Liz Bode

Another good question. In terms of staging MMVD dogs, if there is a left apical systolic heart murmur in a small bred dog then it is pretty much guaranteed to be MMVD. In that case anything <2/6 we can be pretty sure (96%) that the dog is a stage B1, so that helps. If the murmur is louder than that then it does become more challenging in financially limited cases. If the owner is willing to spend money on medications then there is an argument to say that there money is better spent performing echo to check as it's 50:50 in grade 3 and 4 heart murmurs whether or not they will need to give it. If the dog has sinus arrhythmia then they are at least fully compensated, but we can't tell their stage and so that is the tricky bit! If sinus arrhythmia with a grade 5/6 murmur without respiratory signs then they are probably a stage B2. I am sorry I have no helpful answers here, you probably will be correct using your best clinical judgement in the majority of cases!

Liz

Hi Cristina,

Thank you again for good questions. Also, that you think clients would be interested and you are right, clinicians need to be as clued up as possible to advise.

The aim is to eventually stop most/ all heart meds. A correctly placed device should result in reverse remodelling such that the heart gets smaller. The devices are only really placed in stage C dogs, therefore, the aim is to stop furosemide but pimobendan might need to be continued. The survival data is relatively sparse currently as it is such a new technique, however this pilot study suggests feasibility and obviously will then lead to survival data. The cost will be lower than MV repair via bypass, but the device itself is expensive and so the procedure overall will be £10,000 plus. The device stays where it is for the life of the dog and shouldn’t need to be replaced if placed appropriately.

Watch this space…

Liz

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