Case Studies In Small Animal

Cardiovascular Medicine

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"Your Veterinary Educational Advisor"

Richard B. Ford, DVM, MS

This month’s WebMed review centers on companion animal Cardiology and represents what must be considered among the top on-line educational resources available to practicing veterinarians today. As we have discovered, finding WebSites that address canine and/or feline cardiovascular disease is not difficult. In fact, what makes any review of this type difficult is the inordinately large number of sites produced by the various search engines.  Depending on the Search Engine used, from as few as 1 to as many as 513 WebSites were identifiedmost of which were simply not suited to practicing veterinarians.  An advanced search yielded a workable number of sites that ultimately included Dr. Kittleson’s  “Clinical Cases in Small Animal Cardiology”.  Definitely worth bookmarking, this WebSite should be “required” reading for any veterinarian in small animal practice. 

Topic Searched:     Veterinary Cardiology


Title:                       Case Studies in Small Animal Cardiovascular Medicine

WebSite Author:     Mark Kittleson, DVM, PhD

                               Professor of Cardiology

                               School of Veterinary Medicine

                               University of California-Davis

Last Update:           February 12, 2001

User Fee:                None

                    (Four stars out of four)



After a thorough review of “Cases Studies in Small Animal Cardiovascular Medicine” it is apparent that this WebSite offers one of the best on-line sources of continuing medical education for companion animal practitioners that we’ve reviewed….hence, the 4-STAR rating.  Through a series of case-based studies, the author utilizes a clinical rounds format to lead the clinician through diverse and clinically challenging cases designed to illustrate both common and complex clinical cardiovascular disorders.  Cases presented were actual dogs and cats presented to the University of California Veterinary Teaching Hospital.  Of particular importance, the WebSite content, which we’ve tracked for several months now, is the subject of regular updates.  The most recent enhancement being the introduction of video clips, or streams, into this latest update.       

Of particular importance to the clinician, this WebSite utilizes a consistent format making access to individual cases simple and intuitive. More importantly, the case-based approach used throughout this WebSite means that a ‘visitor’ can rapidly access the site, study as few as one case or study all cases, and exit.  This means it’s possible for someone with a very busy schedule to spend relatively little time in front of the computer yet receive a significant ‘dose’ of excellent and applicable information. 

Home Page:  

The ‘Home Page’ is simple and straightforward.  In addition to a brief author profile, there is opportunity to review and/or purchase the text Small Animal Cardiovascular Medicine, edited by Kittleson and Kienle (1998).  Beyond that, the Home Page leads to the Case Reports.


The Case Reports section of the WebSite comprises the remainder of the content.  In all, 27 cases were available for selection at the time of this review. Each case is presented separately using a 1 or 2-word history (e.g.,  Syncope) or a clinical problem (e.g., Heart Failure).  It is not possible to determine whether the patient is feline or canine until the topic problem is selected, although that might serve as a suggestion for a future update.  The opening page for Case Reports includes an outstanding list of topics, such as:  pleural fluid, cyanosis, hemoptysis, bradycardia, tachycardia, collapse, and even “blind”. Select the case…and the fun begins…humbling as it might be.

Case Presentation Format: The approach selected by the author for this ‘on-line’  presentation works exceptionally well.  Using the elements of History, Signalment, and a Physical Exam (information that’s provided) to introduce the case, the “Rounds” format that follows was found to be straightforward and logical…and that’s helpful when time is limited. Additionally, a Working Problem List is provided for each case.  If you elect to make your own List of Problems and compare with those of the author, just avoid scrolling the screen through the PROBLEMS portion of the introduction.

Submenus:  The consistent use of submenus (an example is shown below) allows the clinician to make decisions on which additional diagnostic tests/studies would be useful in reaching a clinical diagnosis. We found this to be especially educational.  If you don’t routinely have access to M-Mode echocardiography, for example, here’s an opportunity to attempt making a diagnosis without selecting that particular study.  THEN…select it later to determine what you might be missing in the practice without having or without using that technology.

