Sinus Arrhythmia - what is it and why does it matter?
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♥️ If a pet is on several cardiac medications, as most patients in congestive heart failure are, I would recommend giving the owner a prioritised list of medications, with number one being the most essential, life saving medication where a dose can’t be missed under any circumstances, down to the least essential medication ( say number 3 or 4 on the priority list for example), where if a dose of the medication is missed it is not critical. This is particularly important for patients on chronic meds that don’t always cooperate for taking their medications - we all know that some pets can find ninja like skills in spitting out tablets when they want to. It’s not easy being an owner of a pet needing chronic medications. We want to preserve the human animal bond in these tricky situations . This prioritisation means that on those tough days where your owner is struggling to get their pet to take the tablets, that they can focus on prioritising the most important one and stay friends with their pet. It’s a win win - stress reduction for the pet and pet owner and you make sure the pet gets its essential life saving medication.
♥️ Explain how the medication works and why it benefits their pet in simple, accessible terms. Understanding why we are going to the trouble and expense of giving the medication may help the owner to persevere when medicating becomes challenging.
♥️ Information sheets about the pet’s condition will empower your pet owner to learn about the ‘ins and outs’ of their pet’s heart condition, why medication is needed and the expected disease course from a reliable source that you have either created or from a reliable free resource that you have found online (my favourite free resource for this is veterinarypartner.vin.com - and they actively encourage printing their resources for client education). In my experience, the more background knowledge of the heart condition we can give a pet carer, the more likely they are to gain
Have you been in this nightmare situation before? 😳
😱 As vets and vet nurses, we deal with compliance issues regularly, however in a situation such as congestive heart failure, diuretic non-compliance can be catastrophic.
🤔 Poor compliance with medicating or at home monitoring of patients is of course multi factorial and individual to each patient situation, however in my experience and opinion, most issues can be avoided by investing time in educating the client appropriately on their pet’s condition and treatment. I appreciate this is not an easy thing to do amidst the time pressures of practice!
❤️ Pet owners want to do the very best by their beloved pet; in most cases I find that poor compliance was unintentional, due to misunderstanding or embarrassment about admitting difficulty with medication administration. All very understandable issues! 😊
✅ Stay tuned for my upcoming posts where I will give you my easy top tips for how to encourage great owner compliance in your cardio cases ❤️
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😂…..But seriously, we just really love cardiology 🤓
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❓When should we assess older dogs with a characteristic left apical systolic murmur of mitral valve disease?
🩺We know that murmur intensity increases with severity of disease in mitral valve disease ➡️Although most MVD dogs with significant disease (Stage B2 or above) will have moderate, loud or thrilling murmurs (Grade 3 and above/6), a small but important number of dogs with soft murmurs (Grade 1 and 2) will also have cardiac remodelling which would place them in the B2 category (Ljungvall et al., 2014), meaning the might benefit from medication.
❤️We ideally need to catch all stage B2 MVD dogs (evidence of left atrial and left ventricular dilation) which meet ‘EPIC’ criteria (LA:Ao of >1.6 & LVIDdN of > 1.7), as these little guys would benefit massively from treatment with pimobendan. A small number of these dogs may only have a soft murmur - we don’t want to leave these guys out of the pimobendan party if they might potentially benefit too 🥳🎉
💊Pimobendan has the potential to extend the preclinical period before progression to congestive heart failure in eligible dogs by a median time of 15 months (Boswood et al.,2016). That’s a huge period of potential extra time in the life of a little dog! ⭐️
🧐So what is the bottom line? Consider starting to stage small breed adult dogs with a characteristic left apical systolic murmur of MVD with either thoracic radiography or echo when their murmur is grade 2/6 or above. That way no potentially pimobendan eligible dogs will miss out on the benefits of treatment!
📖Worth reading
Murmur intensity in small breed dogs with myxomatous mitral valve disease reflects disease severity (Ljungvall et al., 2014)
Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegally: The EPIC study - a randomised clinical trial (Boswood et al., 2016)
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A massive left atrium in this little HCM cat, with an LA:Ao of 2.9 🙀
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