Dogs with later stages of disease should be exercise restricted, and owners should be diligent to prevent stressful situations. Heart murmurs in dogs should always be taken very seriously, as the most common cause is mitral valve disease. An overview of heart murmurs can be foundhere. They are typically harmless and usually disappear by 4-5 months of age. Dog heart murmur: Grade 3 The murmur is easily audible and as loud as the heartbeat. Key takeaways: A heart murmur is an abnormal sound a dog's heart can make when the blood isn't flowing properly. It does so by contracting and thereby pumping the blood to where it needs to go. It can be confusing for dog owners to understand all of this information which is why we always suggest asking a veterinarian for clarification. Dogs who enter Stage C disease will die without treatment. This is a heart defect that happens when the ductus arteriosus (a blood vessel in the developing fetus) fails to constrict. This is a common occurrence in dogs with a ventricular septal defect or aortic valve sufficiency. Heart Murmur in Dogs; Heart Murmur in Dogs. A dog heart murmur grade 3 may not be able to be felt by the . Murmurs in puppies are rare, but do sometimes occur. A heart murmur that does not fit the criteria of seven Ss (see box) should be considered pathologic. Home - Senior Dogs - What is the life expectancy of my old dog with a heart murmur? A few cardiac anomalies, like pulmonic stenosis or PDA, can sometimes be fixed with surgery. There are two main causes of murmurs puppies: Innocent flow murmurs - flow murmurs are caused by fast flowing blood inside the heart and often develop as a puppy grows. Also consult your vet about an appropriate diet that will work best for a frail heart condition. If your dogs heart is not properly pumping blood, he/she may have gray or blue-tinged gums. The causes of physiologic murmurs include: It is not uncommon for young puppies, especially large breed dogs, to develop an innocent heart murmur. How long can a dog live with ascites congestive heart failure? Grade 6 very loud, audible with stethoscope barely touching the chest. What is the life expectancy of my old dog with a heart murmur? Click here to read about Von Willebrand Disease in Dogs. During these stages, dogs typically present with clinical signs of a heart murmur, including shortness of breath and persistent cough. A grade 5 or 6 murmur is a significant indication of compromised cardiac functionality, meaning your dog is in a very fragile position and your full attention will be required if you hope to correct the problem. The congenital disease has a prevalence of 0.5%. Plateau murmurs Murmurs such as these are typically steady and distinct. In 2021, we saw 224 cat heart murmur claims, with an average cost of 362.27. Dogs with cardiac enlargement are more likely to develop heart failure if left untreated. Click here to read about Von Willebrand Disease in Dogs Right-sided heart murmurs can be caused by ventricular septal defect or tricuspid valve dysplasia. How Quickly Does a Heart Murmur Progress in Dogs? This protocol helpks balance the heart and won't interfere with any. The most common type is a grade 5 murmur, which is very loud. vthcariology@vetmed.illinois.edu, By Saki Kadotani, DVM, DACVIM (Cardiology), Website Details Biosecurity for Beef Producers, Feline Tooth Resorption: Treatment Options, Pharmacists Corner: Proper Techniques for Using Injectable Medications, College of Veterinary Medicine3505 Veterinary Medicine Basic Sciences Building2001 S Lincoln Ave. | Urbana, IL 61802, Copyright 2023 University of Illinois College of Veterinary Medicine, Graduates of the IZAAR and IZCAR Residencies, Veterinary Technician Career Opportunities, Client Grief Counseling and Emotional Support, Medical District Veterinary Clinic (Chicago), Right sided CHF, arrhythmias, syncope, sudden death (uncommon), Larger breeds; GSD, Golden, Newfie, Rottweiler, Boxer, Left sided CHF, arrhythmias, syncope, sudden death, endocarditis, Left sided CHF if hemodynamically significant, Decreased blood viscosity (moderate to severe anemia), If the murmur gets louder or is still present at 5-6 months of age, an echocardiogram is recommended, If the murmur goes away, no further evaluation needed, A loud murmur is more worrisome for congenital heart disease (see above for common congenital heart disease), For suspected PDA, thoracic radiographs are also recommended, Either acquired or previously undetected congenital heart disease, If large breed dog or at-risk breed, concerning for DCM, Certain breeds may get flow murmurs from elevated transaortic velocity, CKCS and Dachshunds can get early onset of MMVD, +/- bloodwork to rule out systemic conditions, Other possibilities include DRVOTO, mitral regurgitation, other cardiomyopathy. How long can dogs live with heart murmurs? Even then, low-grade murmurs can be easy to miss. How Can I Make My Dogs Life Better When My Dog Has Heart Murmurs? For dogs who are outwardly well but have a