What to ask the vet,

[emmastewartliberty]

Hello
I have just left Tilly, a rescue girl from a puppy farm that I've had for about 5 weeks, in to the vet for a general check up prior to her spay. He has found a "marked irregularity"
in her heart beat- and when he told me where to put my hand I could feel it myself. we have decided against having her spayed until he can regulate it.( She's about 7 or 8 he reckons). Should I ask him about seeing a cardiologist and whats the state of play re recommended drugs- I was checking the forum and it seems pimobendan is now the preferred option?
Any help or advice would be so appreciated. I'm worried sick-, having lost my sweet little whisper-a similar life story, to pancreatitis earlier this year, this time i want to be as informed as possible.
Thanks
Emma

[Karlin]

Sorry there are signs of a heart issue- though for that age in this breed, it would be more likely than not for there to be a murmur. But what was he saying she has - I assume a murmur? Did he guess at a grade? Did he see any other signs of MVD?

Ideally you'd want to see a cardiologist but specialist care is generally more costly. A basic auscultation though would still tell you far more than you will get from most vets. There is much debate over when to start meds but most would not treat a murmur unless there are initial signs of congestive heart failure. Some vets and cardios do give some drugs earlier than symptoms though.

I'd want to know the details of what a 'marked irregularity' means. MVD and a murmur? What grade? CHF? To what degree? If meds are advised, why? And prognosis?

[emmastewartliberty]

Well, went i went back to collect Tilly- she was having bloods done, being micro chipped and her glands seen to,I asked him was the irregularity a murmur, he said no, but he has put her on Vetmedin- 1.25mg a day for 14 days, then I've to bring her back in. I think he's doing this to see if her heart settles down enough to be spayed, but I'm not keen to put her through a general anasthetic, if there is a question of heart problems,( and he said he absolutely didn't want to give her a GA at the moment,) and am happy to deal with her being on heat in the future. I did print off stuff from the health pages to bring with me, and I believe he will look at them over the next two weeks. Have you any experience of this drug she is on?,
In the mean time , Tilly is in great form, loves her grub, loves her walks once it's not anywhere near the sea- scary-and loves the other dogs here- three of them curl up together in a big bed.
Thanks for your answer, fingers crossed all goes well.

[Karlin]

In your shoes, I'd really want to know what he thinks the irregularity is and why he put her on Vetmedin. Vetmedin is pimobendan. It is generally given for congestive heart failure (end result of MVD). Heart problems are not that big a concern with a GA unless very very advanced. She would be at a far more serious risk for pyometra, which can be fatal ( female cavaliers have one of the highest risk levels for any breed - up around a 40% lifetime risk).

[Pat]

The vet is talking about an arrhythmia - this is an irregular heart rate - could be too slow (bradycardia), could be too fast (tachycardia), could be erratic. There are different kinds of arrhythmias (ventricular tachycardia, PVCs, SVT, atrial fibrillation, etc.). On the other hand, he may have heard a pronounced sinus arrhythmia - this is perfectly NORMAL for Cavaliers.

There are other meds used for arrhythmias that are not used for MVD or CHF. A diagnosis is made from an ECG (or EKG) which is an electrocardiogram. Serious arrhythmia problems can result in syncope (fainting) or sudden death.

I would absolutely consult a cardiologist in this case. GP vets are just not equipped to deal with serious arrhythmias.

Rushing to attend a meeting - I'll post links later.

Pat

[Pat]

Just have a second - but further to my post:

1. Arrhythmias are usually not a component of degenerative valvular disease (MVD) until the disease is advanced or end stage and the dog is already in congestive heart failure. They are more often found in DCM (dilated cardiomyopathy) which is the heart disease found in large breed dogs - boxers, dobermans, great danes, labs. This is one reason why the prognosis for DCM is worse than the prognosis for MVD. I had one 16 year old Peke in advanced MVD die of cardiac arrest from a fatal arrhythmia, and a friend lost a Cavalier to a fatal arrhythmia, but this is not a common occurrence with MVD. Fainting (syncope) from arrhythmias is common. At the AVMA seminar, Dr. Abbott commented that the only difference between syncope and death is that you wake up if it's syncope. Many years ago, I had to have a 24 hour Holter monitor ECG done for one of my Cavaliers because her arrhythmia could not be detected on a regular, short ECG because it was so infrequent.

