Vet Tips

Veterinary Tips from Dr. Tilley
11/29/2008

Two New Textbooks Just Published!

• Tilley, L.P., Smith, F.W.K., Oyama M., & Sleeper, M.: Manual of Canine and Feline Cardiology. 4th Edition. Saunders/Elsevier, St Louis, 2008.

• Tilley, L.P., Smith, F.W.K.: The 5 Minute Veterinary Consult – Canine and Feline, 4th Edition. Textbook, CD-ROM. Blackwell Publishing, Ames, Iowa, 2008.

Mitral Valve Disease - Standard Medical Therapy for Heart Failure

• Furosemide, an ACE inhibitor, and in some cases, digoxin if atrial fibrillation.
• Pimobendan has been approved for the treatment of mild, moderate, and severe CHF.


Spironolactone (Aldactone)

• When to use spironolactone or other aldosterone antagonist therapy is not clear at this time. I routinely administer spironolactone to patients with severe heart failure.
• Administration of spironolactone may be useful for myocardial remodeling.
• Spironolactone may reduce the risk of hypokalemia from chronic furosemide therapy.

Cardiac Disease and Anesthesia

• A neuroleptanalgesia combination using acepromazine will provide a sedative effect; however, acepromazine has a long duration of effect, including the effect of vasodilation. Acepromazine also has no reversal agent.

VPC's in a Boxer or Doberman

• The finding of isolated VPC's (ventricular premature complexes) in a young to middle-aged Doberman Pinscher or Boxer is highly suggestive of occult-dilated cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy. An ultrasound test should be done.

Holter Monitoring and the Doberman

• Holter monitoring is the current gold standard for detection of occult DCM in Doberman Pinschers. Holter monitoring is relatively easy to perform and equipment is readily available. Many veterinary telemedicine or remote consulting practices lease Holter units and assist in analysis.

Feline Hyperthyroidism

• Negative effect on the cardiovascular system – enhanced cardiac contractility, tachycardia, cardiomegaly, left ventricular hypertrophy, high cardiac output, systemic hypertension, and occasionally high output heart failure.


Hypertrophic Cardiomyopathy (HCM)– Feline

• HCM can be present, and the thoracic radiographs still be normal.
• Sudden death may occur in otherwise healthy appearing cats.
• Mask induction with isoflurane or sevoflurane is not recommended in cardiac patients. Most animals become very excited during mask induction, even with adequate preanesthetic medication, which could predispose to arrhythmias and increased myocardial work secondary to the stress response.

Hypertension in the Dog

• Dogs with a sustained systolic BP >160 mm Hg are likely to be proteinuric, often from renal disease.
• ACE inhibitors (e.g. enalapril, benazepril, etc.) have been shown to decrease proteinuria and cause balanced vasodilation. Benazepril (0.5 mg/kg) is first tried; given twice daily with blood pressure measured after 2 weeks of treatment. Amlodipine should be added if no response.

Submitted by:
Larry P. Tilley, DVM
Diplomate ACVIM (Internal Medicine)
Santa Fe, New Mexico