Liz Bode
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Replying to Emma Holt 14/07/2025 - 08:53
Keep us posted!!!
Replying to Emma Holt 14/07/2025 - 08:53
Keep us posted!!!
Replying to Mike Nikolaou 13/07/2025 - 19:57
Haha!! I think the things to focus on are:
Volume overload (e.g. MMVD, PDA, hypovolaemia from other causes) results in eccentric hypertrophy secondary to increased preload – so a more dilated looking heart.
Pressure overload results in concentric hypertrophy (as you would expect if you were trying to build muscle), so a thicker heartFrom a physiology perspective the cardiac cycle is super important, especially when you are using Doppler, but it is better to look at it for a long period of time and read about it in chunks to get your head round it!!!
Sorry!
Liz
Replying to Rosie Marshall 14/07/2025 - 22:18
Hi Rosie,
Great to have you join us too 🙂
Replying to Rosie Marshall 14/07/2025 - 22:18
Hi Rosie,
Great to have you join us too 🙂
Nice case Scott!
Another cardiologist friend of mine saw a 1yo Great Dane today that developed pericardial effusion after being run into by his brother! So, definitely myocardial contusion/ trauma is a thing. I think it is rare that it causes issues though so i wouldn’t be too concerned about looking at the heart in trauma cases unless there were signs of a problem e.g. new murmur, arrhythmia etc
Liz
Hi Emma,
Lovely to hear from you – hope you are all well.
So, in terms of sildenafil I actually do very little monitoring. I would usually monitor RRR if there was evidence of left sided heart disease – opening the pulmonary vessels could overload the LA if it is dilated/ MMVD – but I have never seen this happen, although colleagues have. I don’t monitor BP either (I check it once after starting whilst in hospital), but I do warn owners that their pet could experience hypotension and if there are any signs of that then they should let us know. I also very rarely escalate it – in my experience dogs either respond well to it or they don’t. In cases where I have increased the dose then there is often little benefit observed (but always worth a try). If I was worried about side effects then I would stop it.
Was there any ascites in this case? How severe was the PHT? I wonder if the effusion could be heart failure related and the dog might benefit from a low dose furosemide? Just a thought!
Liz
Replying to Fenella J. 01/07/2025 - 14:34
Lovely to have you both join me on this course 🙂
Hi Scott,
Thanks for picking this one up, I will likely cover it in our journal club in August. I tried to do a similar study using SAVSNET some years ago, but it was difficult with this data, so hats off to the RVC for managing it!
I haven’t read the paper in its entirety yet (I will save that for JC) but I think you raise valid points:
1) it doesn’t replace the advice that echo should be gold standard in an animal with a heart murmur. We echo lots of MMVD dogs that have just that, whether stage B1/ B2 or more advanced. However, some of these animals have concurrent heart disease (congenital disease for example) that might change what we do medically/ change prognosis and so on. We wouldn’t know this if we don’t perform an echo.
2) people find it tricky to determine if an animal has a grade 4/6 murmur, and mis-grading might be one issue (although even I find this tricky sometimes!), so that means a dog might have a grade 3/6 murmur mis-graded as a grade 4/6 and started on pimobendan unnecessarily. We know that dogs with a garde 3/6 murmur only 50% will have stage B2 disease, and that was the issue after EPIC lots of grade 3/6 murmurs were started on pimobendan when they don’t need it.
3) Prescribing to the incorrect individuals is costly, and it might be more cost effective over the long term to have echocardiography!
4) However, being pragmatic, if an owner is financially unable/unwilling to have echo performed then this gives us peace of mind that we aren’t necessarily doing the ‘wrong’ thing in a small breed dog with a grade 4/6 left apical systolic HM. A large breed dog/ Cocker spaniel could have DCM so it has to be used in the right selection of cases.Hope that all makes sense!!
Liz
Replying to Sybil Dryburgh 06/07/2025 - 17:23
Hi Scott,
Thanks for picking this one up, I will likely cover it in our journal club in August. I tried to do a similar study using SAVSNET some years ago, but it was difficult with this data, so hats off to the RVC for managing it!
I haven’t read the paper in its entirety yet (I will save that for JC) but I think you raise valid points:
1) it doesn’t replace the advice that echo should be gold standard in an animal with a heart murmur. We echo lots of MMVD dogs that have just that, whether stage B1/ B2 or more advanced. However, some of these animals have concurrent heart disease (congenital disease for example) that might change what we do medically/ change prognosis and so on. We wouldn’t know this if we don’t perform an echo.
2) people find it tricky to determine if an animal has a grade 4/6 murmur, and mis-grading might be one issue (although even I find this tricky sometimes!), so that means a dog might have a grade 3/6 murmur mis-graded as a grade 4/6 and started on pimobendan unnecessarily. We know that dogs with a garde 3/6 murmur only 50% will have stage B2 disease, and that was the issue after EPIC lots of grade 3/6 murmurs were started on pimobendan when they don’t need it.
3) Prescribing to the incorrect individuals is costly, and it might be more cost effective over the long term to have echocardiography!
4) However, being pragmatic, if an owner is financially unable/unwilling to have echo performed then this gives us peace of mind that we aren’t necessarily doing the ‘wrong’ thing in a small breed dog with a grade 4/6 left apical systolic HM. A large breed dog/ Cocker spaniel could have DCM so it has to be used in the right selection of cases.
Hope that all makes sense!!
LizReplying to scott@vtx-cpd.com 28/06/2025 - 15:46
Hi both,
Most of the data we have on prolongation of QT interval with any drug is based on human studies/ side effects. This is because they are much more prone to problems associated with QT prolongation, especially as there are significant numbers of individuals with ion channelopathies whereby you really don’t want to be messing with their QT intervals! We know little about QT intervals in dogs and cats, and the data for drugs and prolongation or otherwise is scant/ non-existent. However, it would seem sensible to still avoid using drugs together with this theoretical possibility, I wouldn’t want to be the person causing sudden death by combining these drugs 😉
Liz
Hi Scott,
This is interesting and I do love VetCompass and SAVSNET papers, such powerful data. To play devil’s advocate here though I do think we need to be cautious when interpreting survival data from either a first opinion point of view or referral. Survival in either world is determined by the bias that is inherent in these populations, namely perhaps clients in primary care are more financially restricted/ less likely to pursue further test/ more realistic and so will choose euthanasia earlier than in a referral setting where perhaps money is less of a problem/ owners go to extraordinary lengths to pursue treatment etc. Unlike in our medical compatriots where data on survival is more reliable because they do not (until recently at least) have the option of euthanasia. Therefore, can we really interpret survival data accurately from this population? Food for thought, still a terrible disease with a truly poor survival time!
Liz
Replying to scott@vtx-cpd.com 12/06/2025 - 13:58
Not really, I think as you say time and supportive care is usually sufficient but they do sometimes go on to develop worsening respiratory signs, presumably from further ARDS/ ALI and that is always sad. However, I feel the majority of them do well!
Replying to scott@vtx-cpd.com 12/06/2025 - 14:01
Not yet…There are studies being talked about in cats though so who knows – will be a while until any truly robust data comes out with a a’cool’ name 😉
Hi Scott,
Thanks for posting this. I have seen cases where furosemide has been used and those that haven’t. Anecdotally I do not perceive a difference in survival either. As you point out, for me it makes no sense to give furosemide when your circulating blood volume is normal and there is no reason why you would be volume loaded.
interesting condition though and rewarding cases when they leave hospital!
Liz
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