Cardiology - Diagnostics and Procedures

Dr. Schroeder is a board-certified veterinary cardiologist that joined the staff at Veterinary Specialists of South Florida (VSSF) in August of 2006, and stayed on after the transition to LeadER Animal Specialty Hospital in the summer of 2016. He received his Bachelor of Science from the University of Nebraska at Omaha in 1998. He received his Doctorate of Veterinary Medicine from the Kansas State University College of Veterinary Medicine in 2002. He completed a 1-year internship in small animal medicine and surgery here at VSSF in 2003. In 2006, he completed a 3-year cardiology residency at the California Animal Hospital in Los Angeles, California under the mentorship of the renowned Stephen Ettinger, DVM DACVIM (cardiology and small animal internal medicine), Kirstie Barrett, DVM DACVIM (cardiology) and Kelly Wessberg, DVM DACVIM (cardiology). He received Diplomate status and board certification in Cardiology from the American College of Veterinary Internal Medicine in 2006. Dr. Schroeder sees referrals for dogs and cats with cardiac (heart) and pulmonary (lung and lower airway) disease.

 

Services: The Cardiology Department at LeadER ASH offers a full-range of advanced veterinary services for dogs and cats. The following is an explanation of the common services (diagnostics – aimed at getting a diagnosis) used at our hospital by the Cardiology Department.

Thoracic radiography: Chest x-ray is a non-painful, non-invasive test that exposes a patient to a minimum amount of radiation that is available to help us diagnose heart enlargement, evidence of congestive heart failure, airway collapse, pneumonia and other pulmonary or pleural diseases. Your regular veterinarian may provide these services as well.

  

Thoracic radiographs of a dog with fluid around the heart.

Dr. Schroeder is reviewing thoracic radiographs on the computer. Digital radiography allows us to review radiographs from any computer terminal in the hospital.

High resolution monitors allow us to provide optimal diagnostic capacity.

Fluoroscopy: Fluoroscopy, or real-time x-ray, is a non-painful, non-invasive test that exposes the patient to a minor amount of radiation, and is used to help us diagnose airway collapse. It is also used for guidance during catheterization procedures such as balloon valvuloplasty, pacemaker implantation, and tracheal stent implantation.

Manometry: Blood pressure measurement via Doppler is a non-painful, non-invasive, harmless test that allows us to help diagnose hypertension, or high blood pressure, a common complication in patients suffering from heart or kidney disease. Patients diagnosed with high blood pressure require careful monitoring while on medication.

The doctors at LeadER are able to measure the blood pressure in this patient utilizing Doppler technology.

Electrocardiography: EKG or ECG is a non-painful, non-invasive, harmless test that allows us to properly diagnose arrhythmias, or abnormal heart beats, rhythms, conduction disturbances, and may be helpful in the monitoring of patients taking antiarrhythmic medications or medications that may cause arrhythmias.

Patients are gently restrained for the EKG.

EKG of a dog.

The computer allows us to visualize the electrical activity of the heart.

Holter and Event Monitoring: Holter monitoring is a non-invasive, painless test that involves the placement of leads, a 24-hour magnetic tape or digital recording device with a backpack or bandage that records the EKG of a patient suspected of having arrhythmias, or abnormal heart beats/rhythms. Holter monitoring may be recommended for patients receiving antiarrhythmic medications for known cardiac arrhythmias. Event monitoring is a non-invasive, painless test that involves the placement of leads, a digital recording device, and backpack or bandage that records the EKG of a patient suspected of having arrhythmias, or abnormal heart beats/rhythms during episodic collapse. You will be asked to record your pet’s activities in a log, and the device is sent to an outside lab for computer analysis. Typically, a full-disclosure of the EKG during the recording periods is obtained, and the results are given to you when we receive them.