Quizzes:  A true test of your knowledge base in cardiology is the frequent use of a short (2 to 4 multiple-choice questions) self-assessment quiz within selected submenu items.  Immediate feedback is provided (beware…your test is graded!).   If you answer correctly, you are congratulated.  If you answer incorrectly, the correct answer is provided.  What has not been provided is an explanation of each selection…whether correct or incorrect.  From an educational standpoint, that would be helpful. 

Imaging:  Radiographs, along with still views of 2D and M-mode echocardiography, are used throughout the case studies.  “Video Streams” have recently been incorporated into 4 cases and offer a significant advantage over still views.   The images provide a level of dynamics to the diagnostic studies…especially the 2D echocardiography…that is difficult to achieve otherwise. Speed and software available on individual computers will determine both quality of the image and access.  The “Video Streams” are extremely short…when possible, the video should be placed in the “repeat” mode in order to study (easier said than done).

Audio: The use of audio tracks, although available for selected cases, seems underutilized. It is possible to listen to the heart murmur on some cases but not on others, despite the fact that the primary problem is ‘heart murmur’.  Like the video streams, the audio tracks are very short and require frequent ‘clicking’ on the PLAY button (awkward) or use of a REPEAT mode…if you can access it. Expanding the use of audio tracks, for example to include cough or respiratory sounds, would add significantly to educational WebSites such as this, but there are acknowledged technical difficulties reproducing, as well as playing, high quality sounds on a computer.

Somewhat bothersome was the continuous normal heartbeat added as background noise audible throughout all of the case presentations. While attempting to pass one of the quizzes, you may be asked to determine the type of murmur while, at the same time, having to listen to what is a normal heartbeat. Admittedly, it’s easy enough to simply turn the speaker volume down or off.  But we learned (the hard way) to turn the volume back up while trying to access the abnormal heartbeat recording of the patient.  A minor issue, but we suggest the background normal heartbeat be limited to the excellent beating heart graphic on the Home Page. 

Diagnosis: The ultimate test of your humility as well as your ability to diagnose and treat the patient comes by clicking on the “Diagnosis” icon.   Whether you’ve correctly identified the problem or not, there is an excellent opportunity to learn by taking advantage of what this section has to offer.  After reviewing background information on the patient and evaluating results of additional studies you’ve selected, the “Diagnosis” section offers an opportunity to answer a question or two.  In some cases, multiple ‘guess’ is not an option…you’ll have to actually type in your diagnosis then submit it.  This is an excellent feature that really does put your knowledge to the test. 

That done, a ‘click’  of the mouse reveals the correct answer.  But there’s more.  Another icon is likely to appear offering additional “Discussion” or, in some cases, “Follow-up” information on the case.  Clicking on the icon brings up several paragraphs of text relating to the diagnosis at hand.  This is a much more in-depth discussion of the diagnosis and, importantly, the treatment decisions pertaining to the diagnosis.  For some cases, yet another icon, entitled “Text”, offers an opportunity to review out-takes from the text Small Animal Cardiovascular Medicine (Kittleson and Kienle) mentioned on the Home Page. 

Although we discovered that the sections labeled “Discussion” and “Text” did make it possible to obtain a considerable amount of additional information, including explanations for answers to the quizzes, reading paragraphs of text on-line is neither easy nor is it especially enjoyable.  The text provided is current and certainly in accordance with the highest standards practiced in companion animal cardiology today.   However, it is laborious to read several lines of text from a computer screen.  This section might benefit from an altered style, such as the use of an outline or bullet statements, to bring the same information to the reader in as compressed a format as practical.

Time Commitment:  Truly one of the exceptional features of this WebSite is the ability to spend hours working your way through a series of real-life feline and canine cardiology cases or, simply,  to delve into one case at time.  For most of us, the one-at-a-time approach will work best.  A single case, depending on your own experience in cardiology and the complexity of the case, is estimated to take as little as 15 minutes to as long as 45 minutes to complete.  Yet the value of the information contained in each of these 27 modules of cardiovascular medicine is outstanding and well worth the time. 


©Mark D. Kittleson, D.V.M., Ph.D. All rights reserved.