Liz Bode
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Replying to Christina G. 23/04/2025 - 14:29
Hi Chirstina,
Glad you are enjoying the course so far 🙂
I always find this a tricky one too, I tend to er on the side of the higher dose though, if the owners can afford it. Obviously easy if they are at 1.5 x 2.5mg tablets but anything else is annoying!
Liz
Replying to Spela Bavcar 21/04/2025 - 23:00
Welcome everyone,
I’m Liz, one of the Directors of vtx but also a Specialist in Cardiology working out of Chestergates Veterinary Specialists in the North West of UK. I will be covering coughing dogs, and of course we will touch on the cardiac cough conundrum…
I hope you enjoy this course and do not hesitate to ask any cardio related questions.
Liz
Hi Scott,
Thanks for posting this. I remember some time ago that the human literature certainly pointed out that peri-hilar oedema due to CHF wasn’t actually as common as everyone imagined, and it has also been shown in the veterinary literature. We have known for some time that cats can get pulmonary oedema pretty much anywhere and there was a relatively recent study that also showed dogs with MMVD tended to be bilaterally symmetrical. I am sure there is another paper that shows in dogs there tends to be a more torso-caudal pattern too, but I can’t find it now!
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
Hi Cristina,
Thank you for the nice question. I think something broad spectrum such as potentiated amoxicillin would be fine and I would do this in the run up to the dental (2-3 days before) to reduce the bacterial load and then for 2-3 days afterwards. Around 5/6 days total.
Liz
Eek not sure I can help here, we would usually rely on our anaesthesia colleagues for that answer!
Replying to scott@vtx-cpd.com 07/03/2025 - 03:35
Hi both,
Not sure I have too much more to offer here!
We use Butorphanol and alfaxalone fairly frequently – usually IV though. I find IM is less reliable and unpredictable with some cats sedating well and others not at all. Overall, we rarely reach for sedation, a quiet and dark room with gentle handling negates the need for sedation in many and we tend to use oral meds to good effect. Gaba the night before and day of the consult and trazadone in dogs (or both).
We will use alpha-2s in cats only and only if very aggressive, usually in combination with butorphanol and alfaxalone at a low dose (5ug/kg) IM. We don’t use ketamine at all.
Oscar will cover more about the above in his lesson at the end of the course 🙂
Liz
Replying to scott@vtx-cpd.com 24/02/2025 - 13:09
Couldn’t agree more, very interested to hear if anyone has any experience (bad or good) with these diets, and also to know your thoughts Georgia. I haven’t seen any grain-free associated DCM although I have seen plenty of dogs on a GF diet that have a DCM-phenotype that I advise changing to a proprietary diet, just in case. Sadly, many dogs are lost to follow-up especially if they have pre-clinical disease. I think the prevalence of diet-induced DCM is pretty low in UK/ Europe and might be more common in USA, but not sure why that would be!? Perhaps a reflection of the wider offering of such diets with very novel protein sources in the USA?
Just a few musings from me!
Liz
Replying to Emma G. 10/01/2025 - 15:56
Good tip, thanks Emma. I agree with your echo assessment and always good to offer referral I think, up to owner then if they follow that path or not.
We checked haem and biochem (inc electrolytes) and all was within normal limits.
Blood pressure 136mmHg
Cardiac troponin I = 1.5ng/ml (ref <0.04)
ECG - sinus tachycardiaSo we gave the cat 2mg/kg IV furosemide and started clopidogrel.
Based on the troponin I results what would your consideration be? Any further tests?
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 - 17:30
Hi Emma
Thanks again for some great questions and observations.
I agree, dogs we will use trazodone and possibly gabapentin the day before and the day of the consult, that seems to work best. Then if we need something more butorphanol and then Alfaxalone if required. In cats, 100mg gaba day before and day of and then a high dose of butorphanol IV seems to work quite nicely. A small number of cats would then require alfaxalone.
In terms of medetomidine, sometimes you don’t have a choice! However, it markedly reduces systolic function and in that case I don’t think you can use the echo to really determine anything about that. However, it would usually reduce global systolic function (all of the LV would be affected) and would rarely/ never cause regional systolic dysfunction so if you see that then I might be more concerned that it’s real. Not sure if that’s very helpful though!!
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 - 16:43
It’s certainly quite complicated. Again, the lecture on PHT and all the ins and outs is a long lecture so I just touch on it here but the consensus statement covers everything.
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
Replying to Nektarios Chasapis 06/01/2025 - 18:29
Happy New Year to you too.
The problem is that the loops are so short and I’m not sure how to make them longer so I’m not surprised you didn’t recognise anything in FAST scan – it shows a low volume pleural effusion. I agree with your assessment of the other view, the walls look hypertrophied, septum and free wall, the LA looks dilated and systolic function look normal.
What would you do next?
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