Management of Dilated Cardiomyopathy - questions provided by Dr Clarke Atkins

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Question n°1

Dogs with DCM develop mitral insufficiency secondary to myopathy but do not typically have significant mitral valvular endocardiosis (thickening and clubbing of valve)

  • Yes, the mitral insufficiency is mild and caused by heart enlargement (rather than thickening of the valve). However, it is probably clinically significant.

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Question n°2

The management of asymptomatic DCM typically emplys the use of an ACE Inhibitor, as there is clinical evidence for its efficacy?

  • In a retrospective study carried out by O Grady and associates, and published in 2009 the median days until clinical signs or death were significantly greater in those dogs that received benazepril (almost 100 days longer). So, it is generally felt that ACE Inhibitors are a treatment of choice in dogs with dilated cardiomyopathy but prior to the advent of congestive heart failure.

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Question n°3

After the onset of heart failure due to DCM, the ideal chronic therapy would include:

  • CORRECT - Once these animals go home then we are going to use triple therapy, which is furosemide, ACE Inhibitor and pimobendan but I also now believe that we have enough data to strongly indicate the use of spironolactone in this point. So chronic stage 3 would now be a quadruple therapy in my opinion.

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Question n°4

Pick the statement in the following list which is INCORRECT regarding furosemide therapy?

  • This is actually CORRECT. Furosemide reduces preload and, by the Frank Starling law, will cause the cardiac output to fall.

  • This is actually CORRECT. Furosemide reduces left atrial pressures and subsequently pulmonary oedema.

  • CORRECT. In fact, furosemide can result in hypokalaemia and hypomagnesaemia which will increase out chances of arrhythmia

  • This is actually CORRECT. By altering renal blood flow, furosemide has been shown to activate RAAS and increase plasma rennin, angiotensin II and aldosterone levels.

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Question n°5

Which of the following statements regarding digoxin is INCORRECT?

  • This statement is actually correct. In recent years, we have learned that lower blood levels of digoxin give us some of the neurohormonal benefits, such as reparation of baroreceptor function, and so we shoot for somewhat lower blood levels of digoxin than we used to and we have reduced our chances of intoxication.

  • YES, this is INCORRECT. Digoxin is generally only used in dilated cardiomyopathy for the management of supraventricular tachyarrhythmias, such as atrial fibrillation.

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Question n°6

Pick the INCORRECT statement concerning atrial fibrillation and DCM

  • Yes this statement is INCORRECT.

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Question n°7

Which of the following dietary advice would be recommended for dog which has just developed heart failure due to DCM?

  • INCORRECT – many standard dog foods are high in salt may exacerbate pulmonary oedema in Dilated Cardiomyopathy

  • INCORRECT – heavily salt restricted diets may activate the RAAS, which can be harmful. The use of heavily salt restricted cardiac diet should be reserved for refractory heart failure, particularly if we are having trouble controlling signs of congestion in this dog with dilated cardiomyopathy.

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