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Q&A with Angell West Cardiologist Dr. Rebecca Malakoff

malakoff-cardiology-waltham-teamCardiology Service, MSPCA-Angell West
www.angell.org/cardiology
cardiology@angell.org
617-541-5038

Dr. Malakoff is a board-certified cardiologist who specializes in the diagnosis and treatment of heart disease in pets. Her work includes testing such as echocardiograms, electrocardiograms and blood pressure measurement, the stabilization of critical cardiac patients, and the long-term medical management of congenital and acquired forms of heart disease. Dr. Malakoff performs cardiac catheterization procedures to aid in the diagnosis and treatment of specific cardiac disorders including procedures such as pacemaker implantation, Amplatzer ductal occlusion and coil embolization of PDA, and balloon valvuloplasty. Dr. Malakoff is the director of the cardiology residency program, which trains aspiring cardiologists in the art and science of cardiology.

What are the most common heart problems you see in dogs and cats?
For cats, the most common heart disease we diagnose is Hypertrophic Cardiomyopathy (HCM). This is a disease where the heart muscle becomes too thick, and cannot relax normally to allow blood to fill the chamber. It is most often diagnosed in middle aged cats, but can be seen in all ages ranging from the young to old. Although Hypertrophic Cardiomyopathy is typically a progressive form of heart disease, the rate of progression is highly variable between patients. Some patients with HCM never develop symptoms or problems from their heart disease, whereas others can develop fluid buildup in their lungs or problems caused by blood clots which form in an enlarged heart chamber.

In our canine patients, the most common cardiac diagnosis is chronic degenerative valve disease. With this disorder, one or more of the heart valves become thickened and leaky, allowing blood to flow back into the chamber it just came from, instead of all moving forward with each contraction. This disease is fairly common in all middle age to older small breed dogs, and can be seen in larger breeds as well. Chronic degenerative valve disease is a progressive disorder, but just like in cats with HCM, there is a big variation in how quickly it may progress in an individual patient, and some can live for many years without developing symptoms. For those dogs with severe valve leakage, they can develop fluid buildup in the lungs, around the lungs, or in the belly, which is called congestive heart failure.

My dog/cat has a heart murmur. What does this mean?
A heart murmur is a “swooshing” sound heard while listening to the heart, instead of a crisp “lub-dub” sound. This typically indicates some turbulence to blood flow in the heart. It can be caused by a leaking valve, by an area of narrowing within the heart causing disturbance to blood flow, or by other abnormalities such as a defect or “hole” in a heart wall from birth. As in people, some pets can have a soft “innocent” murmur, where no significant heart disease is present. Murmurs are graded on a scale of 1 to 6 depending on how loud they are and how many places over the heart they are audible (with 6 being the loudest and most widespread). To determine the cause of a heart murmur, an echocardiogram, which is an ultrasound of the heart, is recommended.

Color doppler shows us blood flow in the heart

What tests are commonly performed in the diagnosis of cardiac disease in veterinary patients?
An echocardiogram (ultrasound of the heart) is one of the most common tests we perform. For this test, we lay the pet on its side on a specially constructed table, and an ultrasound probe is used to visualize the cardiac chambers. A small area of hair may need to be shaved, and ultrasound gel is used to make contact between the probe and the body wall. The echocardiogram does not hurt, and for most patients we can complete this test in about 15-20 minutes without sedation. For very anxious pets (or those who resist laying relatively still to the point of getting stressed), we may give a sedative (the patient does not lose consciousness, but is sleepy).

An ECG tracing in a canine patient

An ECG tracing in a canine patient

An electrocardiogram(also called ECG or EKG), is a recording of the electrical activity of the heart. This is performed using leads in contact with the patient’s skin, resulting in a tracing that shows various typical deflections. An ECG is used to diagnose arrhythmias or irregular heart rhythms (such as heart beats that come too early or late). This test typically takes a few minutes. Sometimes we will place a heart monitor (holter) that records the ECG for 24 hours at home, to more thoroughly assess severity and frequency of arrhythmia.

An example of a chest xray in dog, showing an enlarged heart, and clear lungs.

An example of a chest xray in dog, showing an enlarged heart and clear lungs.

Chest xrays are also very useful in the workup of cardiac disorders. Chest xrays give us an overview of the heart size, although they won’t tell us about the detailed inner workings of the heart like an echocardiogram. But unlike an echocardiogram, chest xrays show us what the lungs look like, and are used to determine whether a patient has developed fluid buildup in the lungs from heart disease.

Finally, we can measure blood pressure in our patients much like is done in people, using smaller cuffs and specialized equipment.

What services can the Cardiology service provide at Angell West in Waltham?
We can provide all of the services listed above! As clients, you are able to remain with your pet during the physical exam and testing such as echocardiogram and ECG. (For chest xrays, we take the patient to a separate radiology section in the back, where clients are not allowed for safety reasons). We also are able to provide 24 hour care via our emergency service for patients who require hospitalization for heart disease, such as with supplemental oxygen and IV medications.

For more information about Angell’s Cardiology Service, please call 617-541-5038 or email cardiology@angell.org.

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