and the severity of the disease.

Donald Schrope, DVM, Diplomate, ACVIM (Cardiology)

Dr. Schrope received his veterinary degree from the College of Veterinary Medicine at the University of Minnesota. He then completed a 1 year internship and a 3 year residency program in cardiology at the Animal Medical Center in New York City. After completing his residency, he moved to New Jersey and began working at Garden State Veterinary Specialists in Tinton Falls, New Jersey. Dr. Schrope was the first full-time board certified cardiologist in New Jersey. In August of 1996 he joined the staff at the Veterinary Referral Center and Cardiopet in Little Falls, New Jersey and in February, 2002 he joined the staff at Oradell Animal Hospital. Dr. Schrope's special interests include the identification and treatment of feline and canine congenital heart disease. He is currently involved in research regarding the incidence of congenital heart disease in cats and dogs, the natural history of and treatment of aortic and pulmonic stenosis in cats, natural history of atrioventricular septal defects is cats, and the use of neurohormones such as proBNP to identify the presence of heart diease in cats. He has authored multiple publications and book chapters on subjects such as balloon vavuloplasty for the treatment of pulmonic stenosis in cats as well as dogs, identification and treatment of pulmonary hypertension, atrial septal defects, atrioventricular block in dogs, and the effects of non-cardiac disease on the heart. When not working, Dr. Schrope enjoys spending time with his three children, swimming, playing guitar, and tinkering with computers, as well as caring for his families cats: Double Stuff, Ricky, Curly and Cookie.