Liz Bode
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Replying to Zenobie H. 18/09/2026 - 00:44
Hi Zenobia,
Unfortunately, this really depends on the machine that you have and the probes. If the machine is relatively new you should be able to get the company back in to your practice to adjust the pre-sets to your requirements/ personal preferences. The latter also forms some of the pre-set as some people prefer an image that is highly gained for example.
Sorry that I am not much use with this one.
Liz
Hi Fiona,
For dogs we use trazodone +/- gabapentin the night before and morning of the appointment, if we know that they are going to be anxious. However, more often than not we don’t and so they then tend to get either butorphanol IV or IM. If we have to do that then we go for doses of 0.3-0.4mg/kg, ideally IV. I will also add this to the gaba/ trazodone at the same dose if needed, prior to reaching for anything like alfaxalone. However, I’d say for the majority of dogs either gaba +/- trazodone OR butorphanol is adequate.
For cats we would give them 100mg gabapentin the night before and the day of the appointment. Then if required we would use a top up of butorphanol IV ideally, at the same doses as for the dogs. However, invariably if we have to do this then we end up using alfaxalone IV too. Rarely would we have to reach for anything more.
We always scan lying down, unless it is a POCUS. We are lucky that we have a dedicated cardiology room, which is dark and very quiet so the majority of cats we manage just fine with 2 handlers without anything more. Gaba works very well though if needed. Only those very nervous/ aggressive cats need more than this.
Hope that is helpful!
Liz
Replying to Fiona C. 27/08/2026 - 15:40
Hi Fiona,
It is a good question, but generally, even if tamponade is present, we don’t drain these. The ones that I have seen the tamponade is mild. I have seen cases that have been drained and end up with huge blood clots in their pericardial space. Obviously if the dog is in cardiogenic shock that might be different, but in that case I would give them a fluid bolus and try to improve cardiac output that way and see how they respond to that before draining them. That being said, I have also a drained pericardial effusion which I later suspected to be due to a LA tear, and the dog was fine and didn’t develop blood clots!
There’s no hard and fast rule, but generally the advice is to leave them alone, and hospitalise them for monitoring.
Liz
Replying to Emma Riley 25/06/2026 - 21:09
Hi Emma,
As a screening tool for HCM/ severe heart disease in cats it could be helpful, but I don’t think I would use it in all older cats pre-GA. I think it might be sensible to include it if you had a murmur/ arrhythmia/ gallop sound or any of the other risk factors we discussed. However, it will miss a significant proportion of cats with mild/ moderate disease and might lull you/ owners into a fale sense of security if it was used routinely.
In terms of troponin, I do measure it in all cats with HCM-phenotype on echo (if clinical for it at least), the main reason being that myocarditis is a differential for an HCM phenotype. We don’t tend to use it in pre-clinical, unless there was an arrhythmia we were investigating, for example. Mainly because myocarditis could also manifest itself that way.
Best wishes,
LizReplying to Emma Riley 23/06/2026 - 13:04
Great! I am sure if you choose Beecardia you will like it 🙂
Replying to Emma Riley 16/06/2026 - 15:44
Hi Emma,
No, no need to have paper ones we use digital in our practice (although I still prefer paper traces lol!).
Many people reeally like the Beecardia system, it works off a tablet, is very portable and circa £1500-2k so not terrible price wise. It is a cloud based system and takes a good trace. My gripe with it is that it was slow to start up and then you couldn’t review live ECG traces, you have to save them and log on to the cloud. We have the dextronix system, and whilst this allows review in real-time, it also has frustrations. It is a similar price point. If I had to choose I would probably go back to the Beecardia!!
Let me know what you choose!
Liz
Replying to Liz Bode 07/06/2026 - 19:53
Hi Emma,
Sid answered:
We didn’t do any further investigations, started amox-clav and doxy (alongside furosemide and clopidogrel), the cat passed away at home a week later.
Endocarditis cases go one way or the other in my experience, they either survive beyond expectations or die suddenly in a relatively short time frame 🙁
Liz
Replying to Emma Riley 02/06/2026 - 11:38
Hi Emma,
I will reach out to Sid and get back to you once he has responded.
Liz
Sorry this took so long to reply too, I was waiting for info from Oscar as it was beyond my expertise 🙂
Hi Julia,
Great question – it’s a really interesting point and one that’s a bit controversial taking into account how we’re usually taught to be cautious with alpha-2s in cardiac patients.
What I meant is that the effects of dexmedetomidine (and medetomidine as well) are very dose-dependent. At “normal” doses or when given as a bolus, you get the classic picture – peripheral vasoconstriction, reflex bradycardia, and a marked reduction in cardiac output. That is obviously not ideal in many cardiac cases.
