In this Issue:

  • The CEO Corner - Industry Changes and Impact to CVCA
  • SAVE the DATE! - October 14, 2018 - Cardiology & Neurology Symposium 
  • Article: The Vertebral Heart Scale by Gina Pasieka, DVM, Diplomate, ACVIM (Cardiology)
  • Montgomery County - Get to Know CVCA Doctors, Team Leaders and Support Staff 
  • NEW 2018 - Client Handout Materials 
  • CVCA Featured Locations
  • Payment Options and Flexibility
  • Follow us on Social Media

The CEO Corner


The veterinary industry is continually evolving. There have been multiple ownership changes in the emergency and referral practices in which we are located.  This may raise questions on how those changes impact CVCA services inside of hospitals.

CVCA remains locally owned and operated and we continue to hold to our core values of compassion, excellence, and integrity. Our ability to be located within different referral practices allows our clients easy access to emergency and specialty care.  We enjoy being able to collaborate with all of the different groups that we share a hospital with in order to provide comprehensive care. 

The CVCA team is always seeking feedback on how we can improve our service to you and your patients as we are constantly striving to improve. Please visit our primary care veterinarian survey here or reach out to us anytime with questions or concerns. 

We are so grateful for your continued support! 

Katie Newbold, CVCA CEO

Save the Date! The Cardiology & Neurology Symposium 

Date: Sunday, October 14th, 2018

Lecture Tracks: Veterinarians, Technicians and Practice Managers
Where:  Fairview Park Marriott in Falls Church, VA
Registration opens: June 2018

CVCA Cardiac Care for Pets and Bush Veterinary Neurological Services (BVNS) are joining forces again for the second Cardiology & Neurology Symposium, a day of CE for doctors, technicians and practice managers. 

Sponsors, updates, lectures titles and more are continually updated on the Symposium website at



The Vertebral Heart Scale



By: Gina Pasieka, DVM, Diplomate, ACVIM (Cardiology)


The Vertebral Heart Scale (VHS) system was developed as a means of evaluating radiographic cardiac silhouette size by indexing heart size to body size using thoracic vertebrae as units of measure. Originally described by Dr. Buchanan, et al in 1991 for the use in dogs, it has since been substantiated in cats, ferrets and other exotic species. It is a quick diagnostic measurement that can be easily added to your daily practice.

How Can We Use VHS?

-VHS can be a useful tool when combined with history and physical exam findings to increase suspicion for the presence of heart disease or to monitor for progression over time. We know that Cavaliers with a VHS >12, with a sudden increased VHS rate of change, were diagnosed with CHF within a 9 month period.

-A VHS >9.3 was found to be highly specific for the presence of CHF in cats with dyspnea. The same study also determined that dyspneic cats with a VHS <8.0 were unlikely to be in heart failure.

-Both the PROTECT (treatment of preclinical DCM) and EPIC (treatment of preclinical MR disease) studies utilized an increased VHS as part of the criteria in determining the appropriate time to start Pimobendan.

Calculating Vertebral Heart Scale

  1. Preferentially use a right lateral thoracic radiograph with T4-T12 vertebra clearly visible
  2. Take the long axis measurement measuring from the carina of the mainstem bronchus to the apex of the cardiac silhouette
  3. Take the short axis measurement at the widest part of the cardiac silhouette perpendicular to the long axis measurement.  For serial radiographic VHS comparison, it is often prudent to select an anatomic landmark for repeatability.  The approximate ventral aspect of the caudal vena cava is often chosen as this specific landmark.
  4. Transfer both the long and short axis measurements separately starting at the cranial edge of T4 and count the number of vertebrae that fall within the caliper points
  5. Add the two measurements: VHS = W + L


Quick Reference


Extent of Cardiomegaly


















Known Breed Normals

While the initial study determined normal VHS in dogs to be 8.5-10.7, other studies have shown some breed variations.  You will note that some breed normals lie well outside the originally documented “normal” VHS.






