Liz Bode

Replying to Emma G. 14/01/2025 - 17:59

Hi Emma,

In terms of medetomidine you can’t make any assumptions about global left ventricular systolic function, so if the whole LV looks reduced you won’t know if that’s real or whether it’s the medetomidine. However, cats with DCM have extremely poor systolic function and so you might still be suspicious of that even with medetomidine on board. However, if there is regional hypokinesis (for example the septum looks poorly contractile but the septum looks normal) then perhaps this is real and not the medetomidine. You’d expect medetomidine to affect the whole of the left side not just one wall.

In terms of butorphanol, we will go up to 0.4mg/kg, our anaesthetists say it’s a bit like water!! If you can’t get an IV we will usually try IM alfaxalone before medetomidine, the reason behind that is as discussed above it affects TS the echo far less. The only issue with that is it is unpredictable so some cats will sedate nicely but others it hardly touches.

Liz

Replying to Emma G. 10/01/2025 - 17:31

Hi Emma,

Thanks for the question. It is eccentric hypertrophy, yes, as you’ve got a dilated LV chamber with relatively thin walls. So we describe this as eccentric hypertrophy too.

Liz 🙂

Replying to Emma G. 10/01/2025 - 16:37

Hi Emma,

Great question! I only touch on endocarditis as the nuances of it would be a lecture in itself.

In short MMVD dogs are not at higher risk of endocarditis compared to those dogs that don’t have MMVD. The only disease process thought to increase the risk of endocarditis is sub aortic stenosis. In dogs with that we would tend to advise prophylactic antibiotics a day or two before the procedure to reduce bacterial load.

Overall, I worry very little about anaesthetising a stage B1/B2 dog, they have good systolic function so BP maintenance is good. I worry more about stage C but I would say the benefit of sorting teeth is greater in these dogs than not doing it. They still tend to have good systolic function, you just need to use fluids carefully and make sure their BP is maintained. It’s dogs with poor systolic function we need to worry about more 🙁

Liz

Hey

Physiology can be confusing – I think a lot of it is made harder because of the terminology. I’d probably suggest looking at some videos to understand the cardiac cycle better. This one might be helpful;

In terms of frame rate the definition is the number of frames the computer can display per second. The more frames you have per second the better the temporal resolution. In animals with fast heart rates you want the number of frames per second to be as high as possible, at least over 30 frames per second. I change it by changing settings such as width, depth etc and try and maximise it for each image I take.

Standing echo is fine, an esteemed colleague in France performs all her echos standing. However, it’s probably just what I’m used to, but I find it much better to get good images in lateral, mainly because the Lings don’t get in the way.

If you use sedatives such as butorphanol, low dose ACP, alfaxalone or midazolam then they don’t change what you see in a clinically relevant way. If you have to use medetomidine or dexmedetomidine then they do change systolic function so we try and avoid those. I find 0.3-0.4mg/kg butorphanol works for most dogs to calm them down. We can combine that with oral trazadone and gabapentin if required. In cats gabapentin works well and sometimes we also add butorphanol but if we need something stronger we will add in alfaxalone (same for dogs). A quiet room, with one good or two good handlers works well for most of our patients but it depends on the temperament of the population and how many people you have to help you!

Liz

Replying to Nektarios Chasapis 04/12/2024 - 10:07

Hey!

I will try and get some images together next week to post – sometimes only really obvious if there is dilation but medium sized dogs they’re easier to see. I’ll see what I can do.

The cardiac cycle is super important to understand to help interpret echo and pathology so I’m fully supportive of you digging deeper. Isovolumic contraction time occurs at the start of systole when the mitral and aortic valves are both shut but the ventricles are starting to contract. As they contract they squeeze the ventricular chamber which increases pressure quickly. Then, there is a point at which the pressure in the ventricle exceeds aortic and pulmonic pressure and the valves open. Blood is ejected and that is the end of IVCT (the start of blood being ejected). It might be obvious but if you have mitral regurgitation you don’t have an IVCT period. As soon as the ventricle contracts you get leak of blood across the MV into the LA. Therefore the volume held in the ventricle changes. When there are no leaks the volume stays the same and only the pressure increases.

Hope that makes sense!

Liz

Replying to Nektarios Chasapis 26/11/2024 - 11:08

Hi,

Lovely to have you join me on this new course and I hope you find it useful 🙂

I have replied to your email just now, but for others here is what I said 🙂

So I have a vivid and you can change the settings and calculations to a veterinary one without too much issue. I really like the GE and Philips machines. I have used Easote and they also have quite good image quality (not as good as GE or Philips) but they are very nice to use too. I’ve also use Sonoscape and they are cheaper machines but produce nice images. I think they would struggle though with larger dogs and the Doppler isn’t as good as the Easote.

I think, if you’ve the money to spend, trialing some of the above would be your best bet. It’s alot about personal preference as well as the probes. You’d be best spending more on the probes and slightly less on the machine sometimes too!

Hope that is a bit helpful 🙂

Liz

Replying to scott@vtx-cpd.com 06/09/2024 - 23:54

Hi both,

I would agree with Scott’s comments above. The only time I’d consider performing this procedure is in a dyspnoeic dog and then the owners have to be aware that coughing will continue. I was working with Scott last year and he was referred a case for stent placement and when the dog walked through the door I think Scott and I were both thinking it would be a great candidate. However, the dog did very well on medical management and never (this far at least) required a stent.

The dogs that we have performed stents in don’t have further dyspnoeic episodes and the coughing can be relatively well managed with medications. At the time off stent placement we will scope and BAL them to make sure we haven’t got any infectious component to the cough. We tend to try and do everything under one GA (scope, BAL and stent) as recovery is risky in these patients if work up is done in a staged approach.

Liz