There are always going to be ethical questions and concerns when introducing new treatment modalities, and rightly so. As veterinarians we must always have animal welfare at the forefront of our decision making. Heart disease is a very common disease in dogs and can have a huge impact on quality of life, a subject that until recent years has been largely unresearched in veterinary patients. When considering any treatment option we must always consider its likely effect on quality of life; expected detrimental effects weighed up against potential improvements, in addition to quantity of life expected to be gained. This is particularly challenging in veterinary patients when assessment of quality of life and decision making has to be made by proxy. Maintaining a good health related quality of life (HrQOL) is just as important as survival to most humans in chronic heart failure (Lewis et al. 2001) and is also more important than quantity of life in owners of cats and dogs with cardiac disease (Oyama et al 2008, Reynolds et al. 2010). It is imperative that with any intervention, be they medical or surgical that owners are fully informed of potential risks and consequences, and presented with the most up to date and accurate information candidly.