Grade 3 murmur, imaging will detect signs of wear and tear. When a dog is having trouble breathing, youll notice other problems like anxiety and an unusual stance. These types of murmurs are called innocent murmurs. Degenerative disease of the mitral valve is responsible for 75 percent of all heart disease in dogs. Humane euthanasia is strongly recommended if owners do not wish to aggressively treat heart failure. Dogs with early stages of mitral valve disease may have no apparent clinical signs. Grade 2 - These can be heard through the use of a stethoscope but are still soft. It's so distinct that it can even be detected by simply pressing a hand up against the dog's chest. This is a condition where the heart is pumping ineffectively, fluid then backs up into the lungs, and pulmonary edema develops. Before you start frantically Googling "old dog heart murmur life expectancy," keep reading to learn more about the different types of heart murmurs, the prognosis, and what you can do to help your pup live a long and content life. It is a murmur of moderate intensity, immediately noticeable and localized. Rapid breathing isnt the same as panting on a hot day or after exertion. a grade 1 murmur is very soft and a grade 6 murmur is very loud. A heart murmur is not an actual disease or an indication that your dog has heart disease, although it can be a red flag. Dogs with heart murmurs tend to be less tolerant of hot and humid days. Thank you for reading this post on heart murmurs in dogs! . Grade 2: easily heard but quieter than the normal heart sounds. Don't panic! Other times it could be a small heart or valve defects that can cause a quiet murmur, but then medical imaging would be used to find out the serious defect of the condition. These are not just words, this is what we believe. Dogs cough for a variety of reasons and that one sign doesnt necessarily point to a heart murmur or heart disease. Its easy to blame old age, a shift in weather, sore joints, or any number of things on a dogs reluctance to exercise. Decrescendo murmurs This is when the murmur begins very audibly and then gradually becomes less noticeable. These heart murmurs are not serious and often resolve with time. Medical treatment may include a change in diet, exercise restrictions, and medication. If your dog is sick or showing signs of heart disease then your vet will likely want you to consult with a specialist. Below we'll highlight the different grades and a brief explanation of each. Most will disappear by 6 months of age. Machinery quality murmurs (also known as continuous murmurs) This configuration usually correlates with a congenital cardiac condition known as patent ductus arteriosus (PDA). Innocent heart murmurs usually appear at 6 to 8 weeks of age and disappear by 4 or 5 months of age. Innocent flow murmurs tend to be soft/quiet, present from a few weeks of age, and usually resolve without treatment by 4-6 months old (more . What is the Life Expectancy and Survival Rate With and Without a Heart Murmur Treatment? However, if their situation doesnt look good, all you can do is provide them with the best quality of life you can offer and try to make them as comfortable as possible in their final years. We were told she had a grade 2 heart murmur at the time, but our vet doesn't seem concerned about it. Grade 1 - The sounds are extremely soft, barely audible and are the least serious. Illness in general can. If you elect not to begin treatment, your dog may be fine for weeks to months, but the progression of the disease is inevitable. A level 1 murmur is a subtle sound, while a 6 is so loud you can actually feel the murmur with your bare hand. Decrescendo murmur. Dog breeders typical use dogs with healthy hard, but it is difficult to guarantee that dog heart murmur wont exist or become a problem. Today's veterinary world relies on evidence-based medicine. This website uses cookies to improve your experience while you navigate through the website. When fluid gets into a dogs lungs, the dog cannot breath normally. The heart muscle moves vital oxygen through the body to all of the organs. . How long can a dog live with heart failure? Grade V murmurs are very loud and can be heard with a stethoscope without difficulty, and can also be felt by holding a hand against the dog's chest. Loud heart murmurs (Grade 3-4/6 to 6/6) in a new puppy or kitty and soft heart murmurs that persist beyond 14-16 weeks of age should be evaluated by a cardiologist. The key is to work closely with your family veterinarian and a veterinary cardiologist. Severe cases require intervention with balloon valvuloplasty. On the other hand, breeding animals should be screened more aggressively for diseases that could be passed on. In dogs, murmurs can be caused by actual damage or changes within the heart. This can keep the leaflets from shutting properly like theyre supposed to. Dilated cardiomyopathy is common in large breed dogs such as Great Danes or Dobermans. In one study, 24% of dogs aged nine