Cardiology

The Cardiology Service at the Shreiber School of Veterinary Medicine

The Cardiology Department at the Shreiber School of Veterinary Medicine is dedicated to providing compassionate, thorough, and high-quality care for pets with heart disease while supporting the education of future veterinary professionals. We strive to create a welcoming and supportive environment for both pets and their families, taking the time to perform comprehensive evaluations and clearly explain diagnostic findings and treatment recommendations. Through a collaborative approach that includes board-certified cardiologists, trainees, and referring veterinarians, we are committed to delivering individualized, evidence-based care that prioritizes comfort, quality of life, and long-term heart health for every patient we have the privilege to care for.

Book Your Appointment

Call 856-256-6000 (between 8am-4pm)

Request an Appointment by Online Form

Request an Appointment by Email

If you are an existing patient with the Cardiology Service, for NON-EMERGENT matters, email: ssvmcardio@rowan.edu

Why your Pet may need a Cardiologist

Heart murmur
Arrhythmia
Gallop sound
Collapse/fainting episodes (syncope)
Congestive heart failure (CHF)
Congenital heart disease (heart defect present from birth)
Trouble breathing
Abdominal distention from fluid accumulation
Coughing
Enlarged heart
Heartworm disease
Exercise intolerance
Paralysis/inability to walk (cat)
Elevated cardiac biomarkers (NT-proBNP or cardiac troponin I)

What to Expect for your Pet's Visit

After checking in at the Specialty Desk, a veterinary technician will meet you and your pet in an exam room to obtain more information regarding the reason for the visit, history, clinical signs, medications, and any other pertinent information you feel important to share. If you are comfortable, the technician may then bring your pet to the cardiologist for a physical examination.
For new patients, the doctor will often greet you in the exam room after obtaining the history from the veterinary technician to discuss physical examination findings and recommended diagnostics and/or treatments.
For recheck appointments, a diagnostic plan is often established by the cardiologist in advance. After the technician obtains an updated history and reviews the plan with you, your pet may be escorted to the cardiologist to perform the recommended diagnostics, as you are comfortable.
All diagnostics are performed in Cardiology with Fear Free patient handling to optimize their comfort. If your pet is particularly nervous, you may be asked if light sedation could be given to make the visit as calm as possible for your pet so that they have a positive experience. Medications given are safe for the heart and are not the same as general anesthesia, meaning your pet will still be awake/alert during the appointment. If you are already aware that your pet may benefit from sedation before your visit, we kindly ask that you inquire with your primary care veterinarian about appropriate and safe medications that you can consider giving at home before the car ride. The Cardiology Department is also happy to speak with your primary care veterinarian before the appointment if they have any questions about specific medications to use.
Following completion of your pet’s diagnostics and/or treatments, we will have them wait with you either in the lobby or an exam room. Once the cardiologist has had time to fully assess the results and formulate a plan, all findings will be reviewed with you including a summary of your pet’s condition, medications (if indicated), monitoring recommendations, and a recheck plan (if necessary).
A summary of the visit will be provided to you via email (or hard copy) as well as the completed medical record forwarded to your family veterinarian.

Diagnostic Procedures

Echocardiography (ultrasound of the heart)
- 2-dimensional
- Color-flow Doppler
- Spectral Doppler
- Agitated saline contrast echocardiogram (“bubble study”)
Electrocardiography (ECG or EKG)
- 6-lead
- 12-lead
- Continuous ECG monitoring in hospital via Telemetry
Fluoroscopy
- Selective and non-selective angiography
Blood pressure
- Doppler and Oscillometric methods
Holter and Event monitoring
Digital radiography (x-rays)
Computed Tomography with angiography (CTA) and cardiac-gating
Laboratory blood, urine, and fluid analysis

Therapeutic Procedures

Centesis (fluid removal)
- Thoracocentesis (removal of fluid from around the lungs)
- Abdominocentesis (removal of fluid from the abdomen)
- Pericardiocentesis (removal from fluid from around the heart)
Balloon dilation for stenotic vascular lesions
Patent ductus arteriosus (PDA) occlusion
- ACDO, coils, and vascular plug placement
Permanent transvenous pacemaker implantation
Biphasic electrocardioversion for atrial fibrillation and incessant non-responsive ventricular tachycardia
Jugular venotomy and heartworm extraction
Phlebotomy for cardiogenic causes of polycythemia

Samantha Kochie, DVM, MS, DACVIM (Cardiology)

^{Clinical Assistant Professor, Cardiology}

FAQs and Resources

What does it mean when my pet has a heart murmur?

