Then he'll be rushed to the cardiologist, and if he is diagnosed with congestive heart failure, he will immediately be prescribed Vetmedin and 3 other drugs.
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Cathy,
I'm curious about your post. What are the three other drugs? You are saying that four drugs will be started at the same time? That this is the course for ALL dogs as soon as they go into CHF -- a "one size fits all" treatment plan rather than a drug regime geared to the particular dog's cardiac functioning as determined by an echo?
My experience has been far different - over a 15 year period with 10 elderly Cavaliers, a Peke, and a Shih Tzu. The treatment protocols were quite varied depending on the individual dog; there were different combinations of meds depending on the results from the echos and other tests, the symptoms in the particular dogs, etc. (I have had the same cardiologist for 15 yrs or so, but my regular vet and I can diagnose CHF. I then take x-rays and blood chemistry to cardiologist for an echo, more complete diagnosis and treatment plan. My dogs have had routine work-ups by cardio long before going into CHF.) Drugs were generally added one at a time to monitor whether or not symptoms improved and to monitor any side effects (either observed side effects or changes in blood chemistry). The idea is to use the least amount of drugs at the lowest dosages needed to control symptoms so that the dog is in "compensated" heart failure.
Pimobendan (vetmedin) was not started when CHF first began. All of my dogs began enalapril generally when there were changes in heart size and significant regurg on echo (before CHF ensued); lasix was generally added either when CHF first began or was "imminent," sildenafil (viagra) was used in some that had pulmonary hypertension; spironolactone sometimes added if increased diuresis needed; pimobendan added when CHF became refractory to other drugs and only when contractility was diminished, etc. Other drugs can be used such as hydralazine, hydrochlorthiazide, anti-arrhythmia drugs, etc., but I never had to use those. Only one of my Cavaliers and a Shih Tzu ever took pimobendan. Of the 11 that are gone, only two died of heart failure - one Cavalier of acute CHF (died 30 minutes after onset of symptoms) and the Peke died in his sleep of a fatal arrhythmia at age 16. The Shih Tzu died of pulmonary hypertension at 15. The others lived to be 13-16 and died of other causes (4 from cancer, 2 from kidney failure, 2 euthanized due to quality of life issues - senile/blind/deaf). The point of all that is to say that they were so well compensated on their heart meds that all but one Cavalier died from reasons other than CHF. Several were only ever on enalapril.
I've just never heard of such a "cut and dried" absolute drug regime before. I know that some cardios do start pimobendan earlier in the course of the disease (Dr. Gordon's paper discusses that); mine tends to wait later. (And my cardio studied at OSU under your cardio, assuming that yours is Dr. Bonagura!)
Pat
Atlanta