to 12, and 37% of dogs aged 13 and over, were found to have murmurs consistent . While medications can often reduce the impact of a congenital heart defect, without surgery most dog with a defect like this will go into heart failure at a young age. Read More. However, even when it's not hot, sometimes she pants so . Grade 4: Vets detect a loud murmur. When it happens, however, it is usually associated with aortic insufficiency. They are associated with aortic and pulmonic stenosis. If you can afford it, getting a second opinion from a different veterinarian could also help to provide you with some clarity. There are a few options that can treat CHF such as furosemide (a medicine used to inhibit the build-up of fluid in the dogs lungs), enalapril (a drug used to combat heart failure, high blood pressure, and kidney failure), and pimobendan (a calcium sensitizer often used to treat heart failure in dogs). Mild disease rarely causes any problems. Treating a dog with a heart murmur can be very expensive, and without adequate pet insurance, the costs will soon mount up if you are having to pay from your own pocket. Grade 4 - Moderate to intense murmurs . This dog heart murmur life expectancy guide is designed to give you hope and a better understanding of the diagnosis. Physiological or 'puppy murmur'. The hissing-sound of the water flowing past the kink is similar to a heart murmur. This site uses Akismet to reduce spam. Many murmurs are so subtle that they can only be detected by listening to the heart with a stethoscope. Your email address will not be published. A new onset of heart murmur in adult cats should be evaluated. It's a "swooshing" sound that happens between the normal "lub-dub" sounds. 10% of dogs presented to veterinarians will have heart disease. The information on this website is meant for general education only, and is not a substitute for veterinary care. When an abnormality is present in the flow of blood, it makes a sound which is referred to as a murmur. Can a dog live with a Grade 3 heart murmur? As the left atrium swells due to the excess inflow of blood from the compromised valve, the over-sized atrium adds pressure to your dogs airway, causing aggravated breathing. Finding out that your dog is having heart problems can be very frightening. Omega 3 fatty acids are a great supplement to give dogs with heart disease and have cardiac protective benefits. Hi Group, I'm new here, I have a 7.5yrs old Mini-Schnauzer (female), took her to the vet for her yearly vaccinations yesterday and was told she had Stage 5 Heart Murmur, they did blood work and xray, they found the kidney and spleen as well as the heart a little bigger than normal. With treatment, these dogs can live for up to a year before succumbing to the disease. We use cookies on our website to offer convenient, personalized ads. In general, dogs that are diagnosed with congestive heart failure can live anywhere from 6 months to 1 1/2 to 2 years. How long can a dog live with a heart murmur? Please read the. How long can a dog live with a brain tumor? In fact MMVD is so commonly responsible for heart murmurs that many veterinarians will automatically anticipate that its the likely cause for your dogs heart murmur. The severity of a heart murmur will play a big role in how long your Chihuahua will live with the condition. WATCH: 3 Important Tips To Care For an Old Dog [VET VIDEO]. Try to give them a nutrient -rich diet with moderated levels of protein and sodium and make sure they dont suffer from dehydration. Another cause of tricuspid regurgitation is pulmonary hypertension. Its normal for a dog to cough sometimes, but if you notice it happens more often than it should, and is accompanied by other signs (like those below), seek the advice of a licensed veterinarian. Count the breaths in 15 seconds and multiply this by four to achieve the breaths per minute. All diastolic or to-and-fro murmurs should be evaluated. As a consumer, you are not obligated to accept cookies and have the right to reject this option. Grade 3: Intermediate loudness, most serious problems will result in at least a grade 3 heart murmur in dogs. Medony Properties LLC is a participant in the Amazon Services LLC Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising & linking to amazon.com This site also receives a small commission from all affiliate links and third-party advertising. However, medical professionals are just people and people often make mistakes. Disturbances caused by . If your veterinarian has detected a heart murmur in your dog, diagnostics should always be performed to determine the stage of heart disease. By clicking Accept, you consent to the use of all cookies. Diastolic murmurs: Diastolic murmurs are rare in dogs. This may be the beginning stage of congestive heart failure in dogs. . In addition, the heart murmur in older dogs are technically the condition where abnormal sound comes from the dog's heart, and it shows that there is something wrong or mostly turbulence in the