Heart murmur not found on PPE

[ATXmom]

Hi there, looking for input. We just imported a 5 year old horse from Europe who passed his PPE with no issues, he had been in work there and also since he arrived in the US, also with no issues.

He ended up at the local emergency clinic last night with colic but the vet didn’t hear anything unusual (granted she was not looking for a heart murmur). We decided to send him to the large regional emergency because of the late hour and the admitting vet there also did not hear a murmur.

Admitting vet administered a lot of IV fluids to obviously keep him hydrated and also to help the impaction pass. Anyway, when he examined him this morning, he heard a murmur. He was going off shift and the attending/head of ER care took over, heard the murmur, ordered an echo and diagnosed a loud mitral regurgitation murmur. The horse wouldn’t stand still & they didn’t want to sedate due to the colic, so she was unable to grade it.

Has anyone had any experience with anything similar? Other than this episode, a very healthy, happy horse.

Thank you!

[Ghazzu]

Murmurs can be transient/episodic.

[ATXmom]

Thank you. The younger vet (admitting Dr) thought it might have been due to the amount of fluids, but the attending dismissed that. Attending said it must have been missed it last night during his exam. And that it was so loud it was hard to believe it hadn’t been picked up on the PPE

[ATXmom]

If it’s episodic - how long does it generally take to resolve? Obviously, we’ll have him checked by our vet when he returns to the barn

Thank you!

[2tempe]

I would have them do more evaluation before release if not already planned. Heart ultrasound will tell you whether or not there are defects or enlargements anywhere. There can be murmurs without defects as mentioned above, but in any event you need to know.

[Hightale]

I experienced a very similar situation!
Purchased a very lovely filly from Spain, passed full and very thorough vetting with zero issues.
Travelled over to UK fine, settled in well, happy and healthy
Four months in vet over for vaccinations and picks up heart murmur.
Thorough investigation with specialist from vet hospital in Newmarket - confirmed it was there but not of concern. Would have to dig the report out for full info as it was ten years ago.
It has never given her any bother whatsoever.

[GoodTimes]

I’m a cardiac sonographer (for humans). If they actually visualized mitral regurgitation on the echo than it probably isn’t transient. The grade could go up or down a little based on blood volume. Without knowing the mechanism behind the MR and an accurate grading it’s difficult to make any sort of diagnosis or prognosis.
It’s also very possible that it wasn’t there during the PPE, or it was trivial and has progressed. Again that’s pure speculation without knowing why there is regurgitant flow.

I’m very, very skeptical of “murmurs” diagnosed via auscultation. Some doctors and vets are good at it, but many are not. We get referrals almost daily for “heart murmurs”, many have perfectly normal hearts, and based on the structure and the patient’s health it’s unlikely that the doctor heard something transient. They’re often misinterpreting normal heart sounds.
Or they did hear a murmur, but the grade is way off, or they claim it was systolic but it’s actually diastolic.

[2tempe]

Had a horse (TB) years ago, showing upper level dressage, diagnosed at 17 with A-fib and a murmur. No symptoms, accidental finding because he had some minor colic symptoms. Work up showed mild heart damage, told to watch for symptoms like off feed, exercise intolerance, lethargy. Horse was backed down from that work level at about 21 due to age only, sound, happy and still being ridden at 24, when cervical arthritis caught up with him. At that time had the heart checked again, level of damage had increased. He was a happy pasture puff for more than a year after, when the heart finally showed syptoms : dropping weight, lethargic, as if he had mentally checked out. Then suddenly major ventral edema.

[PREs_Rock]

In people with fluid overload one can sometimes hear an S3 sound (gallop rhythm). It is purely a function of the fluid volume and often transient. Also often mislabeled as a murmur. Since the OPs horse had large volumes of fluid administered for the colic, that was the first thing that jumped into this old CCU nurse’s mind.

[beowulf]

I once brought a cat in for routine vaccinations and attending vet said I hear a murmur, it’s bad and you need to bring her to a cardiologist right now.

It was COVID, and the referred cardiologist was booked out a year in advance. Earliest slot was August of the following year, fine, booked it. In the meantime, the cat had a few unexpected vet visits not related to the murmur. Both times, vet said they heard murmur on vitals.

Finally the August appointment comes. Cat is sedated, examined, heart is ultrasounded to the gills. No murmur, no pathology explaining the murmur, no inflammation, everything looks good for a 10 y/o cat.

Best answer I got from the cardiologist is that the stress of traveling to the clinic might be causing the murmur and at rest, it might not be evident.

Maybe the stress of colic is making the murmur episodic, or it could be related to the fluid volume, since it sounds like this guy had IVs administered for colic. That’s a good point I didn’t think of.

[Ghazzu]

@beowulf

Maybe the stress of colic is making the murmur episodic.

Transient murmurs are not infrequently seen in colic cases.
Had one in my old stallion years ago. If he had been a client horse, I’d probably not have been too concenred, but since he was mine, I booked a cardiac consult and spent the following week before the visit expecting him to drop dead.
Cardiologist said he was surprised I even picked up the murmur, since it was maybe a II/VI, did I want to go ahead w/ the echo?
Well, we’re already here.
It was pronounced the most boring echo he had done in weeks. (yay)

If the echocardiogram did show significant mitral regurgitation though, I’d not expect a transient murmur.

[ATXmom]

The vet on since yesterday is not the best communicator, so it’s hard to fully know what’s going on. The murmur is still present this morning, not sure when they pulled the fluids but he was still on them as of 3 pm yesterday. But he gets to come home today, so that’s good news

[ATXmom]

Wanted to update this as we had the mobile cardiologist out for the follow up this morning. Horse has a very soft murmur and very mild regurgitation that are pretty normal findings. Cardio indicated that this would have not likely been picked up as it is currently without the colic episode. The colic, combined with the 2x normal volume of IV fluids, and some operator error on the echo (likely because of the patients’ naughtiness), caused the quite alarming initial Dx. In any case, he will be fine and is able to go back to work with no limitations.

We are very relieved! If anyone else goes through this, try to stay calm and not panic because hopefully, when the patient is not acute, the dx will be in a more normal range.