2. Originally, (and I'm not sure if there is updated research) there was much concern among cardiologists that pimobendan (Vetmedin) could be a "pro-arrhythmic" drug - which means that there could be a side effect of making certain kinds of arrhythmias WORSE. There were reports of sudden death, but mainly in dogs with DCM. This was outlined in Dr. Sonya Gordon's ground-breaking paper on pimobendan. This and other research can be found on Rod's site. In fact, hopefully Rod will see this thread and he can comment on more recent research.

3. There are other drugs used specifically for arrhythmias, but the choice of drug and dosage and monitoring is very tricky and most GP vets don't use these drugs - they usually refer to a cardiologist. These include sotalol and mexitil. Digoxin (and pimobendan also) are used to slow down a fast heart rate (tachycardia) but the other drugs are used for some of the other types of arrhythmias. Pacemakers are used for serious bradycardia (slow heart rate) due to defects like sick sinus syndrome, second or third degree A/V block, etc.

4. As Karlin stated, the risk of anesthesia in dogs with MVD is not particularly serious. The risk is VERY serious for dogs with arrhythmias, particularly if the kind of arrhythmia is not diagnosed and is not controlled by meds.

http://www.petplace.com/dogs/cardiac...ogs/page1.aspx
(lots of pop up ads in this link - sorry, just close them)

http://www.vetinfo.com/canine-cardiac-arrhythmia.html

http://www.heartydog.co.uk/diseases/...hythmias.shtml

http://www.dogchannel.com/dog-inform...is-normal.aspx

Pat (written quickly and not proofread)

[emmastewartliberty]

Thank you both for all the info.I have read all the articles on the links- thank you Pat.. It seems sensible to bring her to a cardiologist, hopefully there is one here in the west of Ireland, otherwise I will bring her up to Dublin.
It seems to me that she has an arrythmia, so now I'm worried about the drug she is on, I will phone the vet tomorrow.
Thanks again

[RodRussell]

... This was outlined in Dr. Sonya Gordon's ground-breaking paper on pimobendan. This and other research can be found on Rod's site. In fact, hopefully Rod will see this thread (perhaps not because of the title of the thread) and he can comment on more recent research. ...

I just read this -- as Pat predicted. I don't have much of anything to add to what Pat wrote. I cannot say for sure that pimo is an advisable first medication to prescribe for an arrhythmia. I do know that some pimo salesmen are very aggressive in hyping the wonders of pimo to general practice (GP) vets. So, I get very wary of GP vets who prescribe it because I fear they are doing so without taking the precautions that a cardiologist would. For example, our cardiologist required that our dogs have electrocardiograms before he decided if pimo was appropriate.

I've witnessed Cavaliers suffer over-active hearts due to taking pimo, even though they were in congestive heart failure, but despite that fact their heart muscles were strong and did not need the extra kick of pimo. For one Cavalier, I could see his heart beats on the exterior of his chest wall after taking pimo prematurely.

In summary, I would not let a GP vet administer pimo to any of my Cavaliers, but I realize that in some communities, finding a cardiologist or internal medicine specialist is not easy.

[emmastewartliberty]

Thank you Rod, I know from reading lots on this forum that you know so much about this. I am in a terrible quandry about what to do, so I will phone the vet tomorrow and discuss it with him- in light of all your and Karlin and Pat's input i think it may be for the best to stop the medication. She has been on it a week now. It's too easy to try and soldier on when you are quite some distance away from experts.
thanks again.