 

Echocardiography: Cardiac ultrasound, or ultrasound (sonogram, “echo”) of the heart, is a non-painful, non-invasive, harmless test that uses high-frequency sound waves to image the internal anatomy of the heart. Echocardiography allows us to accurately diagnose certain heart conditions including acquired heart diseases such as mitral valve disease or cardiomyopathy, as well as congenital heart disease and cardiac neoplasia (cancer). Color flow Doppler allows us to accurately map blood flow through the various chambers of the heart. Tissue Doppler allows us to document abnormal heart muscle motion. Thoracic ultrasound may allow us to diagnose intrathoracic masses. Contrast studies using agitated saline may be used to help diagnose intracardiac shunting lesions using echocardiographic guidance. Echocardiography may be used to chart the progression of cardiac disease.

Dr. Schroeder is performing an echocardiogram with the help of his assistant, Diana.
 

Ultrasound allows us to see inside the chambers of the heart. The first image, a cat has a large clot within the heart. The second, a dog has a large amount of fluid around the heart.

Bronchoscopy: Bronchoscopy is a moderately invasive test performed under general anesthesia, and employs the use of a flexible endoscope. Bronchoscopy is used to directly visualize the trachea (windpipe) and lower airways, and may be used to help diagnose certain conditions such as airway collapse, bronchitis, foreign bodies, mass-lesions, etc. Typically, transtracheal wash or bronchoalveolar lavage is performed simultaneously. Occasionally, biopsy of the airway tissue or intralesional injections of medications may be performed simultaneously.

Bronchoscopy allows us to directly visualize the airways in this patient.

Dr. Schroeder is able to inject medication into a lesion with bronchoscopic guidance.

Cardiac Catheterization: Cardiac catheterization is an invasive test that is performed under general anesthesia, and helps us diagnose certain cardiac diseases such as pulmonic stenosis. Catheterization is used during procedures such as balloon valvuloplasty with the aid of fluoroscopy. Rarely, biopsy of the cardiac muscle itself or manual removal of heartworms may be performed simultaneously.

Procedures: The Cardiology Department of VSSF offers a full range of advanced veterinary services for dogs and cats. The following is an explanation of the common procedures (diagnostic – aimed at getting a diagnosis, and therapeutic – aimed at achieving a medical benefit) performed at our hospital by the Cardiology Department.

Bloodwork: Bloodwork is a mildly-painful, mildly-invasive, diagnostic test. Our hospital is equipped with a full in-house laboratory with the capability to run routine bloodwork including complete blood count (CBC), serum biochemistry profile (chem. panel), urinalysis (UA), occult heartworm testing, FIV/FeLV testing, etc. Mini-blood profiles (I-STATs) are used in some cases, and may be used to measure blood carbon dioxide, oxygen and pH. Serum digoxin levels, blood taurine levels, thyroid levels, etc. are typically sent to an outside laboratory. Your regular veterinarian may provide these services as well.

Thoracocentesis: This is a moderately invasive, mildly painful procedure used to retrieve diagnostic fluid samples from within the chest cavity. The samples are typically sent to an outside laboratory for a board-certified pathologist to review. Occasionally, we may need to perform a therapeutic thoracocentesis to remove a large amount of fluid (or free air) within the chest to make it easier for the lungs to fully inflate, allowing a patient to breathe more comfortably.

Abdominocentesis: This is a moderately invasive, mildly painful procedure used to retrieve diagnostic fluid samples from within the abdominal cavity. The samples are typically sent to an outside laboratory for a board-certified pathologist to review. Occasionally, we may need to perform a therapeutic abdominocentesis to remove a large amount of fluid from within the abdomen to take pressure off the diaphragm, allowing a patient to breathe more comfortably. Rarely, the placement of a temporary abdominal drain may be required in very large patients with large amounts of fluid accumulation.

Pericardiocentesis: This is a moderately invasive, mildly painful procedure used to retrieve diagnostic fluid samples from within the pericardial cavity. The samples are typically sent to an outside laboratory for a board-certified pathologist to review. Most of the time, we need to perform a therapeutic pericardiocentesis to remove a large amount of fluid from within the pericardial space to take pressure off the heart itself, allowing for better blood flow to the lungs and rest of the body.