A heart murmur is an extra sound your veterinarian hears when listening to your pet’s heart with a stethoscope. Normally, the heart makes the typical “lub-dub” sound as blood flows smoothly through it, similar to that described in people. A heart murmur is appreciated when blood flow becomes turbulent instead of smooth, creating a “whooshing” noise.
A heart murmur can be heard during different stages of the heart cycle, with it most commonly being present during the pumping phase. However, it can also be noted when the heart muscle is relaxing, and in certain conditions, at all times. The timing of the heart murmur in combination with where it is heard the loudest on the chest can help your veterinarian make educated decisions as to what the cause of the heart murmur may be.
Heart murmurs are graded on a 0 to 6 scale, with a grade 0 being no murmur and grade 6 being the loudest and able to be heard without use of a stethoscope. The loudness of the murmur does not always correlate to the severity of the disease as it depends upon the condition present, other systemic factors related to your pet, as well as the heart’s ability to compensate.
General causes of heart murmurs
- Abnormal heart valves that are leaking (called “regurgitation”) or do not open appropriately (“stenotic”)
- Congenital heart defects (present from birth) including abnormal communications between heart chambers and/or vessels
- Narrowed areas of blood flow through a blood vessel or heart chamber
- Non-cardiac conditions including anemia, fever, and hyperthyroidism
- Not all murmurs indicate that disease is present. Some murmurs are innocent or functional, meaning that the heart itself is structurally normal
A heart murmur (indicative of turbulent blood flow within the heart) is solely a finding on physical examination but is not a diagnosis of disease. Definitive diagnosis of the cause of the heart murmur can be further investigated via performing an echocardiogram, which is an ultrasound of the heart. Chest radiographs (x-rays) may also be recommended in order to better assess the status of the lungs, as this cannot be well-evaluated on an echocardiogram.

What does it mean when my pet has an arrhythmia?

A heart rhythm refers to the pattern and timing of the heart’s beats. In a healthy heart, electrical signals travel through the heart in a coordinated and organized way, causing the heart to beat at a steady rate and regular rhythm. This coordinated beating allows the heart to pump blood efficiently to the lungs and the rest of the body. The presence of an arrhythmia indicates that the heart rhythm is abnormal. An arrhythmia occurs when the electrical signals are disrupted, causing the heart to beat too fast, too slow, or irregularly (such as heart beats happening too soon or long pauses between heart beats).
There are many different types of arrhythmias, and some can even be normal findings in certain breeds or species of animals. Some arrhythmias are mild and cause no noticeable problems, while others can interfere with the heart’s ability to pump blood effectively.
A diagnostic tool that is best to help characterize and diagnose what type of arrhythmia your pet may be having is an electrocardiogram (“ECG” or “EKG”).
Pets can also wear monitors at home to further assess their heart rhythm during longer periods of time. This can be important in many cases when the arrhythmia may occur so sporadically that the relatively short period of time at the veterinarian may not be truly representative of what is occurring throughout the entire day. This type of monitoring device is called a Holter monitor.
Arrhythmias can develop for several reasons, including:
- Primary structural heart disease
- Metabolic/electrolyte and endocrine disturbances (thyroid disease, adrenal disease, low potassium, etc.)
- Side effects of certain medications and/or toxin exposure
- Autonomic nervous system imbalance (stress, excitement, etc.)
- Systemic illnesses (non-cardiac diseases, such as splenic disease, GDV, sepsis, etc.)

What does it mean when my pet has been diagnosed with congestive heart failure?

Congestive heart failure (CHF) is a complex clinical syndrome in which the heart is unable to pump blood effectively enough to meet the body’s circulatory demands. As cardiac function declines, pressure within the heart and blood vessels increases, resulting in the accumulation of fluid in areas of the body where it is not normally present. This fluid most commonly develops within the lungs (called pulmonary edema), around the lungs (called pleural effusion), or within the abdominal cavity (called abdominal effusion or ascites), and is responsible for many of the clinical signs associated with heart failure. There are many different conditions that may lead to the development of congestive heart failure in pets, which is why additional diagnostics can facilitate in creating the most appropriate treatment strategy for your pet.
Clickable link for attachment (from Cardiac Education Group): https://cardiaceducationgroup.org/wp-content/uploads/2024/06/CEG-Brochure-CHF.pdf

