Based on clinical insights from Dr. Gary Oswald’s webinar, When the Heart Cries for Help. Using NT-proBNP in Canine Cardiac Disease*
Heart disease affects millions of dogs and cats, yet most cases go undetected until patients present in crisis. Studies show that many cardiac conditions remain hidden for months or years before becoming clinically apparent, often making their first appearance as sudden death or acute heart failure. The TRUFORMA® diagnostic system revolutionizes veterinary cardiac care by bringing advanced heart disease testing directly into general practice, enabling early detection and better patient outcomes through rapid NT-proBNP cardiac biomarker analysis.
The Hidden Epidemic: Heart Disease in Veterinary Practice
Heart disease represents one of the most challenging diagnostic areas for general practitioners, with traditional methods often failing until disease reaches advanced stages.
Common Diagnostic Challenges:
- Physical examination may appear normal in early disease stages
- Heart murmurs can be absent in many cardiomyopathy cases
- Chest radiographs often show no changes until heart failure develops
- ECG abnormalities frequently absent in subclinical patients
- Patient stress during examination masks subtle signs
Clinical Reality: Many pets with significant heart disease show no obvious symptoms during routine wellness visits, leaving veterinarians without clear indicators to pursue cardiac evaluation.
The Cost of Late Detection
Patient Impact:
- First symptom often sudden death or acute heart failure
- Advanced disease requires more aggressive, expensive treatment
- Shorter lifespan and reduced quality of life
- Limited treatment options once heart failure develops
Practice Impact:
- Emergency presentations requiring immediate referral
- Client dissatisfaction when disease “appears suddenly”
- Missed opportunities for preventive care
- Higher liability risk from undiagnosed conditions
How to Diagnose Heart Disease in Dogs and Cats
Subtle Symptoms Pet Owners Report:
- Exercise intolerance or tiring more easily during walks
- Heavy breathing during normal activities
- Restlessness at night or difficulty settling
- Coughing episodes especially at night or early morning
- Decreased appetite or reluctance to eat
- Weight loss despite normal eating habits
Clinical Signs for Veterinarians:
- Soft heart murmurs that may be intermittent
- Increased respiratory effort during examination
- Pale or slow capillary refill indicating poor circulation
- Weak pulses or pulse deficits
- Behavioral changes such as hiding or decreased activity
Traditional Diagnostic Limitations
Physical Examination Challenges: While cardiac auscultation remains important, many patients with significant heart disease present with normal or only subtle examination findings, particularly cats with cardiomyopathies and dogs with early dilated cardiomyopathy.
Radiographic Limitations: Chest X-rays frequently appear normal in subclinical cardiac patients. Even when abnormalities are present, distinguishing cardiac from respiratory causes can be challenging, especially in emergency situations.
The Diagnostic Gap: General practitioners need reliable tools to identify cardiac disease before clinical signs develop, allowing for early intervention and improved patient outcomes.
Advanced Heart Disease Testing: The NT-proBNP Solution
NT-proBNP (N-terminal pro-B-type natriuretic peptide) serves as the heart’s “cry for help,” providing objective evidence of cardiac stress when traditional diagnostic methods fall short.
How Cardiac Biomarkers Work: When the heart experiences stress from increased pressure or volume, cardiac cells produce a hormone called pro-BNP. This molecule is then split into two parts:
- Active BNP: Helps the body manage cardiac stress by promoting blood vessel dilation and kidney function
- NT-proBNP: Inactive fragment that remains in the bloodstream longer and can be easily measured
Clinical Advantage: NT-proBNP levels rise significantly before clinical signs appear, enabling early detection of heart disease in apparently healthy patients.
Why NT-proBNP Testing Transforms General Practice
Immediate Clinical Applications:
- Emergency triage of patients with breathing difficulties
- Pre-anesthetic screening for high-risk patients
- Wellness screening in breeds prone to heart disease
- Treatment monitoring for patients with known cardiac conditions
Practice Benefits:
- 15-minute results for immediate clinical decision-making
- Objective data to support clinical findings
- Client confidence in advanced diagnostic capabilities
- Early intervention opportunities improving patient outcomes
Signs of Heart Failure in Pets: When to Test
Dogs Presenting with Breathing Difficulties: Emergency differentiation between heart and lung problems is critical for appropriate treatment. Traditional methods often leave uncertainty in diagnosis.