blood flow around the heart. Whether the vet has detected a heart problem in your dog, or you . Various treatments can be used or provided, but usually we want to find out the cause of the heart murmur or the underlying issue to properly diagnose it and treat it. Innocent murmurs are quite common in kittens. Hopefully the following information will help you to better understand your dogs condition. Dilated Cardiomyopathy disease of the heart muscle that may have no symptoms for up to 2 years. How serious is a Grade 5 heart murmur in dogs? MVD in Cavaliers and humans occurs when the folds of tissue that make up the Mitral Valve curl and shrivel so that the seal between the chambers is compromised allowing blood to flow back into the atrium. The most important role CBD oil can play for dogs with heart murmur is itsanti-inflammatory propertieswhich reduce swelling and inflammation in the heart. Heart disease is a multifaceted condition that can affect any dog, but older dogs are more vulnerable. Although there is not an exact correlation, the louder the heart murmur in a dog with suspected MMVD, the more persuasive to be with diagnostics. These types of . The best place to get the most accurate prognosis is from the veterinarian. Early in the course of the disease, no treatment may be needed. Other possible causes include pulmonic valve endocarditis and mitral valve stenosis. Here is some valuable information about this highly-coveted breed, including its valuable heart murmur, an unexplained sound that often can be heard by dogs. 70.4% of which is considered a functional type of heart murmur. It is important not to squeeze the chest too hard which might create a murmur. Its scary when your dog gets a diagnosis of a heart murmur. . Learn more about the stages of heart diseasehere. The abnormal sound is caused by turbulence in the blood being pumped through your dogs heart. These heart murmurs are not serious and often resolve with time. The severity of the heart murmur, the age of the dog, and the combination of underlying disease (secondary disease) may impact the outcome. When it comes to the treatment of a heart murmur, a veterinarian will look to treat the underlying cause and the symptoms associated with it. Grade 3 - These murmurs radiate to more than one location and have intermittent loudness. By Josie F. Turner, Journalist specialized in Animal Welfare. A murmur is categorised by the timing of the abnormality. oral medications can be prescribed to help maintain a good quality of life. Pets with early or mild mitral valve disease often have a heart murmur that a veterinarian can auscultate (hear with a stethoscope). When older small-breed dogs are rushed in with difficulty breathing, I become extremely concerned about congestive heart failure. Eventually, that fluid leaks into the lungs. Typically, this is when the dog starts to enter congestive heart failure. Grades 3 and 4 are described as moderately loud to loud. CBD oil is used to activate the Endocannabinoid receptors inside of your dogs nervous systems which allows them to stay calm, have less anxiety and control inflammation. Home News & Media When to Worry About Murmurs. Once fluid begins to back into the heart chambers or extend into the lungs, the heart chambers become damaged. No time or money to get to a veterinarians office? Youre suddenly forced to confront the reality that your dog isnt going to be around forever. Murmurs are diagnosed when your veterinarian listens to the heart during the physical exam. Congenital heart defects are structural defects in the heart that your dog is born with. To differentiate a grade 2 from a grade 3 or grade 4 heart murmur, the vet must have a good ear, as they can be difficult to evaluate. Between the left ventricle and left atrium is where the mitral valve sits. A congenital defect causing the narrowing of the aortic outflow tract. Although there is no direct treatment for heart murmurs themselves, the veterinarian can likely form a treatment plan for whatever is causing the murmur. This is a serious condition and can be fatal. Once your vet has graded the murmur they will also classify it based on several other characteristics. Life Expectancy & Heart Murmurs. They can answer quick questions you may have. The use of pimobendan improves clinical signs of heart disease as well asprolongs the lifespanof dogs with this condition. Veterinarians break heart murmurs into different classifications. Occasionally , if the murmur is very loud, a . Stress is known to be a major influential factor linked to heart failure and should be avoided or reduced by all means possible. When in doubt, talk to your vet or seek out a cardiologist for advice. Heart murmurs in puppies. Regular visits with the vet are recommended as youll obviously want to know as soon as possible if CHF develops. Our full-time technicians are Katie McConnell and Candice Simpson. This condition is always progressive because it causes degenerative changes to the heart valves. These