General monitoring recommendations for a patient with heart disease
- General Monitoring Recommendations:
  - The most common symptoms of heart disease in both dogs and cats include difficulty breathing (respiratory distress), inability to sleep or rest comfortably, faster breathing and/or more effort than normal during rest and sleep, recurrent coughing, abdominal distention in cases of right heart disease, reduced activity or exercise capacity, and/or collapse/fainting with exertion or excitement. Other more non-specific signs may include decreased or loss of appetite as well as lethargy. Please monitor for these signs and contact us at the Shreiber School of Veterinary Medicine or your primary care veterinarian if these symptoms occur.
  - Specifically in cats, it will also be important to monitor for signs of arterial thromboembolism (ATE). The most common sign of an ATE is sudden weakness or paralysis of your cat’s hindlimbs. However, an ATE may affect a single leg or other parts of the body. The legs will often feel cool or cold to the touch. Paw pads or nail beds may look blue or purple. An ATE is typically very painful and so your cat will likely meow loudly. Cats with an ATE may breathe rapidly or with an open mouth. This may be due to heart failure or may be related to discomfort. This condition is an emergency, and your cat should see a veterinarian right away.
- Exercise Recommendations:
  - If your pet has mild-moderate heart disease, please avoid strenuous exercise or situations which place undue stress as this will increase the workload of the heart. Unfortunately, many types of heart disease have a risk of sudden death which is increased during times of excitement/exercise. Please attempt to limit strenuous exercise/periods of extreme excitement. Your pet should be able to go for short, controlled leash walks, but activities such as swimming or roughplay should be avoided. Normal amounts of activity or play are fine as we still want to balance your pet’s quality of life at home.
  - If your pet’s heart disease is severe (including but not limited to inadequate control of congestive heart failure, inadequate and/or currently unknown control of arrhythmias, and/or collapse episodes or clinical signs as noted above are present), please limit your pet’s activity in order to facilitate full control and/or resolution of his/her condition. If your primary care veterinarian and/or veterinary cardiologist is not aware that clinical signs are present in order to make therapeutic adjustments, it is important that your pet be examined by a veterinarian as soon as possible.

General monitoring recommendations for a patient with heart disease

General Monitoring Recommendations:
- The most common symptoms of heart disease in both dogs and cats include difficulty breathing (respiratory distress), inability to sleep or rest comfortably, faster breathing and/or more effort than normal during rest and sleep, recurrent coughing, abdominal distention in cases of right heart disease, reduced activity or exercise capacity, and/or collapse/fainting with exertion or excitement. Other more non-specific signs may include decreased or loss of appetite as well as lethargy. Please monitor for these signs and contact us at the Shreiber School of Veterinary Medicine or your primary care veterinarian if these symptoms occur.
- Specifically in cats, it will also be important to monitor for signs of arterial thromboembolism (ATE). The most common sign of an ATE is sudden weakness or paralysis of your cat’s hindlimbs. However, an ATE may affect a single leg or other parts of the body. The legs will often feel cool or cold to the touch. Paw pads or the nail beds may look blue or purple. An ATE is typically very painful and so your cat will likely meow loudly. Cats with an ATE may breathe rapidly or with an open mouth. This may be due to heart failure or may be related to discomfort. This condition is an emergency, and your cat should see a veterinarian right away.
Exercise Recommendations:
- If your pet has mild-moderate heart disease, please avoid strenuous exercise or situations which place undue stress as this will increase the workload of the heart. Unfortunately, many types of heart disease have a risk of sudden death which is increased during times of excitement/exercise. Please attempt to limit strenuous exercise/periods of extreme excitement. Your pet should be able to go for short, controlled leash walks, but activities such as swimming or roughplay should be avoided. Normal amounts of activity or play are fine as we still want to balance your pet’s quality of life at home.
- If your pet’s heart disease is severe (including but not limited to inadequate control of congestive heart failure, inadequate and/or currently unknown control of arrhythmias, and/or collapse episodes or clinical signs as noted above are present), please limit your pet’s activity in order to facilitate full control and/or resolution of his/her condition. If your primary care veterinarian and/or veterinary cardiologist is not aware that clinical signs are present in order to make therapeutic adjustments, it is important that your pet be examined by a veterinarian as soon as possible.
Diet Information
- A diet that is moderately restricted in salt is ideal for cardiac patients, as excessive salt load can cause fluid accumulation. If your pet has cardiac disease, please also avoid salty treats, such as hot dogs or jerky treats.
Tufts University in Massachusetts has a board-certified veterinary nutritionist on staff, Dr. Lisa Freeman, who has a high interest in cardiac disease. They have put together an impressive, comprehensive website with an abundance of information for owners on nutrition at the following: https://heartsmart.vet.tufts.edu/nutrition/
- Due to the recent findings between certain types of diet (boutique, exotic ingredient, grain-free diets, etc.) and the association with dilated cardiomyopathy (DCM) in pets, we recommend feeding a grain-inclusive diet containing standard ingredients (i.e. chicken, beef, rice, corn, wheat) from a well-known, reputable company with a long track record of producing good quality ingredients, such as Hill’s, Royal Canin, Purina, IAMS, or Eukanuba. Avoid grain-free diets, exotic ingredients, and those that list potatoes or other legumes and pulse ingredients (i.e., peas, lentils, fava bean, barley, chickpeas, seeds of legumes) high on their ingredient list. Avoid vegan, raw, or home-cooked diets. If home-cooked is pursued, we strongly recommend a consultation with a veterinary nutritionist.
  - If you would like more information on how to find a veterinary nutritionist, please see the following website: https://www.vetspecialists.com/

