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This work was supported in part by JSPS KAKENHI Grant Number 23770036 and 26460118 (to Naoko Yoshimoto), and Grant Number 22108008 (to Kazuki Saito) of Japan

The ACVIM states: "Thoracic radiography [chest x-ray] is recommended in all patients to assess the hemodynamic significance of the murmur and also to obtain baseline thoracic radiographs at a time when the patient is asymptomatic for CVHD [chronic valvular heart disease]." The ACVIM does not recommend that cavaliers with new murmurs be ultrasounded unless the auscultation and the x-ray do not adequately satisfy the cardiologist about the true cause of the murmur

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6% in patients enrolled in a community weight management program