https://www.vetsurgeon.org/f/clinical-questions/19973/urgent-dyspnoeic-cat---opinion-on-chest-rads-please 6yo main coon not vaccinated sudden onset respiratory embarrasment yesterday evening - not eating today vitals HR 100 heart not muffled rhythm normal no murmur RR 120 crt 2s mm pink not open mouthed breathing pretty lethargic and dull t 39.5 noen-USTelligent Community 10https://www.vetsurgeon.org/thread/121512?ContentTypeID=1Fri, 26 Sep 2014 07:34:26 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:0c8457e5-f263-4938-8114-faf7bb28507fFrancisco Gomez<p>[quote]</p> <table width="100%" cellpadding="0" cellspacing="0" border="0"> <tbody> <tr> <td valign="top"> <div class="pageTitle"></div> <div class="showAbstract"> <div class="abstractSection"> <p><strong>Results</strong>&mdash;Cats receiving pimobendan had a significant benefit in survival time. Median survival time of case cats receiving pimobendan was 626 days, whereas median survival time for control cats not receiving pimobendan was 103 days.&nbsp;</p> </div> </div> </td> </tr> </tbody> </table> <div style="clear:both;"></div> <p>[/quote]</p> <p>Wow!! Weekend read!</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121509?ContentTypeID=1Thu, 25 Sep 2014 23:23:44 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:7646c69c-7b26-45da-b422-52991b1d5ac5mariette asselbergs<p>Thanks for that Alex, very helpful!</p> <p>mariette</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121460?ContentTypeID=1Thu, 25 Sep 2014 17:48:39 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:60dede93-398f-49d5-a07d-6909f01f5b6fAlex Gough<p>To follow up the pimobendam/HCM discussion, just came across this very recent paper, which shows a massive survival advantage in cases of HCM being given pimobendan:&nbsp;</p> <table width="100%" cellpadding="0" cellspacing="0" border="0"> <tbody> <tr> <td valign="top"> <div class="pageTitle">Abstract</div> <div class="journalTitle"><a target='_blank' href="http://avmajournals.avma.org/loi/javma">Journal of the American Veterinary Medical Association</a></div> <div class="black9pt">September 1, 2014, Vol. 245, No. 5, Pages 534-539</div> <div class="black9pt">doi:&nbsp;10.2460/javma.245.5.534</div> <br /> <div class="showAbstract"> <p class="fulltext">&nbsp;</p> <h1 class="arttitle">Case-control study of the effects of pimobendan on survival time in cats with hypertrophic cardiomyopathy and congestive heart failure</h1> <div class="Authors"><span class="name noWrap">Yamir<span class="NLM_x">&nbsp;</span>Reina-Doreste</span><span class="NLM_x">,&nbsp;</span>DVM<span class="NLM_x">:&nbsp;</span><span class="name noWrap">Joshua A.<span class="NLM_x">&nbsp;</span>Stern</span><span class="NLM_x">,&nbsp;</span>DVM, PhD<span class="NLM_x">;&nbsp;</span><span class="name noWrap">Bruce W.<span class="NLM_x">&nbsp;</span>Keene</span><span class="NLM_x">,&nbsp;</span>DVM, MS<span class="NLM_x">;&nbsp;</span><span class="name noWrap">Sandra P.<span class="NLM_x">&nbsp;</span>Tou</span><span class="NLM_x">,&nbsp;</span>DVM<span class="NLM_x">;&nbsp;</span><span class="name noWrap">Clarke E.<span class="NLM_x">&nbsp;</span>Atkins</span><span class="NLM_x">,&nbsp;</span>DVM, MS<span class="NLM_x">;</span><span class="name noWrap">Teresa C.<span class="NLM_x">&nbsp;</span>DeFrancesco</span><span class="NLM_x">,&nbsp;</span>DVM<span class="NLM_x">;&nbsp;</span><span class="name noWrap">Marisa K.<span class="NLM_x">&nbsp;</span>Ames</span><span class="NLM_x">,&nbsp;</span>DVM<span class="NLM_x">;&nbsp;</span><span class="name noWrap">Timothy E.<span class="NLM_x">&nbsp;</span>Hodge</span><span class="NLM_x">,&nbsp;</span>DVM<span class="NLM_x">;&nbsp;</span><span class="name noWrap">Kathryn M.<span class="NLM_x">&nbsp;</span>Meurs</span><span class="NLM_x">,&nbsp;</span>DVM, PHD</div> <div class="affiliations">Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607. (Reina-Doreste, Stern, Keene, Tou, Atkins, DeFrancesco, Ames, Hodge, Meurs)</div> <div class="NLM_author-notes"> <p class="first last">Dr. Stern&#39;s present address is Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.