How to count your pet’s resting respiratory (breathing) rate

Counting your pet’s resting breathing rate at home involves counting you’re their breaths per minute (ideally during true sleep, or at least while he/she is deeply resting). Although there is variability between animals, sleeping respiratory rate should generally be fewer than 30 breaths per minute. One total cycle of inspiration and expiration equals ONE breath. To calculate your pet's breathing rate, please count the number of breaths he/she takes over a full 60 seconds. Alternatively, you may count the number of breaths taken over 30 seconds and multiply by 2 in order to obtain the number of "breaths per minute". For example, 9 breaths over 30 seconds would equal a resting breathing rate of 18 breaths per minute.
If you obtain a number > 30-35 consistently (it is best to repeat this a few times to make sure it is “real”) or if you notice an upward trend compared to the usual rate, please call a veterinarian or have your pet evaluated to determine whether a medication change might be necessary. Significantly elevated rates, efforted breathing, excessive coughing, nasal flaring, and/or breathing with the head/neck extended are considered emergencies to have evaluated immediately.
In order to assist in counting your pet's breathing rates, you can also download a free app on your smartphone called "Cardalis Health & Fitness".
Additional information from Cardiac Education Group https://cardiaceducationgroup.org/wp-content/uploads/2024/09/CEG-Monitoring-Your-Pets-Respiratory-Rate.pdf
Youtube video for Cardalis app on your smartphone: https://www.youtube.com/watch?v=cgUYZ3L_b2o

Cardiac Education Group

From the CEG: “The Cardiac Education Group (CEG) is a not-for-profit group of board-certified veterinary cardiologists from both academia and private practice that offers independent recommendations for the evaluation and treatment of canine heart disease. The group is committed to providing resources and information on the diagnosis, treatment and management of heart disease and heart failure in dogs and cats in order to promote early detection and diagnosis with greater accuracy and confidence. The CEG mission is to offer educational recommendations and resources that will help veterinarians diagnose, treat and manage heart disease and heart failure in dogs and cats, improving the lives of pets with heart disease.”
For more information and extremely useful tools and resources (both for veterinarians and pet parents), please visit the following: https://cardiaceducationgroup.org/

American Heartworm Society

From AHS: “Heartworm disease is a serious and potentially fatal disease in pets in the United States and many other parts of the world. It is caused by foot-long worms (heartworms) that live in the heart, lungs and associated blood vessels of affected pets, causing severe lung disease, heart failure and damage to other organs in the body. Mosquitos play an essential role in the heartworm life cycle. When an animal is infected with adult female worms, baby worms called microfilaria live in the bloodstream and get taken up by mosquitos when they bite. The baby worms mature into infectious larvae in the mosquitos and when that mosquito bites another dog, cat, or other animal that is susceptible, it deposits the infectious larvae. Over approximately 6 months, the larvae then develop into sexually mature adults in the new host. The earlier an infection is detected, the better the chances the pet will recover.”
For more information: https://www.heartwormsociety.org/