American Pit Bull Terrier

10.9 +/- 0.4

Lahm et al 2011


10.5 +/- 0.4

Kraetschmer et al 2008

Belgian Malinois

9.58 +/- 0.53

Almeida et al 2015

Boston Terrier

11.7 +/- 1.4

Jepsen-Grant et al 2013


11.6 +/- 0.8

Lamb et al 2002


12.7 +/- 1.7

Jepsen-Grant et al 2013

Cavalier King Charles

10.6 +/- 0.5

Lamb et al 2001


9.7 +/- 0.5

Jepsen-Grant et al 2013


10.0 +/- 0.6

Lamb et al 2002

German Shepherd

9.7 +/- 0.8

Lamb et al 2001


10.39 +/- 0.05

Jepsen-Grant et al 2013

Lhasa Apso

9.6 +/- 0.8

Jepsen-Grant et al 2013


10.5 +/- 0.9

Jepsen-Grant et al 2013


10.12 +/- 0.51

Fonsecapinto et al 2004


10.7 +/- 0.9

Jepsen-Grant et al 2013


9.8 +/- 0.1

Marin et al 2007

Shih tzu

9.5 +/- 0.6

Jepsen-Grant et al 2013


10.8 +/- 0.6

Bavegems et al 2005


9.9 +/- 0.6

Jepsen-Grant et al 2013


Other Factors Affecting VHS  

  • Some studies have shown a very mild increase in VHS when measuring from the right vs. left lateral radiographs. Consider using the same projection when doing serial monitoring.
  • Hemivertebrae could alter the measurement resulting in Bulldogs having higher VHS.
  • There is an association between higher VHS and increased body condition scores
  • Pericardial effusion in dogs was associated with VHS > 12, but it should also be associated with an increase in sphericity.
  • Chronic moderate to severe anemia in both dogs and cats results in compensatory volume overload with an associated increase in VHS.
  • Studies have shown normal VHS in puppies over 3 months of age while kittens maintain a higher VHS until 9 months of age.


****See last page for Works Cited Sections for “The Vertebral Heart Scale” 


Montgomery County - Get to Know CVCA Doctors, Team Leaders and Support Staff 


Getting to Know CVCA - Montgomery County Locations


Since 2005, CVCA Cardiac Care for Pets has been a staple in Montgomery County.  CVCA is located:

  • inside of Veterinary Referral Associates in Gaithersburg, MD 
  • inside of BluePearl Veterinary Partners (currently known as Hope Advanced Veterinary Center) in Rockville, MD.  

CVCA’s teams are committed to providing the best client service, experience and the highest level of patient care for each and every patient.  Today, we are proud to have multiple doctors in Montgomery County, with a combined experience of over 40+ years. 


CVCA Gaithersburg 


Gaithersburg Staff  Tim Cain, DVM,
 Diplomate, ACVIM 


Dr. Tim Cain is a fixture in Montgomery County.  He has a great bedside manner. And, did you know Dr. Cain is a father to triplets in college!  Managing three kids, all the same age, Dr. Cain can handle anything thrown at him.  His cardiology interests include feline cardiomyopathy and long-term follow-up of patients with chronic heart disease.

  • Kimberly, our Team Leader, used to be in the Army and likes to keep the office in order and running smoothly.  She takes great pride in her team. 
  • Deniseour veterinary assistant, has been working in the veterinary industry for more than 10+ years.  She is an avid animal lover with two guinea pigs, a Holland lop bunny and plans on adding a puppy in this Spring.
  • Sarah, our RVT, started in the veterinary industry during high school volunteering at an area general practice. As a child, she had 3 box turtles, 1 cat, and 1 rabbit.  Today, her love of animals continues with 3 cats.
  • Cheryl, one of our Vet Assistant, has been in the veterinary field for well over 8 years, enjoys volunteering at an animal shelter and spending time with her two dogs.  
  • Samanthaa Vet Assistant, is a Gaithersburg native.  She has been in the veterinary industry for 10 years.  And when she is not busy at work, she has 4 Bengals to keep her busy at home.


CVCA Rockville



RV staff Picture (1).jpg    
Rockville Staff  Kristin Jacob, DVM, 
Diplomate, ACVIM (Cardiology) 
Mike Hickey, DVM, Diplomate, ACVIM 



Dr. Kristin Jacob has been a staple in our Maryland offices since 2005.  She has a set of twin teen boys, so she is constantly busy. She has had several articles published in scientific journals and her cardiology interests include pacemaker therapy, medical therapy for congestive heart failure and feline cardiomyopathies.  

Dr. Mike Hickey is a Maryland native and joined the CVCA family in 2009.  He has two children that keep him on his toes. And, when he isn’t working on the offices, you might find him on the CVCA CE lecture circuit. He does many doctor and technician lectures.   

  • Samantha, an RVT and Team Leader,  has been working in the veterinary field for 20+ years.  She is a huge animal lover with 2 cats, 3 dogs, and has a community fish tank.  And she fosters dogs as well. Samantha is the founder and current Vice President of the Maryland Veterinary Technician group.
  • Jennifer has been in the veterinary field since 2003 and has 2 dogs, 24 chickens, and a miniature donkey.  She enjoys hiking with her dogs, cooking and reading books. She is a survivor of Hodgkin’s Lymphoma and an active fundraiser for the Leukemia & Lymphoma Society.
  • Caitlin is a native of Rockville, MD.  She’s been in the veterinary industry since 2006.  She has 3 dogs and a cat.  She enjoys hiking and traveling with her husband.
  • Lisa, an LVT, has been working in the veterinary industry for 20 years before joining CVCA.  

