I attended a lecture by I

I attended a lecture by I believe Lombard at ECVIM back in 2003 when you had to do a pile opf paperwork to even use Pimo in USA. He was discussing how pimo was marketed in europe orioginally in th elate 1990s and lots of sudden death occurred because the vet would hear a murmur and start pimo as the magic bullet and boom dead dog. North america was very slow to bring pimo on board and started as an end stage ally oop cant hurt therapy and then a C1 and now a B2. The problem with B2 is that they are not all created equal and I have had this discussion with Peter and I’m sure he will discuss this with lots iof good research that doesnt get front page news (the kids that dont sit at the cool table research) as he always does and why I love his cardio game so much. And B2 is where all the heated discussions happen on cardio circles right now which is a progression of the when to use and acei discussions of the 2000s.

The answer is tx the patient and “treat what you see on echo with solid criteria” which is the best advice I received from my original mentor in 2001. “Forget about categorizing and labeling but tx what you see.”

So shameless plug but Peter is leturing at our echo lab in October

https://sonopath.com/educationevents/2019-sonopath-sdep-veterinary-ultrasound-training-educationce-events/sdep-echo-lectu

at our new facility in Andover, NJ (advanced to beginner tables in lab) and lots and lots of Peter and a little bit of me:)

But aside from that, as i know of I have never had a sudden death starting pimo on a B2 even an early B2 but never ever use it without volume overload LVE LAE and VHS enlargement though i personally despise the VHS because vets start meds when not needed based on VHS and echo hasnt been done but that’s another story.

I use the LA max measurement as my end all and use la/ao june boon and heart base as supportive measurments but a correct LA max measurement is the most consistent expecially in KCS that always expand out of the june boon (JB) angle so JB doesnt work well with KCS and usually underestimates the LA size. Moreover, B2 can be minor with minor atrial septal deviation or severe and just not in C1 wet lung yet. So I will add lasix in the advanced B2 and look for hypertension and reason to add an acei anywhere in B2. Why not tx when C1 is knocking on the door? Why let the patient get there and not be a little proactive in advanced B2?

But every case ids different so we have to look at the patient confirmation as a labrador B2 will look different than a KCS B2. What’s the basal resp rate? Is there main stem bronchus impingement by the LA on rads? Is there concurrent bronchial disease or even bronchomalacia and collapsing trachea causing/contributing to the cough? Then combine the findings with FS% LVIDd and LA max and other.

I think studies try to put things in a box but then we lose the art of veterinary medicine that actually treats the patient and keeps the tail wagging in dogs and cats chasing the ball without turning blue. If the patient is clinical with ex intoll, cough, increased resp rate and has B2 + then we do something and the patient improves. Then we have done our job and we mointor and stay ahead of the degenerative process best we can. And if anyone says anythign regarding my protocol I just ask, “So how’s the patient?” 🙂

Ok Off my Sunday cardio soap box:)