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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 and the heart does not appear to be significantly enlarged