Client Handouts

Medications that may be Prescribed for your pet

Amlodipine

Drug Class: This is a dihydropyridine calcium channel blocker that is used as an arterial dilator to help reduce systemic blood pressure. It also may slightly depress cardiac conduction velocity and pump function.
Side Effects: Gastrointestinal side effects are uncommon but possible (decreased appetite, nausea, vomiting, diarrhea). Additional side effects include low blood pressure, heart rate changes, gingival hyperplasia, and very uncommonly peripheral edema has been reported in dogs.
Other names: Norvasc

Amiodarone

Drug Class: This is a Class III anti-arrhythmic.
Side Effects: Side effects include gastrointestinal upset such as nausea, vomiting, and anorexia, as well as arrhythmias, liver injury, lung injury, and sometimes thyroid and cell line changes. Regular monitoring of your pet’s bloodwork will be required while your pet is receiving this medication. Please do not abruptly discontinue this medication without consulting with us or your primary care veterinarian as significant adverse reactions can result if not performed correctly.
Other names: Cordarone, Pacerone, Nexterone (injectable)

Aspirin

Drug Class: This is a cyclooxygenase inhibitor that is being used for its antiplatelet effects to prevent clot formation.
Side Effects: Side effects include gastrointestinal irritation (nausea, anorexia, vomiting) as well as bleeding. This should never be administered if your pet is also receiving a steroid or another non-steroidal anti-inflammatory medication. Your pet should not be unsupervised outside while receiving this medication due to risk of bleeding if injuries occur.
Other names: ASA Acetylsalicylic Acid

Atenolol

Drug Class: This is a beta-blocker which decreases heart rate and protects the heart from the effects of the sympathetic nervous system.
Side Effects: Possible side effects include weakness, lethargy, or low blood pressure. Please do not abruptly discontinue this medication without consulting with us or your primary care veterinarian as significant adverse reactions can result if not performed correctly.
Other names: Tenormin

Benazepril

Drug Class: This is an ACE-inhibitor which helps to decrease sodium/water retention and blood pressure, to decrease the workload of the heart. It is also used as a cardioprotective medication to decrease remodeling and fibrosis of the heart. This medication will be given lifelong.
Side Effects: Possible side effects include decreased blood pressure (hypotension) and decreased blood flow through the kidneys. Blood pressure and kidney bloodwork will need to be periodically monitored while your pet is receiving this medication. Give with food.
Other names: Fortekor, Lotensin

Cephalexin

Drug Class: This medication is a first-generation cephalosporin, which is an antibiotic.
Side Effects: Most common side effects include gastrointestinal upset (vomiting, diarrhea, anorexia/decreased appetite). Uncommon side effects include lethargy, itchiness, salivation, excitability, and fever. Give with food.
Other names: Rilexine, Keflex

Clopidogrel

Drug Class: This is a platelet aggregation inhibitor being prescribed to help prevent the formation of clots.
Side Effects: Side effects include gastrointestinal upset such as decreased appetite, vomiting, diarrhea, and/or anorexia. It may also lead to bleeding. It is bitter and some pets will foam at the mouth when they taste the tablet - please let us know if you would like to be supplied with empty gelatin capsules in order to help administer the medication. Your pet should not be unsupervised outside while receiving this medication due to risk of bleeding if injuries occur.
Other names: Plavix

Digoxin

Drug Class: This is an anti-arrhythmic medication that is used to slow the rate of conduction through the AV node of the heart to decrease heart rate.
Side Effects: Side effects are typically associated with high serum levels and include arrhythmias, gastrointestinal upset, and weight loss. Serum levels of this drug (via bloodwork) will be required regularly to monitor while your pet is receiving this medication. Please do not abruptly discontinue this medication without consulting with us or your primary care veterinarian as significant adverse reactions can result if not performed correctly.
Other names: Lanoxin

Diltiazem

Drug Class: This medication is a calcium-channel blocker which acts as an anti-arrhythmic and decreases heart rate.
Side Effects: Possible side effects include weakness or lethargy. Please do not abruptly discontinue this medication without consulting with us or your primary care veterinarian as significant adverse reactions can result if not performed correctly.
Other names: Cardizem
Caution: Cardizem-CD and Dilacor XR are extended-release formulations of this medication that come in different strengths from regular diltiazem and are prescribed differently per dose and frequency. Please ensure the formulation you receive is the correct form that your pet’s cardiologist intended.

