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Friend, xrays are great and often tell us all that we need to know. But, when it comes to evaluating the heart they can't tell us much as far what is the actual cause for the heart being enlarged. You see, the heart could be enlarged either from: Hypertrophy as a result of the muscle being sick or the valves not closing properly, there could also be heart base tumors, etc. So, it is very important to find out exactly why is the heart enlarged to accurately treat the patient. The echocardiogram will study up close the heart to determine the exact underlying cause. The other aspect is making certain there is nothing else going on systemically like his kidneys or liver. For this reason I would strongly recommend doing both, the blood work and echocardiogram. These test will greatly help your vet to treat your dog.
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