Heat stroke + Heart failure

Re: Heat stroke + Heart failure

Cesar Moreno — Thu, 01 Aug 2013 12:19:14 GMT

I´m agree with Anthony... and this is what we did.

Re: Heat stroke + Heart failure

Cesar Moreno — Thu, 01 Aug 2013 12:13:51 GMT

Owner said that the dog was fine before the groomer, eating & drinking as normal, playful. The groomer said the dog was normal as well. I was in the groomer and the temperature was very high so I´m quite sure it was that (during the heat wave in London). The dog now is normal and we didn´t give him any antibiotic.

Re: Heat stroke + Heart failure

Anthony Todd — Thu, 01 Aug 2013 08:56:21 GMT

[quote user="Michael Woodhouse"]

How have you decided the dog has heat stroke rather than pyrexia?

It's not uncommon to find a febrile dog with a temperature as high as 40.5°.

A shot of NSAID and temperature can have normalised in under an hour. Like kids and Calpol.

[/quote]

[I assume the dog was normal before it went to the groomers]

Why not just cool the dog, wet fur with cold water and put in front of the AC or fan in the office so that someone can watch it?

Assess in an hour.

I would have given it some Acp I suppose but there'll be thousands of esoteric contraindications these days....

Why turn a drama into a crisis?

Couldn't the dog just be hot?

Re: Heat stroke + Heart failure

Braden Collins — Thu, 01 Aug 2013 07:22:15 GMT

[quote user="David Mills"]In what circumstance is pimobendan dangerous?

[/quote]

I think it's contraindicated with outflow obstruction due to it increasing cardiac contractility. I'm not sure how dangerous this would be, and I would home some sort of abnormalities would have been found on previous checks if this was the case.

Re: Heat stroke + Heart failure

Michael Woodhouse — Wed, 31 Jul 2013 23:17:56 GMT

How have you decided the dog has heat stroke rather than pyrexia?

It's not uncommon to find a febrile dog with a temperature as high as 40.5°.

A shot of NSAID and temperature can have normalised in under an hour. Like kids and Calpol.

Re: Heat stroke + Heart failure

Cesar Moreno — Wed, 31 Jul 2013 23:06:16 GMT

I think would be better first of all treat the severe Heat stroke lowering the temperature (this can be mortal), O2 and then start with the heart failure ( furosemide, pimobendan). Once is stabilized start with investigations (ultrasound, ECG, etc).

Re: Heat stroke + Heart failure

Andrew Kent — Wed, 31 Jul 2013 22:35:04 GMT

[quote user="David Mills"]

[quote user="Andrew Kent"][quote user="David Mills"]In what circumstance is pimobendan dangerous?

[/quote] It has been associated with an increase in ventricular arrhythmias and as we don't know what arrhythmia this dog has we could make it worse with pimo. We have seen this lead to collapse in a couple of dogs.

[/quote]

Do you have a reference for this? 'Tis a very bold statement. And how sure are you that 'pimobendan led to collapse in a couple of dogs'?

Pimobendan is unique amongst the PDE inhibitors in that the majority of its action is by increasing sensitivity to calcium not calcium loading, and it has - as far as I'm aware (and happy to be corrected) - never been associated with arrhythmogenesis in people or animals; certainly nothing published in the latter that I've seen.

[/quote] My cases are completely anecdotal - start drug starts falling over, stop drug and stops falling over, but it seemed the most likely scenario.

there are some publications in people and I believe one in dogs showing increased susceptibility to ventricular arrhythmias when on pimobendan. It may increase the risk of sudden death in people which is why it is unusually used and usually combined with an anti-arrhythmic if used. If you can't find them easily I can have a look when I get some time. It is primarily a theoretical risk but I was using it to make the point about the OP.

BUT, a discussion of pimobendan wasn't really the point, it was illustrative to the fact that we need to know what arrhythmias are before wildly throwing random drugs at them and I really don't buy any excuse not to.

Re: Heat stroke + Heart failure

David Mills — Wed, 31 Jul 2013 22:18:47 GMT

[quote user="Andrew Kent"][quote user="David Mills"]In what circumstance is pimobendan dangerous?

[/quote]

Do you have a reference for this? 'Tis a very bold statement. And how sure are you that 'pimobendan led to collapse in a couple of dogs'?

Re: Heat stroke + Heart failure

Cesar Moreno — Wed, 31 Jul 2013 22:05:57 GMT

It was an emergency at groomers

Re: Heat stroke + Heart failure

Andrew Kent — Wed, 31 Jul 2013 20:03:52 GMT

[quote user="David Mills"]In what circumstance is pimobendan dangerous?

Re: Heat stroke + Heart failure

David Mills — Wed, 31 Jul 2013 17:21:29 GMT

In what circumstance is pimobendan dangerous?

Re: Heat stroke + Heart failure

Andrew Kent — Wed, 31 Jul 2013 14:53:01 GMT

[quote user="Michael Woodhouse"]

I wrote a long answer and computer deleted it.

I'd want the dog stabilising before running tests. I'm not going to give the dog a GA or sedation for rads. I want rid of the fluid, the heart to work better and to deal with any infection that may be there. Reassess tomorrow and do diagnostics in a few days with a patient with much lower anaesthetic risk.

Most practices don't have a decent doppler ultrasound and are doing 'proper echos'.

I'd be much more aggressive in my treatment if dog presented blue and collapsed.

From the brief description we have above the dog doesn't need stressing and being messed about at the vets.

[/quote] Clearly tests should not be run at the expense of the stability of the patients but an ECG and blood pressure and if possible an echo are well tolerated in most cases with some common sense. I think giving something like pimobendan without looking at the origin of the arrhythmia is dangerous. Equally there may be some drugs that are rapidly essential in certain arrhythmias. We can't assume we know what is wrong because we might make the dog worse rather than better.

Re: Heat stroke + Heart failure

Michael Woodhouse — Wed, 31 Jul 2013 10:08:21 GMT

I wrote a long answer and computer deleted it.

Most practices don't have a decent doppler ultrasound and are doing 'proper echos'.

I'd be much more aggressive in my treatment if dog presented blue and collapsed.

From the brief description we have above the dog doesn't need stressing and being messed about at the vets.

Re: Heat stroke + Heart failure

Andrew Kent — Wed, 31 Jul 2013 07:01:55 GMT

I'm not sure you can determine how to treat the dog without some more investigations, a minimum for me would be an ECG, some chest X-rays and a blood pressure. If possible an echo as well. Without that not sure you can treat blindly.

Re: Heat stroke + Heart failure

Linda Filshie — Wed, 31 Jul 2013 00:03:29 GMT

What kind of arrhythmia? Any chance of an ECG or cardiac ultrasound?

Re: Heat stroke + Heart failure

Michael Woodhouse — Tue, 30 Jul 2013 23:58:17 GMT

Not uncommon to have superimposed chest infection with wet lungs.

Frusemide/pimobendan and abs and reassess in 24 hours.Keep cool. Encourage to drink anything.

Any sign of dehydration or cyanotic then keep in and carefully give fluids +/- O2.

(I used to give these dogs steroids with the frusemide and when you saw them back the next day they were so much better. I stopped after some of the guys who know more about hearts tell me it makes things worse. Not my experience and I am leaning back towards my single shot of dex)