Doxycycline

Drug Class: This medication is an antibiotic that is being used (to help treat heartworm disease/for its anti-inflammatory effects to the airways/to treat any possible secondary bacterial infections to the airways).
Side Effects: Side effects include gastrointestinal upset including vomiting, diarrhea, anorexia/decreased appetite as well as esophageal irritation. Increased liver enzymes have also been reported, although not common. Always follow this medication with food and water to help prevent esophageal irritation that could lead to strictures, especially in cats.
Other names: Vibramycin, Periostat, Alodox, Vibra-Tabs, Oraxyl, Monodox, Adoxa

Elura

Drug Class: Capromorelin (Elura in cats) is a ghrelin-receptor agonist that stimulates growth hormone release and causes of the feeling of hunger. It is being prescribed as an appetite stimulant.
Side Effects: Side effects include diarrhea and increased thirst/urination as well as less commonly vomiting, hypersalivation, increased gut sounds, abdominal discomfort, and lethargy.

Enalapril

Drug Class: This is an ACE-inhibitor which helps to decrease sodium/water retention and blood pressure, to decrease the workload of the heart. It is also used as a cardioprotective medication to decrease remodeling and fibrosis of the heart. This medication will be given lifelong.
Side Effects: Possible side effects include decreased blood pressure (hypotension) and decreased blood flow through the kidneys. Blood pressure and kidney bloodwork will need to be periodically monitored while your pet is receiving this medication. Give with food.
Other names: Enacard, Vasotec

Enoxaparin

Drug Class: This is a low molecular weight heparin that can be useful for prophylaxis of thromboembolic disease/clots. This is to be administered using a specific U-100 syringe.
Side Effects: Side effects include bleeding and bruising. Your pet should not be unsupervised outside while receiving this medication due to risk of bleeding if injuries occur.
Other names: Lovenox, LMWH

Entyce

Drug Class: Capromorelin (Entyce in dogs) is a ghrelin-receptor agonist that stimulates growth hormone release and causes of the feeling of hunger. It is being prescribed as an appetite stimulant.
Side Effects: Side effects include diarrhea and increased thirst/urination as well as less commonly vomiting, hypersalivation, increased gut sounds, abdominal discomfort, and lethargy.

Famotidine

Drug Class: This is an H2-receptor antagonist used to reduce stomach acid production (antacid).
Side Effects: This is generally well-tolerated in cats and dogs but rare adverse effects can include gastrointestinal upset, headache, and dry mouth or skin. This medication typically works best if given before the first meal of the day if possible in most pets, but if not tolerated, can be given with food.
Other names: Pepcid

Fish Oil

Drug Class: This is a supplement being prescribed due to its anti-fibrotic (scarring) properties and protection of the heart muscle. Omega-3 fatty acids can help reduce inflammation and have been shown to help reduce muscle loss (cardiac cachexia) in pets with congestive heart failure.
Side Effects: At higher levels, this can cause gastrointestinal upset most commonly demonstrated as diarrhea and flatulence.

Furosemide

Drug Class: This is a diuretic medication used to decrease fluid accumulation in the lungs.
Side Effects: It will cause increased urination and thirst. Possible side effects include dehydration, electrolyte abnormalities, and kidney dysfunction. Kidney bloodwork will need to be periodically monitored while your pet is receiving this medication. Your pet must have water available at all times while receiving this medication.
Other names: Lasix, Salix, Disal

Gabapentin

Drug Class: This medication is a pain medication that can also be given for sedation.
Side Effects: Side effects include sedation and incoordination. Rarely, in cats this may lead to hypersalivation and/or vomiting.
Other names: Neurontin
Caution: Liquid formulations purchased from non-veterinary pharmacies should be used cautiously and always ensure there is no xylitol in the formulation as this is toxic in pets.

Hydralazine

Drug Class: This is a vasodilator medication being prescribed to lower blood pressure and/or to help control congestive heart failure by being an afterload reducer.
Side Effects: Side effects include low blood pressure and weakness/lethargy as well as possible fainting (related to too low of a blood pressure), reflex high heart rate, salt/water retention (if not concurrently given with a diuretic), elevation in kidney values by reducing blood flow to the kidneys, and gastrointestinal upset (decreased appetite, nausea, vomiting, diarrhea).
Other names: Apresoline

Hydrocodone

Drug Class: This medication is an opiate agonist in combination with homatropine that is being prescribed as a cough suppressant.
Side Effects: Side effects include sedation, constipation, vomiting, and other gastrointestinal upset (gastroesophageal reflux, regurgitation). This is a controlled substance and therefore legally we can not prescribe more than one month at a time.
Other names: Tussigon, Hycodan, Hydromet Syrup

