Liz Bode

Replying to Annet Krabbenborg 16/02/2026 - 12:57

Hi Annet,

Good question! Yes, they have been shown to have larger LV than other dogs. We would still use the EPIC criteria though to determine when to start pimobendan, but we might reassure some owners that the LV isn’t that big in reality!! It is confusing. The study wasn’t one looking at CKCS in particular, but Mark Rishniw demonstrated that as a breed CKCS have LV that are often larger then the 1.7 EPIC cut off!

This was the paper:

https://www.sciencedirect.com/science/article/abs/pii/S1760273422000595?via%3Dihub

Liz 🙂

Replying to Ornella R. 08/02/2026 - 19:18

HI Ornella,

Thanks for the question. Generally you will get a dense appearing profile (termed the ‘chin’) and a fainter area of spectral broadening (termed the ‘beard’). We measure the velocity to the chin and ignore any of the fluffy-stuff that will make the velocity faster than it is. In the attached image the red arrows are the chin and blue the beard.

Hope that is helpful.

Liz

Screenshot-2026-02-08-at-20.19.51

Replying to Annet Krabbenborg 18/01/2026 - 15:52

Hi Annet,

Sorry for the delay in replying, I had a really busy week at work so just haven’t had chance to check anything until this evening! I will answer each question in turn below:

– you mentioned torasemide as a rescue diuretic. And you prefer bid dosing? Why is that? I have used it but only use bid dosing if on higher dosages (>0.6mg/kg). How do you swap over from fur to torasemide in stable and unstable patient?
You can use torasemide as a first line diuretic once a day, and I do do that if the animal is tricky to medicate. I use torasemide in my stage D though normally. It has been shown in several studies that it has a t1/2 of about 10 hours so we use it twice daily to try and maintain both plasma levels and renal levels. We take the total daily dose of furosemide e.g. 10/mg/kg/day, and divide that by 1/10th-1/20th dose and then split that into two for BID dosing. We tend to use IV furosemide in an unstable patient before transitioning to torasemide, and I would only swap from furosemide to torasemide orally if the RRR were mildly elevated or we were struggling to control congestion, with the need of escalating the frusemide dose quickly.

And you mentioned you can use furosemide cri? How do you do that? Which dose? And just furosemide or i vaguely remember to dilute it with hypertonic saline and dextrose?

We use it after a 2mg/kg IV bolus, then swap to CRI at 0.5-1mg/kg/hr. You tend to dilute it in D5W to keep it iso-osmolar and remember it is light sensitive!

-xrays… i dont do them much anymore since t pocus…? Is that wrong? And did you say you could have no b lines but still be in chf? I usually use microconex abd probe but can you use a phased array heart probe too?

Not wrong no, I POCUS but is an animal isn’t responding as I think they should then I will radiograph them to make sure I haven’t missed something. Micro-convex probes can be better to pick up B-lines but you can use phased-array too. B-lines should be present usually in CHF, but if you have an animal treated for CHF then there could only be 1 or 2 and that can also be normal!

– in lily’s case you mentioned most likely she’s got PH ? I assume this doesnt need treatment with sildenafil unless causing syncopes?

We don’t treat PH in stage C/D dogs usually before we try and control their congestion. You can overload the LA in theory and worsen CHF. However, if we optimise treatment and the PH remains then we might include sildenafil if they are symptomatic or if the Tr velocity is high on echo. They don’t have to be syncopal for us to use it.

– is telmisartan safe in heartdisease? Mvd st b2? And what about if in chf? I wondered if you could use that to treat the hypertension in stead of amlodipine? I assume amlodipine safer as already on benazepril?

You could use telmisartan. I am not aware of any papers that looks at their use in CHF in dogs. We don’t use ACEi in stage B2 so I don’t see why we would use telmisartan in these cases either. You could use it to treat the hypertension, but amlodipine is ‘better’ at reducing systemic hypertension usually so that would be our first line. Amlodipine also reduces afterload to a greater extent, so if a stage C dog was on an ACEi already and then developed hypertension amlodipine would be chosen and would hopefully reduce afterload enough to even reduce MR and LAP!

Hope that all makes sense.

Liz

Hi Svetlana,

I don’t really like looking for a PDA from the right parasternal view as it is very difficult to distinguish it from the LPA as you say. If we do see one it is mainly through having continuous flow on colour Doppler and then being able to demonstrate a continuous flow on spectral Doppler. That being said, it is always at an angle for me so I prefer to move to the left cranial view!

Pulmonary insufficiency should look like a jet of red originating from the pulmonic valve, not from near the branch of the PA, so should be very different. You would also hear a characteristic continuous murmur. If there is bidirectional or R-L flow then you have more of a difficult time seeing a PDa on 2D and colour – you would need to find evidence for pulmonary hypertension and then a rule out, using contrast study, would be a R-L shunt in a young animal.

If you have a PDA and PS then this can be tricky, you should still have a continuous murmur. When you interrogate the PA you should still see flow that occurs in diastole and systole – this is where moving frame by frame with an ECG is really important.

Hope that helps!

Liz

Replying to Annet Krabbenborg 09/01/2026 - 14:57

Hi Annet,

Sadly not. June Boon’s book on echocardiography has tables of some of them in, otherwise you end up searching for them separately. I then print them out and have them in a folder in my room. The breeds we most commonly see are:

English springer spaniels
Whippets/ other sight hounds
Doberman
Boxer
Lab
Great Dane

Most of the giant breeds have papers. Sorry that isn’t much help for you.

Liz