</p> <p class="first last">Dr. Ames&rsquo; present address is Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.</p> <p class="first last">Dr. Hodge&#39;s present address is Desert Veterinary Medical Specialists, 86 W Juniper Ave, Gilbert, AZ 85233.</p> <div class="NLM_corresp">Address correspondence to Dr. Stern (<a target='_blank' href="mailto:jstern@ucdavis.edu" class="email">jstern@ucdavis.edu</a>).</div> </div> <div class="abstractSection"> <p class="first"><b>Objective</b>&mdash;To assess survival time and adverse events related to the administration of pimobendan to cats with congestive heart failure (CHF) secondary to hypertrophic cardiomyopathy (HCM) or hypertrophic obstructive cardiomyopathy (HOCM).</p> <p><b>Design</b>&mdash;Retrospective case-control study.</p> <p><b>Animals</b>&mdash;27 cats receiving treatment with pimobendan and 27 cats receiving treatment without pimobendan.</p> <p><b>Procedures</b>&mdash;Medical records between 2003 and 2013 were reviewed. All cats with HCM or HOCM treated with a regimen that included pimobendan (case cats) were identified. Control cats (cats with CHF treated during the same period with a regimen that did not include pimobendan) were selected by matching to case cats on the basis of age, sex, body weight, type of cardiomyopathy, and manifestation of CHF. Data collected included signalment, physical examination findings, echocardiographic data, serum biochemical values, and survival time from initial diagnosis of CHF. Kaplan-Meier survival curves were constructed and compared by means of a log rank test.</p> <p><b>Results</b>&mdash;Cats receiving pimobendan had a significant benefit in survival time. Median survival time of case cats receiving pimobendan was 626 days, whereas median survival time for control cats not receiving pimobendan was 103 days. No significant differences were detected for any other variable.</p> <p class="last"><b>Conclusions and Clinical Relevance</b>&mdash;The addition of pimobendan to traditional treatment for CHF may provide a substantial clinical benefit in survival time for HCM-affected cats with CHF and possibly HOCM-affected cats with CHF.</p> </div> </div> </td> </tr> </tbody> </table><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121336?ContentTypeID=1Wed, 24 Sep 2014 13:13:27 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:feaefe5f-1782-4640-bff4-0e9104dddd1dAnthony Todd<p>[quote user=&quot;Martin Atkinson&quot;]</p> <p>[quote user=&quot;Anthony Todd&quot;]If anyone is interested I can detail my way which worked fine for us but, before I get accused of pontificating or teaching the obvious.....[/quote] At least you haven&#39;t suggested giving a precautionary dose of corticosteroids (yet) Anthony. <img src="https://www.vetsurgeon.org/emoticons/v2/devil.png" alt="Mischievous" /></p> <div style="clear:both;"></div> <p>[/quote]</p> <p>That was always given; everything got steroids and B12, even booster vaccs......, sometimes a month&#39;s pred as well.</p> <p>Been replaced these days by full bloods, X-rays and ultrasound......</p> <p>It&#39;s the pinkish colour of the jab that does it for most clients.</p> <p>&nbsp;</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121327?ContentTypeID=1Wed, 24 Sep 2014 11:17:26 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:41976dfc-75ed-4ada-b5f1-7d53dd7d4f9cMartin Atkinson<p>[quote user=&quot;Anthony Todd&quot;]If anyone is interested I can detail my way which worked fine for us but, before I get accused of pontificating or teaching the obvious.....[/quote] At least you haven&#39;t suggested giving a precautionary dose of corticosteroids (yet) Anthony. <img src="https://www.vetsurgeon.org/emoticons/v2/devil.png" alt="Mischievous" /></p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121296?ContentTypeID=1Tue, 23 Sep 2014 17:18:45 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:d95b581c-e805-4bf2-817b-fbd2cb719c83Anthony Todd<p>[quote user=&quot;alex gough&quot;]You might make it worse if you don&#39;t handle it sympathetically.[/quote]</p> <p>So true, we sent one for a second opinion and it expired whilst being positioned for the obligatory X-ray...