This Puppy Has a Murmur: What Shall I Do Next?

Auscultation of a patient should be carried out following (or as part of) a full physical examination. Auscultation is best performed with the animal standing as important cardiac areas may be “hidden” otherwise by the elbows. Prior to cardiac auscultation thoracic auscultation of the respiratory system and “palpation” (lying your hands over the heart area) should be performed. Respiratory auscultation prior to cardiac auscultation will help to avoid diagnosing respiratory sounds as cardiac sounds. Palpation of the chest/heart is of paramount importance as will help determining where the apex beat is (and hence where the mitral and tricuspid valve area are) and whether there is a thrill. In general there are four major initial questions to answer when a patient is auscultated: 1. Is there an arrhythmia such as ectopic beats or atrial fibrillation? 2. Are there abnormal heart sounds such as gallop sounds? 3. Is there a murmur? 4. What is the heart rate? [...]