Heart Sounds and Murmurs: Changes Related to Severity of Chronic Valvular Disease in the Cavalier King Charles Spaniel

Auscultatory, phonocardiographic (PCG), radiographic, and echocardiographic evidence of chronic valvular disease (CVD) were studied in 79 Cavalier King Charles Spaniels with a mean age of 7.6 years (SD 2.6). Cardiac murmurs were present in 59 of the dogs and the intensity of the systolic cardiac murmur, assessed by auscultation (grade 1–6), was correlated (P < .001) to the severity of CVD (heart failure class) and to the echocardiographical dimensions of the heart (left atrial ratio, La/Ao-d, and left ventricular end diastolic diameter, LVEDD) (both P < .001). The heart sounds and duration of electromechanical systole (Q-S2) were investigated in all dogs using measurements obtained from PCG recordings. Normal regression equations describing the relation between heart rate and systolic intervals (Q-S1, Q-S2 and S1-S2) were established based on observations in 11 normal control Cavalier King Charles Spaniels. The total electromechanical systole (Q-S2), Q-S1, and S1-S2 intervals in the 59 dogs were related to the corresponding normal regression equation. A shortening of Q-S2 and S1-S2 intervals were found in dogs belonging to heart failure class I (Q-S2; P < .01 and S1 -S2; P < .05), class II, and classes III and IV (both P < .001). The ratio of the amplitudes of the first (S1) and second heart sounds (S2) measured on the PCG recordings was found to be increased in dogs belonging to class I (P < .01), class II, and classes III and IV (both P < .001). The relationship between cardiac dimensions (LVEDD and La/Ao-d) and S1a/S2a ratio was described by quadratic regression and found to be significant for both parameters (LVEDD; P < .001, R²= .54 and La/Ao-d; P < .001, R²= .63). The presence of a third heart sound (S3) was detected, using PCG, in 21 of the 68 dogs. The proportion of dogs exhibiting S3 increased with heart failure class (and increasing cardiac dimensions) (P < .001). These findings were confirmed by observations in 13 Cavalier King Charles Spaniels with cardiac failure progressing from heart failure class I to class II (Mean LVEDD from 30.2 to 35.2 mm and mean La/Ao-d from 1.09 to 1.43). An increase in intensity of the heart murmur, assessed by auscultation, increase in the ratio of the amplitudes of S1 and S2, as well as a shortening in Q-S2 and S1-S2 intervals (all P < .01) were found in these dogs. None of these dogs showed an S3 in heart failure class I, but 7 of the 13 dogs developed an S3 in class II.