</p> <p>If anyone is interested I can detail my way which worked fine for us but, before I get accused of pontificating or teaching the obvious.....</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121295?ContentTypeID=1Tue, 23 Sep 2014 17:10:48 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:729967d3-e275-4560-ab40-d901fe8fb121Alex Gough<p>[quote user=&quot;Anthony Todd&quot;]&nbsp;I think any dyspneic cat should be tapped in sternal recumbency at the first consult; you may save it&#39;s life, and you won&#39;t make it worse.[/quote]</p> <p>You might make it worse if you don&#39;t handle it sympathetically. Any restraint and it might crash. My approach with dyspnoeic cats is to get them in an oxygen tent immediately, then after a few minutes do a very brief ultrasound scan of the chest, no clip, just spirit to damp the fur down, and you will know straight away whether there is an effusion, and can decide on a therapeutic thoracocentesis then (which I agree should be very high on the to do list.)</p> <p>Alex</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121294?ContentTypeID=1Tue, 23 Sep 2014 17:07:54 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:dbfc7c2c-6977-4114-941a-5badb2859febMartin Atkinson<p>[quote user=&quot;Elizabeth Billimore&quot;]....a bit harsh.[/quote] On whom? Anthony expects it and will dish it back. As for the rest: notice the &#39;wicked&#39; smiley. I don&#39;t doubt what you have said in reply.</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121293?ContentTypeID=1Tue, 23 Sep 2014 17:00:02 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:8c554d09-50c1-4023-a61d-7f03e897ee20Anthony Todd<p>[quote user=&quot;Elizabeth Billimore&quot;]I thought everyone was being taught that you should tap the chest before x-rays in a dyspneic cat these days if you suspect effusion on exam.[/quote]</p> <p>So why don&#39;t you see or hear it being done first up? &nbsp;I think any dyspneic cat should be tapped in sternal recumbency at the first consult; you may save it&#39;s life, and you won&#39;t make it worse.</p> <p>If it&#39;s negative on one side do the other, if positive then do both sides anyway.</p> <p>Pontification is better than bull dust I suppose.</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121291?ContentTypeID=1Tue, 23 Sep 2014 16:48:45 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:0c3a2c39-9544-43aa-a854-68230277445aBibs<p>[quote user=&quot;Martin Atkinson&quot;]</p> <p>[quote user=&quot;Anthony Todd&quot;]Just another reason to have a look at the chest fluid at the beginning of the saga.....[/quote]I disagree with most of what you pontificate on about Anthony old man but I agree that thoracocentesis is a very useful form of early intervention both diagnostically and therapeutically and I have saved the life of more than one cat by performing if before X-rays as they have been too critical to restrain. Yet another simple thing with virtually no serious complications that the newer generation of vets are scared to perform without X-rays, ultrasound and probably MRI as well first (albeit Iain looks past the first flush of youth). <img src="https://www.vetsurgeon.org/emoticons/v2/devil.png" alt="Mischievous" /></p> <div style="clear:both;"></div> <p>[/quote]</p> <p>&nbsp;</p> <p>....a bit harsh. I thought everyone was being taught that you should tap the chest before x-rays in a dyspneic cat these days if you suspect effusion on exam. In a case like this the chest is not full of fluid so it might not clinically look like a typical pleural effusion and you might miss the fluid on a blind tap so maybe sticking a ultrasound probe on the chest wall with the cat in sternal and getting flow by oxygen wouldn&#39;t be such a bad thing if stable enough.&nbsp;</p> <p>&nbsp;</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121286?ContentTypeID=1Tue, 23 Sep 2014 15:34:33 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:c898d662-f1a7-499e-a3b0-4eccfe008861Martin Atkinson<p>[quote user=&quot;Anthony Todd&quot;]Just another reason to have a look at the chest fluid at the beginning of the saga.....