[Harpdog01]

Today in the mail I finally received the echo report from the cardiologist that performed Harper's echo at MSU back on 1-9-12. We were told that Harper had early stage, occult DCM and he was only put on enalapril and spironolactone. After reading the report today I immediately wondered why more wasn't done (as far as meds) to begin with.

Just a little history...Harper had coughed maybe 4-6 times the weekend before his echo but was otherwise fine and we didn't know that it was heart related. We DID tell the cardiologist about the coughing but he dismissed it. According to him, Harper's first "symptoms" were after the echo and were some breathing difficulties that night and we were given a script for lasix and told to use it as needed. The cardiologist even mentioned to me that he thought Harper might have had some "mild heart failure" that day, but never said to do anything more at that time. I asked repeatedly about if he should be on pimobendan and he kept saying that he only uses it in animals with "clear, clinical signs of CHF" and that Harper didn't need it yet. He finally agreed to put him on a "low dose" of pimo after I explained to him again that Harper was more restless at night and I was concerned that his breathing was more labored and that we were having to use more lasix. The addition of the pimo made a HUGE difference and we were able to wean the lasix way back and Harper was back to his wild, bouncy self after just two doses of it.

The report is below and I'm not sure what all of it means, but I'd really appreciate some feedback on the findings. We are going to see a new cardiologist, but we're waiting for Harper's holter results before we consult with her. In the mean time I'm trying to decide if I should speak with the head of Cardiology at MSU about my concerns about how Harper's case was handled. Am I way out of line for thinking that more should have been done to begin with? Are these the results of a Doberman with early stage DCM???

M-Mode
IVSd 6.24mm
LVlDd 64.86mm
LVPWd 6.24mm
IVSs 9.67mm
LVlDs 53.17mm
LVPWs 10.76mm
EDV(Teich) 215ml
ESV(Teich) 136ml
EF(Teich) 37 %
%FS 18 %
SV(Teich) 79 ml


2-D
AoA 3.9cm2
AoD 2.2cm
Ao Circm 7.0cm
LA Diam 51.03mm
LA/Ao 2.304

ECG revealed normal sinus rhythm with intermittent premature ventricular contractions.

Severe dilation of the LA and LV. Systolic function was depressed. Color flow doppler revealed a small concentric jet of MR.

Diagnosis and Recommendations:
Dilated cardiomyopathy with intermittent ventricular premature contractions.

Pending holter results I am not recommending any primary anti-arrhythmic therapies.

He is not showing any clinical signs so I decided not to use any diuretics of vetmedin. I did start enalapril and spironolactone for the antagonism of the RAAS system. These drugs may help prolong the subclinical phase of DCM. "



Thanks for any thoughts or feedback.

 

[sam&macksmom]

his fractional shortening (FS) was 18%?

From the Doberman Pincher DPCA website:
"Occult disease: When the disease is in an asymptomatic or occult stage, the diagnosis maybe suspected by testing, but at this date these criteria are not uniform from center to center. Echocardiography of healthy Dobermans recently studied at the UDC nationals and it was found that the average fractional shortening of these healthy dogs was 26% using a short axis view, and 22.5% using a long axis view. In other breeds a fractional shortening of 25% or less in the short axis view is considered abnormal. This either indicates that a large percentage of healthy Dobermans have occult DCM or that the Doberman heart at baseline is not comparable to that of most breeds. As such, to diagnose occult DCM, most centers now require not only a depressed fractional shortening, but some evidence of functional impairment such as dilated heart chambers or frequent ventricular arrhythmias. "

 

[dax0402]

Hoping you know more when you get the holter results back. I am looking at Baron's last 3 echos and his FS%'s were 35.65%, 35.65%, and 25.71%. My "senior" mind has a hard time comprehending technical things but Dr. Goodwin said the 3 values he thinks are most important are LVIDd, %FS, and LA/Ao. Baron's numbers are all within normal range on all his echos but his last echo was the best: LVIDd was 4.10 cm, %FS 25.71%, LA/Ao 1.34 Baron has early stage DCM because his holters have shown VPC's and couplets even though his echos are normal.

Not sure if this helps or not. I think you will have a better picture when you get the holter results and talk directly to your cardiologist. My thoughts are with you.

 

[Harpdog01]

his fractional shortening (FS) was 18%?

From the Doberman Pincher DPCA website:
"Occult disease: When the disease is in an asymptomatic or occult stage, the diagnosis maybe suspected by testing, but at this date these criteria are not uniform from center to center. Echocardiography of healthy Dobermans recently studied at the UDC nationals and it was found that the average fractional shortening of these healthy dogs was 26% using a short axis view, and 22.5% using a long axis view. In other breeds a fractional shortening of 25% or less in the short axis view is considered abnormal. This either indicates that a large percentage of healthy Dobermans have occult DCM or that the Doberman heart at baseline is not comparable to that of most breeds. As such, to diagnose occult DCM, most centers now require not only a depressed fractional shortening, but some evidence of functional impairment such as dilated heart chambers or frequent ventricular arrhythmias. "

I double checked the echo report and it indeed states %FS 18%.