Fine needle aspirate: FNA is a moderately invasive, mildly painful procedure used to retrieve very small, potentially diagnostic samples of cells from abnormal tissue from within the chest cavity or other areas of the body. The samples are typically sent to an outside laboratory for a board-certified pathologist to review.

Transtracheal wash (TTW)/Bronchoalveolar lavage (BAL): These are procedures that are moderately invasive and require brief sedation or general anesthesia. A transtracheal wash employs the use of a suction apparatus to obtain airway secretions, and bronchoalveolar lavage employs the same technique with the aid of a small amount of infused sterile saline. This allows us to obtain diagnostic samples to send to the laboratory for culture of infectious organisms, as well as for cytology sent to an outside laboratory for a board-certified pathologist to review.

Tracheal stent implantation: This is a moderately-invasive therapeutic procedure performed under general anesthesia with the guidance of fluoroscopy (and sometimes bronchoscopy) for the treatment of severe tracheal collapse.

Radiograph of a patient with a tracheal stent.

Balloon Valvuloplasty: This is an invasive therapeutic procedure performed under general anesthesia with the guidance of fluoroscopy, and may be used in the management of congenital pulmonic stenosis. Cardiac catheterization is performed simultaneously, and pressure gradients across the narrowed valve are measured before and after inflation of the dilating balloon.

Transvenous permanent pacemaker implantation: This is an invasive, therapeutic procedure performed under general anesthesia with the guidance of fluoroscopy, and may be used in the management of patients suffering from symptomatic bradycardia (excessively slow heart rates) secondary to atrioventricular block (AV block), sick sinus syndrome (SSS), or atrial standstill. Typically, patients implanted with a pacemaker will require periodic follow-up examinations, pacemaker reprogramming, etc.

Radiograph of a patient with a pacemaker.

Our hospital works by referral only. Ask your regular veterinarian about a referral to our hospital if your dog or cat has a major medical or surgical problem. We work with our referring veterinarians to provide the best service for our patients. Your veterinarian will be updated with all results of pertinent diagnostic testing and any therapeutic procedures provided. If your pet requires a specific advanced diagnostic or therapeutic procedure (i.e. coil embolization or Amplatzer occlusion for PDA, open-heart surgery/cardiopulmonary bypass for valvular replacement, repair or other congenital heart defect repairs, electrophysiologic (EP) study/catheter ablation, nuclear scintigraphy, etc.), we will be happy to refer you to the nearest facility that fulfills your pet’s needs.

We have very dedicated staff in the Cardiology Department. Diana is the Cardiology Nurse and Edgar is the Cardiology Assistant. If you are calling for a consultation, please contact the Front Desk to book an appointment. Dr. Schroeder currently sees appointments Mondays through Fridays. If you are calling for a refill of medication, kindly allow us 48 hours to fill it, and please ask to leave a message on Diana’s/Edgar’s voicemail. If your patient is in the hospital or you are a referring veterinarian, please ask the Front Desk to page Dr. Schroeder during normal business hours. If your pet is a patient of Dr. Schroeder’s, and you have a question or update on your pet’s condition, please ask the Front Desk to put you through to Dr. Schroeder’s voicemail. Leave your name, your pet’s name, and a number where we can reach you in the evenings, and we will return your call by the end of the business day. If you have an emergency (i.e. your pet is having difficult breathing, is collapsing, etc.), bring your pet in ON EMERGENCY immediately. Our hospital is equipped with a 24-hour staff, including emergency veterinarians, technicians, etc. We have oxygen cages for patients having difficult or labored breathing. If your pet is a patient of ours, and you need medical records sent or faxed to another hospital, please let us know. We are dedicated to providing you with the foremost care for our patients. Please let us know if we can do anything to make your experience better here at LeadER ASH. Thank-you for considering us for the care of your pet.