[/quote]I disagree with most of what you pontificate on about Anthony old man but I agree that thoracocentesis is a very useful form of early intervention both diagnostically and therapeutically and I have saved the life of more than one cat by performing if before X-rays as they have been too critical to restrain. Yet another simple thing with virtually no serious complications that the newer generation of vets are scared to perform without X-rays, ultrasound and probably MRI as well first (albeit Iain looks past the first flush of youth). <img src="https://www.vetsurgeon.org/emoticons/v2/devil.png" alt="Mischievous" /></p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121279?ContentTypeID=1Tue, 23 Sep 2014 14:06:23 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:890b937a-e399-4fe1-9253-78efa0feffc6Anthony Todd<p>[quote user=&quot;Martin Atkinson&quot;]</p> <p>Only just come to this. Clearly the cat may be better or pushing up daisies by now but am I the only one to think it doesn&#39;t have a clean ventral diaphragmatic line? Might fit the sudden onset.</p> <div style="clear:both;"></div> <p>[/quote]</p> <p>Just another reason to have a look at the chest fluid at the beginning of the saga.....</p> <p>&nbsp;</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121276?ContentTypeID=1Tue, 23 Sep 2014 13:08:37 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:2bcee0d8-c8ee-4176-968c-0f5324433682Martin Atkinson<p>Only just come to this. Clearly the cat may be better or pushing up daisies by now but am I the only one to think it doesn&#39;t have a clean ventral diaphragmatic line? Might fit the sudden onset.</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121249?ContentTypeID=1Mon, 22 Sep 2014 20:43:37 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:ff93cf34-f55a-49e5-a3ac-77d777f16de4mariette asselbergs<p>&quot;<span>The problem, speaking as an ECC clinician, is that ECC clinicians tend to trade in experiential certainties based on theories given the incredibly poor evidence base - given the diverse and critical nature of ECC patients and the inherent problems in obtaining reliable data - but few of them are cardiologists.&quot; David Mills</span></p> <p><span>The person explaining why pimobendan was contra-indicated in hypertrophic Cardiomyopathy was a cardiologist, Ruth Willis,lecturing on the BSAVA ECC Cert course and answering a question about the use of pimobendan in these cases. &nbsp;In combination with your posting I would be willing to try and see.... and maybe read some more. Mariette,</span></p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121183?ContentTypeID=1Sun, 21 Sep 2014 21:31:11 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:713f2882-4e43-42d3-a97e-a7c8eabc3f5aBibs<p>What do people think about the pulmonary veins on this X-ray? They look a little big to me and that would also fit with heart failure (but I&#39;ve only recently starting looking for them on xrays after doing cpd). Looks like a soft tissue opacity ventral chest - probably fluid. Would be interesting to know what happened.</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/121175?ContentTypeID=1Sun, 21 Sep 2014 11:54:52 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:47553adc-f551-4b09-867f-8d7440b421acAnthony Todd<p>What happened to the cat and the diagnosis?</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/120236?ContentTypeID=1Thu, 04 Sep 2014 00:30:08 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:60b897e7-b20b-4a8a-a8a7-1da398d71fa2Anthony Todd<p>Geez, if you&#39;d done a conscious chest tap we&#39;d probably know the diagnosis and prognosis before the Xrays had been developed....