 

[Cathy43]

It also says "severe dilation". I'd want a new cardiologist or have a talk with the other reminding him that it's my dog and I prefer to treat aggresively in this case.

 

[sam&macksmom]

I agree with Cathy.

Is there a chief cardiologist you can speak to at MSU?

 

[Harpdog01]

It also says "severe dilation". I'd want a new cardiologist or have a talk with the other reminding him that it's my dog and I prefer to treat aggresively in this case.

When I started reading it and came across "severe dilation" I was horrified and pissed as he NEVER told us it was "severe" or anything of the sort. He told us told us Harper had early stage DCM or "occult" DCM and no other meds besides the spironolactone and enalapril were needed at this time.

I'm just really angry that this "board certified cardiologist" treated Harper's case as no big deal. If I wouldn't have kept asking a million questions and insisting repeatedly that we try pimo, I'm not entirely sure Harper would be alive right now.

Thankfully we do have a new cardiologist but we are waiting for the Holter results to come in before we consult with her on where to go now with his meds.

Thank you all for your time and feedback.

 

[Harpdog01]

I agree with Cathy.

Is there a chief cardiologist you can speak to at MSU?

There is, and I'm going to call them today.

 

[Murreydobe]

When I started reading it and came across "severe dilation" I was horrified and pissed as he NEVER told us it was "severe" or anything of the sort. He told us told us Harper had early stage DCM or "occult" DCM and no other meds besides the spironolactone and enalapril were needed at this time.

I'm just really angry that this "board certified cardiologist" treated Harper's case as no big deal. If I wouldn't have kept asking a million questions and insisting repeatedly that we try pimo, I'm not entirely sure Harper would be alive right now.

Thankfully we do have a new cardiologist but we are waiting for the Holter results to come in before we consult with her on where to go now with his meds.

Thank you all for your time and feedback.

Pimobendan has been studied and found to be effective in dogs with congestive heart failure. While Dr. O'Grady was studying whether Pimo would actually delay progression of the disease in dogs with the occult form of the disease, I don't believe there have been any findings about that yet-at least I've never heard of any.

IOW-the use of Pimo prior to a dog going into CHF is still in the experimental stage. Some docs are going to be more willing to go out on that limb than others.

Personally, I wouldn't insist a dog be put on Pimo until they'd had a holter done and we knew what was going on with cardiac rhythm for sure. The drug itself CAN kill some dogs through sudden death, you know. Holter results may indicate some dogs need to be put on anti arrythmic meds and cardiac rhythm stabilized before starting Pimo, some dogs may just not be a good candidate for this drug at all.

 

[sam&macksmom]

With dogs at the occult stage of DCM, has carvedilol been successful at slowing down the disease?

 

[Murreydobe]

With dogs at the occult stage of DCM, has carvedilol been successful at slowing down the disease?

I found this with a real quick search.

Carvedilol in dogs with dilated car... [J Vet Intern Med. 2007 Nov-Dec] - PubMed - NCBI

That's from 2007, and not a large study.

 

[sam&macksmom]

oh Guelph was using this drug as part of their study but I didn't see results of their findings yet.

I found this with a real quick search.

Carvedilol in dogs with dilated car... [J Vet Intern Med. 2007 Nov-Dec] - PubMed - NCBI

 

[bean]

I am so far from an expert on this topic, but when we did the cardio clinic for Silas, the cardiologist specifically mentioned coughing as a common first clinical sx in Dobermans. He said because they are a stoic breed, the disease is often far along before they show any symptoms.

He said that if Silas ever experienced coughing, any decrease in energy/stamina, or any sign of increase in difficulty breathing, we should contact him immediately.

Their clinic's numbers for occult DCM are:
"Occult DCM criteria in Dobermans: LVIDD >46mm if <39 kg body weight. LVIDD >49 mm if >39 kg body weight. Fractional shortening (FS) <25%. One premature ventricular beat on ECG, or more than 50 premature ventricular beats on a 24 hour Holter Monitor ECG."

Hoping you can talk with someone else soon, and I'm thinking healthy thoughts for your boy.
xoxo

 

[Harpdog01]

Thank you all for your feedback. I talked in depth with Dr. Riepe's (new cardiologist) tech this afternoon and we went over the reports together. He said based on the information from the echo and the fact that Harper had coughed a few times before the appointment that he was probably experiencing some CHF at that time. He said a Doberman with enlargement as severe as Harper's along with his FS%, that was having some mild coughing would have been put on pimo and lasix immediately by Dr. Riepe. Said Harper is on a really low dose of pimo and that they will most likely increase it and possibly adjust the other meds as well when we go in for our appointment on Tuesday. We should have the holter results by then to take in with us.

Adam, the tech, was awesome and thoroughly answered all my questions and went over the reports in great detail with me. Oh what a nice change of pace it was!! I am looking forward to our visit with him and Dr. Riepe next week.