We look forward to continuing to work with you and your clients. Let us know if you have any questions!

CVCA Gaithersburg

CVCA Rockville


NEW 2018 Client Materials
Available at No Cost. Order online at:

  Final - CVCA-HeartDisease-.jpg  Final -- CVCA-Paladin Handout - January 2018.jpg
An educational handout for primary care veterinarians to use when referring clients to CVCA.  This handout discusses heart disease symptoms, diagnosis, consultation and payment costs and options.  11 x 17 Clinic Poster Paladin's Survival Story



 CVCA Featured Locations  


Rockville, MD 
CVCA in BluePearl Veterinary Partners
1 Taft Court
Rockville, MD 20850
Phone: 301-984-5791 
Fax: 301-770-7461   




Annapolis, MD

CVCA in Chesapeake Veterinary Referral Center 

808 Bestgate Road
Annapolis, MD 21401
Phone: 410-224-0039
Fax: 410-224-3735   



Gaithersburg, MD         

CVCA in Veterinary Referral Associates
500 Perry Parkway
Gaithersburg, MD 20877
Phone: 240-361-3820 
Fax: 240-361-3821 













Frederick, MD

CVCA in CARE Veterinary Center 

1080 West Patrick Street  
Frederick, MD 21703
Phone: 240-457-4387  
Fax: 240-457-4487  


We Offer Payment Options and Flexibility                                    

Questions, email us at

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Works Cited Sections for “The Vertebral Heart Scale

  1. Summerfield NJ, Boswood A, O’Grady MR, et al. Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in Doberman pinschers with preclinical dilated cardiomyopathy (the PROTECT Study). JVIM. 2012;26(6):1337-1349.
  2. Lord P, Hansson K, Kvart C, et al. Rate of change of heart size before congestive heart failure in dogs with mitral regurgitation. J Small Anim Pract. 2010;51(4):210-218.
  3. Lord PF, Hansson K, Carnabuci C, Kvart C, Häggström J. Radiographic heart size and its rate of increase as tests for onset of congestive heart failure in Cavalier King Charles spaniels with mitral valve regurgitation. JVIM. 2011;25(6):1312-1319.
  4. Guglielmini C, Diana A, Pietra M, Di Tommaso M, Cipone M. Use of the vertebral heart score in coughing dogs with chronic degenerative mitral valve disease. J Vet Med Sci. 2009;71(1):9-13.
  5. Sleeper MM, Roland R, Drobatz KJ. Use of the vertebral heart scale for differentiation of cardiac and noncardiac causes of respiratory distress in cats: 67 cases (2002-2003). JAVMA. 2013;242(3):366-371. 
  6. Buchanan JW, Bücheler J. Vertebral scale system to measure canine heart size in radiographs. JAVMA. 1995;206(2):194-199.
  7. Jepsen-Grant K, Pollard RE, Johnson LR. Vertebral heart scores in eight dog breeds. Vet Radiol Ultrasound. 2013;54(1):3-8.
  8. Lamb CR, Wikeley H, Boswood A, Pfeiffer DU. Use of breed-specific ranges for the vertebral heart scale as an aid to the radiographic diagnosis of cardiac disease in dogs. Vet Rec. 2001;148(23):707-711.
  9. Bavegems V, Van Caelenberg A, Duchateau L, Sys SU, Van Bree H, De Rick A. Vertebral heart size ranges specific for whippets. Vet Radiol Ultrasound. 2005;46(5):400-403. 
  10. Litster AL, Buchanan JW. Vertebral scale system to measure heart size in radiographs of cats. JAVMA. 2000;216(2):210-214.
  11. Hansson K, Häggström J, Kvart C, Lord P. Interobserver variability of vertebral heart size measurements in dogs with normal and enlarged hearts. Vet Radiol Ultrasound. 2005;46(2):122-130.
  12. Guglielmini C, Diana A, Santarelli G, et al. Accuracy of radiographic vertebral heart score and sphericity index in the detection of pericardial effusion in dogs. JAVMA. 2012;241(8):1048-1055.
  13. Wilson HE, Jasani S, Wagner TB, et al. Signs of left heart volume overload in severely anaemic cats. J Feline Med Surg. 2010;12(12):904-909.
  14. Greco A, Meomartino L, Raiano V, Fatone G, Brunetti A. Effect of left versus right recumbency on the vertebral heart score in normal dogs. Vet Radiol Ultrasound. 2008;49(5):454-455.