Hyoscyamine

Drug Class: This is an oral anticholinergic medication being prescribed to help increase heart rate in patients with symptomatic bradycardias from sinus node dysfunction or atrioventricular block. In humans, this medication is used primarily for reducing GI tract motility and secretions.
Side Effects: Side effects include dilated pupils, dry mouth, constipation, urinary retention, and dry eye. High doses can lead to central nervous system effects (depression or excitement) or high heart rates.
Other names: Levsin

L-Arginine

Drug Class: This is an amino acid that increases nitric oxide (NO) production that helps to relax the blood vessels in the lungs and aid in pulmonary hypertension treatment. It is not a sole therapy for pulmonary hypertension management and can be considered as an adjunct in refractory cases as efficacy is variable with limited literature evidence of usage in animals.
Side Effects: This supplement is generally well-tolerated

L-Carnitine

Drug Class: This is a nutrient required for normal fat utilization and energy metabolism (including energy production in the heart muscle) that is being prescribed due to documented benefit in certain breeds with cardiomyopathies due to a deficiency.
Side Effects: This is generally well-tolerated, but vomiting or diarrhea can occur with higher doses
Caution: Use only the “L-“ or “levo” racemic form

Lomotil

Drug Class: This is an opiate agonist/anti-cholinergic medication made of diphenoxylate in a fixed-dose combination with atropine. It is a GI motility modifier (inhibits motility and intestinal secretions) with anti-coughing properties in dogs.
Side Effects: Side effects include constipation, bloating, and sedation. Although unlikely, there is the potential for ileus, megacolon, pancreatitis, and central nervous system effects. This is a controlled substance.

Maropitant Citrate

Drug Class: This is a neurokinin (NK-1) receptor antagonist antiemetic medication (drug name: maropitant) being prescribed as an anti-vomiting medication.
Side Effects: It appears to be well-tolerated in dogs and cats. Allergic reactions are possible but rare. Other side effects include depression, lethargy, anorexia, diarrhea, and incoordination. This should not be given to puppies less than 8 weeks of age due to bone marrow suppression. QT prolongation on EKG leading to arrhythmias has been documented in people, but not as readily known in animals.
Other names: Cerenia

Mexiletine

Drug Class: This is a Class IB anti-arrhythmic.
Side Effects: Side effects that are most common include gastrointestinal upset such as anorexia, decreased appetite, vomiting, and/or diarrhea as well as less commonly possible lethargy, tremors, neurologic signs, and worsening arrhythmias. Please do not abruptly discontinue this medication without consulting with us or your primary care veterinarian as significant adverse reactions can result if not performed correctly.
Other names: Mexitil

Mirtazapine

Drug Class: This is a 5-HT3 receptor antagonist tetracyclic antidepressant drug being used as an appetite stimulant. It may also have anti-vomiting properties in cats with chronic kidney disease. Formulations include oral in both cats and dogs as well as transdermal (on the ear) in cats.
Side Effects: Side effects include sedation and lethargy. In cats, vocalization and increased affection can sometimes be noted. Rarely, agitation/behavioral changes, vomiting, incoordination, hypersalivation, and increased breathing and heart rates can be seen. Skin irritation can be seen at the application site in cats using the transdermal formulation.
Other names: Mirataz (transdermal), Remeron

Omeprazole

Drug Class: This is a proton pump inhibitor (PPI)/acid reducer that may help with stomach erosions leading to gastrointestinal upset.
Side Effects: Omeprazole appears to be well-tolerated in cats and dogs. Gastrointestinal distress (anorexia, abdominal pain, nausea, vomiting, flatulence, diarrhea), protein in the urine, and central nervous system signs can potentially occur. This medication typically works best if given before the first meal of the day if possible.
Other names: Prilosec

Ondansetron

Drug Class: This is a serotonin type 3 (5-HT3) receptor antagonist being prescribed for prevention and treatment of nausea and vomiting.
Side Effects: This medication appears to be well-tolerated in cats and dogs. Gastrointestinal effects (constipation, diarrhea), sedation, head shaking, increased liver enzymes, and low blood pressure are possible. QT prolongation on EKG leading to arrhythmias has been documented in people, but not as readily known in animals.
Other names: Zofran, Zuplenz