Common Emergency Presentations:
- Labored breathing with or without coughing
- Exercise intolerance or collapse during activity
- Loud heart murmurs in breeds not typically affected
- Distended abdomen potentially indicating heart failure
- Anxiety or restlessness especially at night
NT-proBNP Reference Values for Dogs:
- Below 900 pmol/L: Respiratory cause likely, heart failure unlikely
- Above 2500 pmol/L: Congestive heart failure probable
- 900-2500 pmol/L: Consider pulmonary hypertension, pursue cardiac evaluation
Cat Heart Problems: Silent Disease Detection
Feline Cardiac Disease Challenges: Cats excel at hiding cardiac disease, often showing no symptoms until presenting in acute heart failure or sudden death.
When to Suspect Feline Heart Disease:
- Any heart murmur detected during examination
- Breathing difficulties or open-mouth breathing
- Sudden onset of rear limb paralysis
- Hiding behavior or decreased activity
- Poor appetite or weight loss
NT-proBNP Reference Values for Cats:
- Below 100 pmol/L: Heart disease unlikely
- Above 300 pmol/L: Significant cardiac disease probable
- Special consideration: All cats with heart murmurs should receive NT-proBNP testing
TRUFORMA® Diagnostic System: Revolutionary Point-of-Care Testing
The TRUFORMA diagnostic system brings laboratory-quality cardiac testing directly into veterinary clinics, providing rapid, accurate results that guide immediate treatment decisions.
Key Technology Features:
- Bulk acoustic wave technology eliminates interference from hemolysis or lipemia
- 15-20 minute results for immediate clinical decision-making
- Self-contained cartridges require no reagent preparation
- Multiple test capabilities beyond cardiac biomarkers
Clinical Advantages:
- Sample flexibility: Works with both plasma and serum
- Minimal training required for operation
- Compact design fits in any clinic setting
- Proven accuracy with correlation >0.95 to reference laboratories
TRUFORMA System vs. Send-Out Testing
Breed-Specific Cardiac Screening Guidelines
High-Risk Canine Breeds
Dilated Cardiomyopathy-Prone Breeds:
- Doberman Pinschers: Special consideration with lower threshold (700 pmol/L)
- Great Danes: Standard screening protocols
- Irish Wolfhounds: Annual screening recommended
- Standard Schnauzers: Begin screening at 4-5 years
- Boxers: Monitor for both DCM and arrhythmogenic cardiomyopathy
Breed-Specific Considerations: Labrador Retrievers, Newfoundlands, Greyhounds: May have elevated NT-proBNP values (>900 pmol/L) even with normal hearts. Pursue cardiac evaluation but normal echo findings are not uncommon in these breeds.
High-Risk Feline Breeds
Hypertrophic Cardiomyopathy-Prone Breeds:
- Maine Coons: Begin screening at 2-3 years
- Ragdolls: Annual testing recommended
- Sphynx cats: High predisposition requires early screening
- British Shorthairs: Include in routine wellness protocols
- Persians: Consider screening all breeding animals
Universal Feline Screening: Given the difficulty in detecting feline heart disease through examination alone, many specialists recommend annual NT-proBNP screening for all adult cats as part of routine wellness care.
Ready to Transform Your Heart Disease Detection?
Don’t let cardiac disease hide in your patients until emergency situations develop. Implement advanced cardiac testing to provide early detection, accurate emergency triage, and comprehensive patient management throughout the disease process.
Visit zomedica.com to explore the TRUFORMA diagnostic system’s cardiac testing capabilities and discover how advanced heart disease detection can enhance your practice’s patient care standards while improving diagnostic confidence and practice profitability.
© 2025 Zomedica, Inc. All rights reserved.
*Dr. Oswald was paid by Zomedica, Inc. for his webinar presentation
