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Patients with cardiac murmurs identified during the pre-anesthetic examination often prompt heightened concern because of the potential for underlying cardiovascular disease. While cardiovascular disease is common in the dogs and cats we care for, anesthesia requires the cardiovascular system to do something it may no longer do well: compensate. Many of the sedatives and anesthetics we use can alter heart rate, contractility, preload, or afterload. The art of anesthetizing the cardiac patient lies in minimizing these impacts and tailoring our plans to fit the patient’s unique requirements.