Pimobendan

Drug Class: This is a medication which dilates blood vessels (decreasing the workload on the heart) and increases the heart’s pumping ability.
Side Effects: Possible side effects include gastrointestinal upset.
Other names: Vetmedin (name brand)

Potassium gluconate

Drug Class/Side Effects: This is a potassium supplement, which is an electrolyte, being prescribed as potassium gluconate formulation. Formulations include tablets, powder, and gel.
Side Effects: Adverse effects are uncommon but may include gastrointestinal upset and rarely too high of a level of potassium.
Other names: Tumil-K, Renakare

Prednisone/prednisolone

Drug Class: This medication is a glucocorticoid (steroid) being used for (treatment of heartworm disease/as an anti-inflammatory medication to the airways).
Side Effects: Most common side effects include increased thirst, urination, appetite, panting, and agitation as well as a dry coat, elevated liver enzymes, muscle loss with chronic use, and gastrointestinal ulcers. Always have water available for your pet. Never administer with a non-steroidal anti-inflammatory (NSAID) medication as this predisposes to gastrointestinal ulceration.

Rivaroxaban

Drug Class: This is a factor Xa inhibitor that is an oral anti-thrombotic agent to help decrease the risk of formation of blood clots.
Side Effects: Side effects include gastrointestinal upset (decreased appetite, nausea, vomiting, diarrhea) and sometimes an increase in liver enzymes has been reported in humans. Your pet may bruise or bleed more easily while taking this medication. Doses may need to be adjusted if severe liver and/or kidney disease is present.
Other names: Xarelto

Sildenafil

Drug Class: This medication is a Class III anti-arrhythmic which also decreases heart rate.
Side Effects: Possible side effects include weakness or lethargy as well as more rarely gastrointestinal effects (decreased appetite, anorexia, vomiting, diarrhea). Although it seems peculiar, all anti-arrhythmics can also be pro-arrhythmic and worsen the current arrhythmia. Please do not abruptly discontinue this medication without consulting with us or your primary care veterinarian as significant adverse reactions can result if not performed correctly.
Other names: Betapace

Spironolactone

Drug Class: This is an aldosterone antagonist and potassium-sparing weak diuretic being prescribed for its cardioprotective effects and to help keep your pet's potassium level within range.
Side Effects: Side effects are typically mild and include gastrointestinal upset, anorexia, electrolyte disturbances, and dehydration.
Other names: Aldactone
Caution: Aldactazide is a combination medication of spironolactone + hydrochlorothiazide. This is a more potent medication and NOT equivalent to spironolactone alone and should not be given unless recommended by the cardiologist.

Taurine

Drug Class: This medication is a supplemented amino acid that may be deficient in your pet’s system causing the changes we have seen on echocardiogram.
Side Effects: This supplement is typically well-tolerated and therefore side effects are rare.

Theophylline

Drug Class: This is a phosphodiesterase inhibitor bronchodilator (to open the airways by relaxing the muscles) with mild diuretic activity. It is often prescribed for chronic coughing associated with tracheitis and/or bronchitis associated with airway collapse. It is also commonly used in dogs with bradyarrhythmias (slow heart rates and rhythms).
Side Effects: Side effects include central nervous system activation such as anxiety, hyperactivity, tremors, and incoordination, as well as gastrointestinal signs (vomiting, anorexia, diarrhea), high heart rate, and increased thirst/urination.

Torsemide

Drug Class: This is a more potent diuretic medication than furosemide that is being used to decrease fluid accumulation in the lungs. It will cause increased urination and thirst.
Side Effects: Possible side effects include dehydration, electrolyte abnormalities, and kidney dysfunction. Kidney bloodwork will need to be periodically monitored while your pet is receiving this medication. Your pet must have water available at all times while receiving this medication.
Other names: Demadex, Torasemide

Trazodone

Drug Class: This medication is a serotonin antagonist being used for its sedation and anti-anxiety properties.
Side Effects: Side effects include gastrointestinal upset, incoordination, and sedation. Rarely, in dogs it can have the opposite effect and lead to increased anxiety and aggression, therefore we recommend testing the recommended dosage at home prior to continued usage.

Yunnan Baiyao

Drug Class: This is a Chinese herbal supplement blend used to stop bleeding. It is believed to possibly work by activating platelets, but this is not definitively known.
Side Effects: Side effects are uncommon but could include gastrointestinal upset (decreased appetite, nausea, vomiting, diarrhea).