Liz Bode

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

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!!
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 - 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,

Such interesting drugs! I haven’t anything to add to the DM chat but I do think these drugs are going to be really useful in the management of heart failure. They have already shown significant advantages in people with both systolic and diastolic heart failure (or heart failure with reduced ejection fraction and heart failure with preserved rejection fraction). The first studies showed these drugs, which were looking at their use in people with DM, reduced the CV risk of death overall. Since then studies have shown that they reduce CV death in patients with HF but no DM!!! So watch this space – a drug that we can add in to furosemide with hopefully good effects (unlike ACE inhibitors which might not do a great deal!)…of course we need the studies in veterinary medicine to support their use first.

Liz

Replying to Jen Rowland 14/05/2025 - 22:22

Hi Jen,

This is the paper:

https://onlinelibrary.wiley.com/doi/10.1111/vec.13224

So, when I said they do well – they are weaned off the ventilator successfully but obviously have CHF so their long term survival isn’t necessarily good, but probably no worse than many cats with CHF!

Let us know what you think 🙂

Liz