Finnish Kennel Club's New Guidelines for Combating Cardiac Disease

An official cardiac examination sanctioned by the Finnish Kennel Club may be performed on any breed, but for certain breeds the exam or some component of it can be a requirement for breeding use (PEVISA health programme).

The cardiac examination includes

• an auscultation, i.e. listening to heart sounds
• an ultrasound exam, which includes an auscultation and an electrocardiogram test in addition to a heart ultrasound

The owner/holder of the dog must sign an approval of publicity regarding the findings of the cardiac examination before the exam is performed. Examination findings as well as the identity of the party issuing the veterinary certificate will be recorded into the Finnish Kennel Club breeding database.

Duration of validity of the cardiac examination and minimum age for testing

A veterinary certificate of the cardiac examination is valid for a period determined according to the breed-specific PEVISA programme, or for one year if the exam is not included in the breed's PEVISA programme. The cardiac examination can be performed to identify congenital heart diseases in dogs less than one year old, in which case there is no need to renew the examination later. Pulmonary and aortic stenosis are exceptions to this; an official veterinary certificate of the cardiac examination for these conditions cannot be issued before the dog is at least one year old.

An official cardiac examination certificate for acquired cardiac disease (degenerative mitral valve disease and dilated cardiomyopathy DCM) can be issued once the dog is one year old. The certificate is valid for one year. A heart auscultation does not constitute a sufficient examination for issuing a certificate regarding the occurrence of DCM.

Performing the examination and certificate issuing procedure

Separate instructions regarding the performance of a cardiac examination in practice will be issued to veterinarians. Exam findings shall be noted on the veterinary examination certificate.

Clinical examination

A clinical examination shall be performed without exception on all dogs undergoing a cardiac exam. This will focus special attention on identifying possible changes caused by heart failure.

Heart auscultation

Heart auscultations are performed to identify murmurs. Murmurs are associated with several cardiac conditions, such as degenerative valve disease and congenital heart disease. It is not, however, possible to determine which cardiac condition the case involves on the basis of a murmur. Instead, a cardiac ultrasound is usually recommended as a follow-up test. Murmurs cannot always be detected in association with dilated cardiomyopathy. A murmur can also be the result of some other illness of be benign (not associated with a cardiac condition).

Murmur findings are assessed as follows:

• The timing of the murmur: systolic, diastolic or continuous.
• Location of maximal intensity murmur: mitral region, pulmonary region, aortic region, tricuspid region or non-localised.
• The intensity of a heart murmur is classified according to the following scale:

Grade 1 – Very faint murmur with low intensity that can only be heard in a peaceful setting
Grade 2 – Localised faint murmur, which can nevertheless be heard immediately
Grade 3 – Medium-level murmur, can also be heard from a broader area, own heart sounds audible
Grade 4 – Strong murmur, which can be heard from a broad area, own heart sounds become inaudible, no palpable thrill
Grade 5 – Strong murmur with a palpable thrill. Readily audible when the stethoscope comes close to the dog's chest
Grade 6 – Strong murmur with a palpable thrill. Audible even when the stethoscope is lifted off the dog's chest

Hearth rhythm examination (resting ECG and/or long-term ECG monitoring)

Electrocardiogram (ECG) tests are performed to analyse the electrical activity of the heart and identify any arrhythmia possibly caused by irregularities in this activity. Resting ECG (for 5 minutes) must always be performed when a clinical examination or auscultation identifies irregularities in the rhythm of the heart. In certain breeds, arrhythmia is associated with cardiac diseases like dilated cardiomyopathy (e.g. the Dobermann and the Boxer). Long-term ECG monitoring, i.e. the Holter monitor, is used to identify more transient types of arrhythmia that might not be revealed by a regular, short recording. This involves the recording of the heart's electrical activity for at least 24 hours using a portable ECG monitor.

Ultrasound examination

Ultrasound can be used to create images of the heart's structure, enabling analysis of its functioning. Ultrasound is used to diagnose congenital heart defects and so-called acquired heart conditions such as dilated cardiomyopathy and degenerative valve disease. An ultrasound exam can identify which specific heart disease the patient is suffering from and the seriousness of the condition underlying the detected murmur.

