All SASH hospitals are open 24/7 all holiday season

Cardiology Commonly Asked Questions

Dr Phil Brain

What questions do you get asked most commonly by referring veterinarians regarding cardiology cases?

The two main questions I get asked by referring vets regarding cardiology cases are:

  1. When should I start cardiac medications such as Pimobendan?
  2. When should I start diuretic medications and other medications for Congestive Heart Failure?

So, when should you start Pimobendan?

Ideally commencing Pimobendan would be based on  echocardiographic parameters – so it is ideal to refer if necessary.

Less ideally, if no echocardiography – and you are presented with a small dog, > 6yo, loud murmur (>3/6), cardiomegaly radiographically based on VHS (> 10.5) or newer parameter VLAS (>3.0) it is reasonable to start pimobendan

What are the benefits of Pimobendan?

The EPIC study showed that Pimobendan can create a 15 month delay in Congestive Heart Failure. 60% more time in stage B2 (pre Congestive Heart Failure). 10% more life without Congestive Heart Failure.

What about Congestive Heart Failure and starting diuretic medication – when should you start?

It’s easier to start by answering when you shouldn’t start it. That’s when you have a coughing dog with a murmur and no evidence of pulmonary oedema. Ideally only start frusemide as a trial if increased SRR and radiographic evidence of pulmonary oedema AND/OR echocardiographic parameters supportive of increased atrial pressure.

Almost always a dog in CHF is a small dog, with a loud murmur, no sinus arrhythmia and left atrial enlargement- an exception to the rule is ruptured chordae tendinae when there may not be left atrial enlargement seen. A Frusemide trial can be done and document radiographic pulmonary oedema resolving and SRR decreasing to normal.

Do not use cough as indication to start or as a tool for monitoring.

But, some veterinarians tell me that a frusemide trial has resolved or improved a cough, doesn’t that mean that frusemide treatment is needed?
It’s more likely due to anti-tussive and bronchodilatory effects of drug. Using a cough only as a reference will result in too much frusemide than is necessary.

For more information, get in touch with the team at SASH

oncology book

Promotional Space for pet owners

The purpose of this valuable resource is to act as a practical guide to assist general practitioners to diagnose cancer earlier, provide more accurate information to clients.

For Vets

We only fill your inbox with happiness.

Share this page

More Resources

For Vets


For Vets