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Liz Bode

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  • Liz Bode
    Keymaster
    02:34 12/09/23

    Hi Natalie,

    So there is one loop only (I’m on holiday this week but will add more next week once I’ve got my laptop). In this loop you can see left atrial and ventricular dilation with normal systolic function. There is also AF on the ECG. The MV is slightly thickened but isn’t the concern in this dog. Any other thoughts as to processes that could cause these findings in a dog with a loud murmur?

    Liz

    Liz Bode
    Keymaster
    02:31 12/09/23

    Replying to Natalie Niven 07/09/2023 - 17:01

    Hi Natalie,

    I’ve not seen one performed in dogs, only people, but the procedure is the same for both. They use cardioplegia and then place catheters within various vessels and circulate the blood through the bypass machine. The heart is approached via the left atrium and as this is a low pressure chamber with thin walls you can suture it up with little risk, but yes that will always be a risk. The main risk though is thrombosis following recovery and these dogs are given clopidogrel to prevent it. They then repair the valve by placing new chordae to tether the valve again.

    Yes, with decompression that is what you do. 30% have R CHF afterwards, but this is easier to manage than L. 30% close up. We don’t have any evidence as to whether they do better than meds alone but this technique is used in people too.

    Scott – that’s a great episode of Grey’s!

    Liz

    Liz Bode
    Keymaster
    21:59 05/09/23

    Hi everyone

    Great to have you all join us on this course. I’m Liz, one of the directors of vtx but also a specialist in cardiologist working in private practice in the NW of England. Please feel free to ask me anything cardio related.

    Liz 🙂

    Liz Bode
    Keymaster
    20:47 03/09/23

    Replying to scott@vtx-cpd.com 03/09/2023 - 20:11

    Yes, they were the pioneers of the approach and for realising replacement was not as good as repair in dogs in terms of survival post surgery.

    Liz Bode
    Keymaster
    20:28 01/09/23

    Replying to scott@vtx-cpd.com 30/08/2023 - 10:52

    Hi Scott,

    We haven’t had a suitable candidate yet, but we would certainly be able to try left atrial decompression in a suitable stage C/D candidate.

    Repair would be my overall preference, they are having some good outcomes with reverse remodelling and many come off medications. TEER is similar in USA but is in the very early stages in UK.

    I haven’t sent any dogs yet, cost is almost prohibitive for many owners in UK where they are not used to paying such high bills for health care vs the USA.

    Liz

    Liz Bode
    Keymaster
    21:45 29/08/23

    Replying to scott@vtx-cpd.com 29/08/2023 - 14:20

    Hi Scott

    That’s hard to answer. If o hear a right sided systolic murmur in a cat I will try and press less hard to see if the murmur goes away. The same when I’m performing echo, if I see turbulence in the RV outflow tract I’ll try and press less hard to see if the turbulence resolves.

    Liz

    Liz Bode
    Keymaster
    21:43 29/08/23

    Replying to scott@vtx-cpd.com 29/08/2023 - 16:56

    Hi Scott

    Unfortunately for the owner it was detected 3 weeks after he rescued him at a routine vaccination. The dog is asymptomatic at present 🙂

    Liz

    Liz Bode
    Keymaster
    21:42 29/08/23

    Hi Lauren

    Great to have you join us and I’m pleased you’re enjoying it so far.

    For a PDA you can see them both on the right parasternal short axis view optimised for the PA and the left cranial view again optimised for the PA. I find the left cranial view gives you much clearer images than the right sided ones though. The trick is to put your probe right where you feel a thrill and then with a few small adjustments it usually comes into view. If you can’t see the whole thing you can often appreciate the flow across it on colour or with continuous wave Doppler.

    Liz

    Liz Bode
    Keymaster
    19:59 23/08/23

    Hi Nadine,

    Thanks for the question. I tend to avoid it because it increases the risk to the cat (albeit small) and the cost for the owner. I find that 75% of cats will tolerate a complete echo with 2 handlers in a quiet dark room fine. About 15% will need gabapentin prior to the echo, a small number will benefit from butorphanol on top and then the remainder will need the combination you describe. We know that the combination affects very little systolic function etc but it will make HOCM more challenging to identify.

    Liz

    Liz Bode
    Keymaster
    15:00 21/08/23

    Replying to Steph Sorrell 21/08/2023 - 09:51

    Hi everyone,

    Very excited to be on this course with the lovely and knowledgable Steph 🙂

    Any cardio questions I’m more than happy to answer.

    Liz

    Liz Bode
    Keymaster
    19:52 19/08/23

    Replying to scott@vtx-cpd.com 19/08/2023 - 07:09

    Hi Fran

    Good question! I’m not 100% sure about the reason but several studies have demonstrated that it is poor at detecting patent infections, unless used in combination with an ELISA. This is presumably due to the amount of DNA present in blood when the adult worms are there vs when the larvae are migrating through the body.

    Liz

    Liz Bode
    Keymaster
    20:31 14/08/23

    Replying to Nadine S. 08/08/2023 - 10:41

    Hi Nadine,
    Welcome to the course.

    That’s great with regards your echo, congenitals are more complex overall so makes sense to refer these, and I am glad you enjoyed the first lecture.

    Liz

    Liz Bode
    Keymaster
    20:15 02/08/23

    Replying to scott@vtx-cpd.com 15/07/2023 - 17:53

    Hi all,

    Here is a little run through I prepared.

    https://drive.google.com/file/d/1mz1gEYAvGt_TpE2HX7ghhz31t4Ul5tU8/view?usp=sharing

    Liz

    Liz Bode
    Keymaster
    20:03 02/08/23

    Replying to Emma Middleton 29/07/2023 - 14:42

    Hi Emma,

    Thanks for the suggestions. I absolutely agree, we want to be using ultrasound to look for any evidence of CHF in a cat with respiratory distress (with or without a heart murmur). The FAST scan showed a normal left atrium but multiple coalescing B-lines. How would you interpret this, what could be the cause for the B-lines? Then what would your next steps be (I see you said thoracic radiographs which I completely agree with), would you do anything else?

    I look forward to hearing your thoughts.
    Liz

    Liz Bode
    Keymaster
    22:19 27/07/23

    Hi Fran,
    It certainly does have some confusing terminology associated with it!

    The PA is measured at the annulus, so where the valve hinges and at the point where the PA is at its widest (in systole). The Ao I measure as I would for a LA:Ao so following the line between the non- and left-coronary cusps.

    Yes, certainly. In that case if money won’t allow a work-up then trying sildenafil is definitely worth it. In my experience it has little side effects, only issue being if the animal has left-sided heart disease. However, being pragmatic most of these old Westies have horrible disease and are less affected by MMVD generally!

    Best wishes

    Liz

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