An ultrasound examination defines many measurements related to the size and functioning of the heart that can be compared to published normal values relative to the dog's breed and weight. The examination is always done to test for all identifiable heart conditions using two-dimensional, M-mode and Doppler ultrasound. All findings are recorded on the cardiac examination certificate.

Conclusions of the cardiac examination

The veterinarian issuing the certificate shall provide an assessment of the existence and severity of possible cardiac conditions on the basis of the examination findings.

If only an auscultation is performed on the dog, the finding of the exam (murmur) is recorded in the section reserved for auscultation tests on the examination certificate.

If a cardiac ultrasound is performed on the dog, the veterinarian issuing the certificate will also fill in the summary in the bottom part of the form. This summary evaluates, based on the examination findings, whether the dog is showing signs of cardiac disease on the day of the exam and, if so, whether the case involves the symptomatic or asymptomatic (occult, latent) phase of the condition.

Examination findings regarding each cardiac condition (MMVD = myxomatous mitral valve disease; DCM = dilated cardiomyopathy; SAS = subvalvular aortic stenosis; PS = pulmonary stenosis, Other heart disease = some other identified cardiac condition) will be noted in the conclusion section using the following abbreviations:

A – no findings point towards a cardiac disease on the day of the examination.

B – the result is inconclusive with regard to this cardiac disease: the findings on the day of the examination do not make it possible to assess without follow-up monitoring whether the dog is, with respect to the cardiac condition in question, healthy or ill.

C – findings point towards the cardiac disease in question on the day of the examination.

If a cardiac examination detects signs, which indicate that the dog has a cardiac disease, the findings and the degree of severity of the disease will remain in force unless they are invalidated through the appeals procedure. An exception to this applies to the Holter monitoring of ventricular arrhythmias, for which the most recent test result is always valid.

Appeals procedure

A dog owner may appeal against a cardiac examination certificate only if the dog has been issued certificates that differ from one another (diagnosis more serious at first, then less severe). The owner must submit a written appeal with appended copies of all earlier examination certificates issued to the dog.

Appeals are handled by the Finnish Kennel Club's cardiac working group. A ruling from the Finnish Kennel Club's cardiac working group overrules all earlier certificates.

Finnish Kennel Club authorisation to perform cardiac examinations

Auscultation

A Finnish Kennel Club -sanctioned heart auscultation may be performed by a veterinarian with a Finnish veterinary specialist degree in small animal diseases or the corresponding international graduate degree in the small animal field (Diplomate certification).

The eligibility of a holder of some other foreign graduate qualification to perform authorised auscultation exams will be assessed by the cardiac working group on application.

Other veterinarians licensed to practice in Finland are required to perform an auscultation examination on 20 dogs under the supervision of a veterinarian with Finnish Kennel Club authorisation to perform auscultations. Ten of these dogs must have a heart murmur. A certificate signed by the veterinarian who supervised these auscultations is then submitted to the Finnish Kennel Club's cardiac working group.

Ultrasound examinations

A Finnish Kennel Club -sanctioned ultrasound cardiac examination may be performed by a veterinarian licensed to practice in Finland who has passed a skills demonstration test organised by the Finnish Kennel Club's cardiac working group. An exception to this applies to veterinarians with European or American Diplomate certification in small animal cardiology who are not required to participate in the test. The eligibility of holders of some other foreign graduate qualification to perform authorised ultrasound cardiac tests will be assessed by the cardiac working group on application.

In order to be granted authorisation to perform ultrasound exams, a veterinarian must submit an application to the Finnish Kennel Club's cardiac working group. The application must be accompanied by a resume that shows the veterinarian has adequate work experience in small animal cardiology, has completed relevant post-graduate courses and details what cardiac exam equipment the applicant has access to (ultrasound machine and electrocardiogram system). A full cardiac examination of two patients (one patient must have a valve disease) performed by the veterinarian with the ultrasound machine he or she uses at work must be appended to the application. Instructions for this ultrasound examination are available from the cardiac working group. The application determines the veterinarian's eligibility to take part in the skills demonstration test organised by the cardiac working group.