However, if you use very low doses as a CRI, you could avoid that plasma peak increase and mainly get the central effects (sympatholysis) without much peripheral vasoconstriction. In practice, that means less catecholamine release, less tachycardia (and bradycardia), reduced myocardial oxygen demand, and generally smoother haemodynamics. That’s where the idea of “cardioprotection” comes from.
In terms of when to use it, I usually think about relatively stable cardiac patients (for example compensated MMVD) where tachycardia or stress responses could be contradictory. It’s not something I would use for in unstable patients. I’d usually start the CRI after induction, once things are stable, and use it as part of maintenance to help with surgical stimulation and reduce inhalant requirements.
For dosing, a typical dexmedetomidine CRI would be around 0.25–1 µg/kg/hour, starting at the lower end and titrating to effect. The aim is trying to remove its sympathetic tone if that makes sense. If dexmedetomidine is not available, medetomidine can be used doubling the dose.
So overall, it’s less about using alpha-2s as “sedatives” and more about using them as a very fine-tuned way of controlling sympathetic tone.
Hope that helps a bit – it’s definitely one of those areas where small dose titration make a big difference!
Thank you
Oscar
Replying to Julia Biernat 11/04/2026 - 09:14
Hi Julia,
No problem!
1. Can we tell from these that the Vtach is right sided? The complexes are positive in lead II which would suggest that these complexes come from the right ventricle.
2: I calculated the HR at 180 is that correct? counted 10 large squares as 1s. I don’t tend to count the squares on an ECG like this, my eyes always make me get different answers from a screen (I am old fashioned an need a printed copy). If you look along the very top of the ECG you will see some markers and numbers after them. These markers correspond to the QRS complexes and are in milliseconds. You can work out an instantaneous rate by dividing 60,000 by the number e.g. 60,000/ 230 = 260bpm.
3: Can we tell from these that it’s Mobitz type II and that’s more advanced disfunction than type I or does it not really matter? This looks like Mobitz Type I – the PQ interval appears to prolong slightly before the blocked P wave and then the PQ after the blocked P wave is shorter again, characteristic of Mobitz type I which tends to be more physiological. Type II tends to be more pathological (although not always pacemaker territory).Hope that helps.
Liz
Replying to scott@vtx-cpd.com 30/03/2026 - 00:31
Our anaesthetists would use dexmedetomidine (or other alpha-2) in cats with HCM, the main reason being is that HCM is a disease of diastolic function and systolic function is often preserved (unless end-stage), so the alpha-2s will have limited adverse effects on cats. They usually use a low dose (I am sure Oscar discussed this in his webinar), together with an opioid. Cats also less commonly have mitral regurgitation, which would be another contra-indication to using this class of drug (they increase afterload and so can worsen regurgitant fraction through the mitral valve).
Thanks for sharing! Yes, this is what we already know, that systolic function cannot be interpreted. Its use in cats is less worriesome as they have diastolic disease (although they can get issues with systolic function too).
LizHi Scott,
This is interesting, thanks for posting.
Monitors like this have been around in people for years, they are often used as part of pacemaker technology and are used for a similar reason; to alert clinicians when early congestion might be present. Their use in dogs and cats has been limited by the fact that they were designed for human chests, measuring changes in impedance with respiration, but had never been validated in dogs before. They were known to be inaccurate in dogs because of panting and movement issues. It is interesting that this collar doesn’t appear to work via impedance (not that I could see from their website at least), and good that it records resting/ sleeping breathing rates. It is a clever subscription service for the worried owner I guess! My feeling is that an owner that invests in such technology would be the more motivated owner regardless, and so might not be a great use of money in terms of they would then be more likely to monitor RRR anyway!
Will be interesting to see take up!
Liz
Hi Julia,
This sounds like a tricky case indeed.
It could be an LA rupture, if the effusion was big enough it might have been causing some limitation to LA size/ the left side might be under-filled due to blood loss. However, normally dogs with LA rupture have significant LA dilation, which is what leads to wall thinning. Often, but not always, you will see a thrombus within the pericardial space as one clue. I think B-lines around the pericardial sac can be misleading. There is a paper that suggests they are conducive to CHF, but in my experience you frequently see B-lines around the heart in normal dogs.
I guess in this case, where I wasn’t sure of the cause but there was significant effusion with tamponade I would attempt to drain it, monitoring carefully for the appearance of a thrombus, so doing it ultrasound guided would be preferable here.
Poor dog, sounds like she was quite poorly!
Liz
Replying to Julia Biernat 20/02/2026 - 12:31
No problem at all!
Yes, it is always a good one to warn owners about. I always say that some ‘idiopathic’ cases will be mesothelioma in the end and we do not have a good way of identifying which cases have it and which don’t!
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