I have a 7 year MN Border Collie with acute onset of grade III/VI systolic heart murmur. I have been bad and not been practicing my echo skills as often as I should be but yesterday I decided to do a mini practice echo- he was very whiny and hyper and hard to get to sit still. I do not have a cardiac probe to measure MR so thats why again I always have the cardiologist come check because I am new and do not have all the good equipment yet.
I got LA measurement of 3.27-3.5 and aorta to 1.27. Cardiac xrays have a VHS of 10.
I have a 7 year MN Border Collie with acute onset of grade III/VI systolic heart murmur. I have been bad and not been practicing my echo skills as often as I should be but yesterday I decided to do a mini practice echo- he was very whiny and hyper and hard to get to sit still. I do not have a cardiac probe to measure MR so thats why again I always have the cardiologist come check because I am new and do not have all the good equipment yet.
I got LA measurement of 3.27-3.5 and aorta to 1.27. Cardiac xrays have a VHS of 10.
Had the board certified cardiologist in and her report is LA in 2d was 3.9cm, ldvv 4-4.4 (nervous nad panting), fs average 33%. She calls mild mitral insuff which is fine but then says no volume overload.
The chart in my ultrasound book says that normal LA for a 30kg dog is 2.5.
I call this volume overload, is that wrong? Cardiologist says do not need meds. I am inclined to start heart meds
Comments
Hello!
The LA measurement
Hello!
The LA measurement range in my older June Boon book for a 30 kg dog is 2.1-3.6 cm. Did you get this measurment in the LA/AO Boon technique? Sometimes, if the cursor is not straight down through the LA and slightly obliqued, it can make the LA seem bigger as the cursor is going diagnonally through the LA and maybe even catching some of the left auricle. The LA 2D or LA max is a slightly different measurement.
THe VHS score does not indicate that cardiomegaly, and volume overload, is present. Also per the EPIC study, I calculate the normalized LV dimension in diastole using the 4.4 measurement at 1.6 which is less than the 1.7 as a criteria in the study to start medication. I would say this dog is headed toward some degree of volume overload but is not there yet and its hard to say when or if this wil happen. I would have the onwers monitor resting respiration rate at home with recheck if the RRR >30-35 breaths per min. Recheck echo in 6 months regardless.
Its more helpful to see where
Its more helpful to see where the measurement is on an image…. here are some LAE vs non LAE notes.
1) Don’t go by measurmenets alone go my morphology. All the studies in the world won’t capture the breed and individual variability.
2)Check out Peter and my scanning pearls on Peter’s page there is a link in the bottom. This is good solid crietria to go by and works in every patient.
https://sonopath.com/about/specialists/peter-modler-dvm-dipl-tzt
3) Consider Epic study crietria top when to pull out the meds on an early LAE and ensure you have all the criteria… then if people ask why you started pimo you just quote the study as its the latest point of reference on this issue.
Here are my bullet point notes on the Epic study and related studies regrading B2… the treatable level of valve disease:
Epic Study based treatment recommendations regarding B2 valvular disease
Valvular disease patients from 4-15kg wt, multicentric global prospective double-blinded study with pimobendan vs placebo treated patients with B2 valve disease
Echocardiogram is essential to allow for proper treatment using ACVIM consensus criteria stages A-D
Pimobendan treatment target of stage B2 valvular disease with this criteria
1) B2: enlarged LV & LA
2) Lateral radiograph VHS score > 10.5
Historical MST for B2 patients: B2 to C is 800 days then once in CHF MST is 200 days.
Epic study focused on this 800-day period between B2 to C
Stage C is wet lung (traditional CHF) with both increased HR at rest & increased respiratory rate.
B2 Echocardiogram Criteria:
La/Ao Swedish method > 1.6
LVIDd> 1.7 *** (Lvidd cm/bw 0.294)
VHS > 10.5 in lateral
Epic treatment protocol results
Pimobendan 1228 days B2 to C1
Placebo 788 days B2 to C1
15 month period from B2 to C1 compared to 7 months if not given Pimobendan in stage B2
Boswood A, Haggstrom J, Gordon SG,Et al. Effect Of Pimobendan In Dogs With Preclinical Myxomatous Mitral Valve Disease And Cardiomegaly: The EPIC Study-°©‐A Randomized Clinical Trial. J Vet Intern Med 2016;30:1765-°©‐1779.
Side Cardiac Tx Notes:
Protect Study DCM in Dobies: Solid benefit of Pimobendan
According to SVEP 1 & 2 & Vetproof studies there is no evidence that ACE inhibitors delay the onset of C1 valvular disease (CHF) but some use may still be accepted in these cases especially if other benefits of ACE inhibitors can be optimized such as hypertension or proteinuria.