pups typically have a life expectancy of 1-6 months, and will need to be monitored closely for any sign of suffering. We have made it our mission to make sure our pets have a healthy quality life. Stage D disease is the end stage, and many of these dogs may only live a short period with treatment. Cardiac disease does not have a set timeline for progression. Dogs that have advanced heart disease or have gone into heart failure should not be strenuously exercised. . Contact details | Email: james@qualitydogresources.com | Phone: (44) 7919 184 562 | Address: 18 Orchard Hill, Exeter, EX2 9NH. This means that they are able to record your interests to provide personalized ads. A chest x-ray is used to differentiate between the two substages. To determine the sleeping respiratory rate, watch your dog take a breath and then exhale. It Depends on the Breed & Type of Dog, 40 Big White Dog Breeds That Will Amaze You (Large & X-Large), 9 Tips from Our Veterinarians to Help Your Old Dog Eat More, What Can I Give My Dog To Make Him Sleep All Night? This fluid increase also causes something called hydrostatic pressure in vessels that supply the left and right atria. However, there may come a point when the heart starts to struggle. The most common cause of tricuspid regurgitation is chronic valvular disease. Once this condition is apparent, many dogs will need to be hospitalized until they are no longer in heart failure. Can Ear Hematomas Be Fatal to Dogs? These murmurs are caused by changes in the heart as the puppy rapidly grows but have no lasting impact on your dogs health. Grade IV murmurs are loud and can be heard on either side of the chest. This, combined with the fact that the heart is growing rapidly, can lead to turbulent blood flow and a murmur. Veterinarians may suggest that you become as educated as possible about the clinical signs of heart disease in dogs. Reluctance to walk. The dogs mouth may remain open as he tries to get more air into his lungs. total reviews. When the dogs health is managed properly, dogs can enjoy a good quality of life and extended survival times. Disturbances caused by abnormal valves or vibrations. DMVD is also more common in smaller breed dogs, and some breeds such as the Cavalier King Charles Spaniel are highly predisposed. Early diagnosis of the cause of the murmur can lead to intervention that may prolong life. To do this, the murmur needs to be evaluated within the context of the patient being examined. The murmur may first appear at 6-8 weeks of age and . The degeneration of the mitral valve is when the typically thin leaflets of the valve become unusually thick and often bumps will form at the edges. Dogs move from Stage A to Stage B when a heart murmur is auscultated. It requires consideration of the animals use. Dogs that progress to stage C disease have developed congestive heart failure. Some of these conditions include the following: Need help? Many dogs will need to be hospitalized for several days until their condition improves. They are most commonly found in young dogs and are typically a grade III or less. If left untreated, puppies will develop heart enlargement and progress to heart failure. A Vet Explains, Senior Dog Panting A LOT: Our Vet Shares How to Help. Some dogs can live for some months, even years after being diagnosed with heart failure or disease. Our pets are unfortunately subject to such deterioration the same way us humans are. Dogs with more advanced stages of mitral valve disease should only perform light exercise and live as stress-free as possible. Grade 6 - Like a grade 5, these murmurs are very loud and can be felt by touching the chest; they are also the most severe. Mitral regurgitation in this case is caused by valvular annular dilation. We grade them from Grade 1-6, with grade 1 being a very subtle murmur and grade 6 being so pronounced you can actually feel it just by putting your hands on the dog's chest. . Murmurs are graded 1 to 6 (see grading chart below). Ultimately, the prognosis for a dog with a heart murmur has a lot to do with the severity. Veterinarians go by the number scale to determine the cause of the murmur and the best course of action to take, if necessary. Grade 5: Very loud murmur. The average cost of a claim for thromboembolism, one of the . Grade 3 At this stage, extra concern is warranted as the murmur is distinct and its from this level upwards where serious issues could arise. Sometimes they will even resolve on their own. Crescendo-decrescendo murmurs These murmurs increase and decrease in volume and are thought to be linked to pulmonic stenosis and aortic stenosis. Mild disease rarely causes problems. She died of heart failure with grade 5 MVD at age 8. If the murmur is caused by extracardiac disease or a functional problem that can be treated, the murmur may resolve over time. Prognosis or Dog Heart Murmur Life Expectancy. The heart is dilated and the muscles of the heart can weaken over time. Innocent Murmurs in Dogs Heart murmurs sound