In this Issue:

  • Louisville, KY - Get to Know our CVCA Louisville Doctor, Team Leader and Support Staff 
  • Article: The Vertebral Heart Scale by Gina Pasieka, DVM, Diplomate, ACVIM (Cardiology)
  • NEW 2018 - Client Handout Materials 
  • Subscribe to our Quarterly Newsletter
  • Upcoming Kentucky Events 
  • Payment Options and Flexibility
  • Follow us on Social Media


Get to Know our CVCA Louisville Doctor, Team Leader and Support Staff 


CVCA Cardiac Care for Pets, along with Dr. Sarah Bell, opened our Louisville, KY location inside of  BluePearl Veterinary Hospital in December 2017.

When our company started in 1987, we wanted to build the best business model to support our clients, patients and referring veterinarians.  Today, all of CVCA’s locations are located inside different 24 hour emergency and referral practices, allowing our clients easy access to emergency and specialty care. We enjoy collaborating with all of the different groups that we share a hospital with to provide comprehensive care for our clients.

Our team is committed to providing the best client service, experience and the highest level of patient care for each and every patient. We hope you enjoy getting to know a little more about  our CVCA Louisville staff!


CVCA Louisville 



CVCA Louisville Staff 

From left to right:
Mary, Alissa, Dr. Bell and Jennifer

Sarah Clay Bell, DVM, MS, 
Diplomate, ACVIM

Sarah E. Bell, DVM, MS, Diplomate, ACVIM (Cardiology) 

Board-certified veterinary cardiologist

Dr. Sarah Bell has family roots in the Lexington area.  She graduated from the University of Georgia College of Veterinary Medicine and completed a rotating internship at North Carolina State University the following year.  She then decided to head North to Pittsburgh, PA to practice emergency medicine before deciding to pursue a residency in Cardiology. Dr. Bell completed her residency at the University of Missouri and achieved Diplomate status with the American College of Veterinary Internal Medicine (Cardiology). 

During her free time, Dr. Bell enjoys cooking and visiting great restaurants, reading and traveling with her husband.  She also enjoys spending time with her two dogs, two cats, and her husband.

  • Alissa, Team LeaderAlissa calls Louisville home for the past 5+ years.  She began her career in the veterinary field in 2012 working in a primary care veterinarian office as a veterinary assistant and in a few years worked her way up to a practice manager within the field.
  • Jennifer, Veterinary AssistantJennifer is a Louisville native. She has over 13+ years of experience in the veterinary field. Outside of work, she enjoys dancing, crafts, spending time with her three dogs and her family.  
  • Mary Ann, Veterinary Assistant, Mary Ann was born and raised in Louisville.  She has been working in the veterinary field for 5+ years.  When she isn’t at work, you will find her spending time with her dog, two cats, and snake.  In her spare time, she enjoys drawing, going to the lake and spending time with her family. If you come into the office and see our a drawing on our Welcome Board, chances are Mary is the artist behind the drawing!  

We look forward to getting to know you and your clients. Please let us know if you have any questions.

CVCA Louisville



The Vertebral Heart Scale



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

CVCA Leesburg, VA location 


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 the last page of the newsletter for the Works Cited Sections on “The Vertebral Heart Scale” 


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

  CVCA-HeartDisease-.jpg  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



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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.