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Sunday, June 19, 2016

Can Pets With Heart Murmurs Have Dental Cleanings?

Whenever I diagnose a pet with a heart murmur there is inevitably a moment of panic from the client.  The phrase "heart murmur" brings to mind serious disease and the potential for cardiac failure.  But truthfully it doesn't have to be really frightening, and in many cases doesn't need any kind of treatment.  Yes, they can even have anesthesia for dental cleanings!

What is a heart murmur?  There are valves between the chambers of the heart that keep the blood flowing in one direction.  If the valves don't close properly some of the flood can flow backwards.  In severe cases this can cause stretching of the heart chambers, abnormal wear on the walls of the vessels, fluid accumulation, and eventually heart failure.

Thankfully most murmurs in dogs are mild and don't cause serious problems.  Yes, the blood may not be flowing absolutely normally and there is indeed a problem with the heart, but functionally everything is fine.  Most of my patients with heart murmurs don't have to be on any kind of medication.

Anesthesia is only dangerous in these cases if there are physical changes to the structure of the heart.  An ultrasound (echocardiogram) is the best way to tell details of heart changes as the sonographer can see the abnormal valve and measure the size of the chambers and thickness of their walls.  But most vets still don't have ultrasound machines, and it can cost several hundred dollars to have it done at a specialist.

One of the best ways to assess the heart is a simple x-ray of the chest.  This is something any vet can do in their office.  Even veterinary cardiology specialist say that while doing both radiographs and ultrasound is the best choice, if a client can only do one they should chose the x-rays.  If the heart and lungs are normal on the x-rays there aren't significant enough changes to make anesthesia highly risky.

If the dog has significant periodontal disease the risks of this disorder outweigh an "innocent" murmur that isn't affecting the heart's function.  Many pet owners don't realize it, but dental infection can be a serious health concern, leading to problems with bone infection, liver disease, kidney disease, heart disease, and even an increased risk of diabetes.  Heavy dental calculus, gingivitis, gum recession, and loose teeth are never normal and should never be taken casually.

All of that being said, there are precautions that you should take when anesthetizing a dog with a heart murmur.  In my practice we use different anesthetic drugs in these patients than we would in an otherwise healthy pet.  We also use ECG, blood pressure, and blood oxygen monitoring in every anesthesia case so that we can keep track of any concerns in heart function before it becomes critical or life-threatening.

If your vet says "She has a heart murmur so she can't have anesthesia", and they haven't done any testing, honestly I would get a second opinion.  I have many patients who have had murmurs for years and still get an annual dental cleaning under anesthesia, never having any problems whatsoever.  We certainly want to be cautious in these cases and do more of a work-up than in a healthy pet, but a murmur doesn't automatically mean that anesthesia is unsafe.