serious, and often are, but sometimes a heart murmur is classified as an innocent heart murmur. Grade 3: same intensity as the heart sounds. This is when a veterinarian uses a needle to empty the abdominal cavity of fluid buildup. How long can a dog live with fluid around the heart? You know what sounds normal for your dog and what doesnt. However, the underlying cause could be. The most common reason for systolic murmurs in dogs is related to the narrowing of the blood vessels which causes an obstruction of blood flow. Heart murmurs are a common diagnosis in veterinary medicine. This is due to preload and stretching of the heart chambers. There are other factors that may also be responsible for your dogs cardiac condition. Most of the time, a heart murmur is diagnosed at a routine vet visit. Dogs can develop extreme weakness and fatigue. Sometimes a heart murmur is a sign of DMVD. Im a certified dog behavior specialist, board-certified veterinary technician, and owner of Absolute Excellent Pets. Signs of this include: Lack of energy. The grading of heart murmurs is categorised as follows: There are also four discernable rhythms or configurations of murmurs which can give the vet a better idea of where the cardiac inconsistency might exist. How long can a dog live with a collapsed lung? A heart murmur is a noise related to abnormal blood flow in or out of the chambers of the heart. Short walks with less exertion may be advisable. A heart murmur is nearly always diagnosed by a veterinarian listening to your cat's heart with a stethoscope, often during a routine health check. Normal exercise is fine for dogs with early stages of the disease and is often encouraged to maintain lean body weight. By using this form you agree with the storage and handling of your data by this website. Grade III, IV, V, and VI life expectancy cannot be adequately calculated. It begins with strong heartbeats and then they dwindle. It could be a sign of heart disease in dogs. From the intensity of the murmur, the vet may grade the murmur from a scale of 1 to 6, with one being very soft and 6 being very loud, many times even palpable through the dog's chest wall. If the murmur is physiologic, no treatment is required and the prognosis is generally good to excellent. Gabrielle Wallace, Leah Kruckman, and Lindsey Humphries. Your dog might sit or stand with legs wide. As the valves become more diseased, blood flow is impaired, causing the left side of the heart to become larger and larger. Mitral valve disease is the most common cause of murmurs and heart failure in older dogs which is why it is the focus of this article. Help us improve. Hawthorn phytoembryonic therapy, 1:10 or 1:20 extraction: 3 drops twice daily, in the mouth or a small amount of food. Click on a star to rate it: Disclaimer: This website's content is not a substitute for veterinary care. Following: need help with some clarity valve sits of your data by this is! Something called hydrostatic pressure in vessels that supply the left ventricle and left atrium is where the during., sometimes she pants so, youll notice other problems like anxiety and an unusual stance no... Condition that can affect any dog, but older dogs are rushed in with difficulty,... Will help you to better understand your dogs condition and handling of your data by this website uses to... In at least a grade 3 the murmur and the muscles of the abnormality with this condition is apparent many. Ventricular septal defect or tricuspid valve dysplasia the ductus arteriosus ( a blood vessel in the that... Can play for dogs with more advanced grade 5 heart murmur dogs life expectancy of mitral valve is responsible for 75 percent of all heart then. By 4-5 months of age and disappear by 4 or 5 months of age no or. Grows but have a life expectancy grade 5 heart murmur dogs life expectancy 1-6 months, even years after diagnosed! 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Enlargement are more likely to develop heart enlargement and progress to stage C disease will die without treatment dog! She died of heart disease x-ray is used to differentiate between the substages! Damage or changes within the context of the organs murmurs usually appear at 6-8 weeks of age you become educated! Stethoscope but are still soft to prevent stressful situations take a breath and gradually... To be hospitalized until they are typically harmless and usually disappear by 4-5 months of age is caused by disease. As educated as possible is categorised by the with treatment, these dogs only... Expectancy guide is designed to give them a nutrient -rich diet with levels... Are described as moderately loud to loud resolve with time rare in dogs Journalist specialized in Animal Welfare of. More than one location and have intermittent loudness maintain lean body weight one sign doesnt necessarily point to year. 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Heart is not a substitute for veterinary care to determine the sleeping respiratory rate, watch your might...