<img src="https://www.vetsurgeon.org/emoticons/v2/Hot_smiley.png" alt="Cool" /></p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/120227?ContentTypeID=1Wed, 03 Sep 2014 17:23:17 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:f3e18517-4f61-472d-a453-d52cc3efbe82Iain McAllister<p>Sorry for the slow follow up&nbsp; - I was working for&nbsp;an &nbsp;emergency service&nbsp; so I was unable to follow it up after discharging in the morning &nbsp;- that evening I gave&nbsp;him 2 shots of frusemide at 8 hourly intervals but didn&#39;t give him any vetmedin - the HR went up to 130 and the respiration rate decreased to 60 -&nbsp; I will be working in his day practice next week so will try to find out what has happened with him </p> <p>Thanks for the help on the night though - much appreciated </p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/120206?ContentTypeID=1Wed, 03 Sep 2014 13:52:24 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:d0ab047c-edeb-42ee-aaf2-8a6966867c29Rob Loxley<p>Also effects of pimobendan on phosphodiesterase will help vasodilation</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/120178?ContentTypeID=1Wed, 03 Sep 2014 00:58:55 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:ea9a88a9-863f-43f7-871e-67650924c495David Mills<p>[quote user=&quot;mariette asselbergs&quot;]</p> <p>If hypertrophic cardiomyopathy, then that is one of the few (the only) heart condition in which vetmedin is actively contra-indicated, supposedly because its inotropic effect might cause more obstruction of the diastolic function.</p> <p>Mariette</p> <p>[/quote]</p> <p>&nbsp;</p> <p>Part of the problem with HCM is generalisation. Its a diverse disease. However, in advanced form, and possibly in earlier forms, there is usually systolic dysfunction as well, mediated, theoretically, by fibrosis, hypoxia, dyskinesis, caused by the HCM phenotype. Some people postulate that it is this systolic dysfunction that tips them over, finally into CHF.</p> <p>Pimobendan is not only a positive inotrope, but part of its beneficial effects are mediated by a positive lusitropic effect, that is, a more rapid rate of relaxation. This mediates a significant improvement in diastolic function. So, in HCM, we have a positive diastolic and systolic improvement. Add to this its anti-cytokine effect (&#39;the happy cat&#39; effect) and I think it&#39;s an excellent drug for HCM.</p> <p>The problem, speaking as an ECC clinician, is that ECC clinicians tend to trade in experiential certainties based on theories given the incredibly poor evidence base - given the diverse and critical nature of ECC patients and the inherent problems in obtaining reliable data - but few of them are cardiologists. Therefore I wouldn&#39;t, necessarily, take it as gospel that it can worsen diastolic function in any way given the - proven - way it performs.&nbsp;</p> <p>Equally, I would use it in HOCM cases. HOCM is a problem primarily when the pressure difference between LV and LVOTO is too low and the blood is diverted into the LA preferentially. This is why beta blockers will improve things in prolonging the diastolic phase and therefore improving LV filling pressures. Pimobendan will improve diastolic relaxation rate (and therefore improve diastolic filling) - as well as improving force of LV contraction - which will help with this condition.</p> <p>There is plenty of evidence out there for pimobendan in cats with CM. More than giving cats frusemide with CHF. Far, far, far more than ACEis for cats in CHF...</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/120163?ContentTypeID=1Tue, 02 Sep 2014 21:19:48 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:041988c9-c1f9-4914-8c54-4e597b9f8296Rob Loxley<p>[quote user=&quot;mariette asselbergs&quot;]But the article only talks about congestive heart failure without specifying the cause[/quote]</p> <p>40% had HCM, 37% unclassified CM, but of the whole 73% had evidence of systolic dysfunction. As I said I&#39;d be cautious about using it early, or if LVOTO or SAM was confirmed.</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/120154?ContentTypeID=1Tue, 02 Sep 2014 17:51:08 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:0d4bb037-773c-488d-b182-bd3e618f4b63Anthony Todd<p>Anyway.... WTF happened to the cat?&nbsp;WTF was it? [seeing we&#39;re back in the land of TLAs]</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/120150?ContentTypeID=1Tue, 02 Sep 2014 16:55:51 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:52989de6-74fd-42ae-bff0-9ababe700c23mariette asselbergs<p>[quote user=&quot;robloxley&quot;]</p> <p>[quote user=&quot;mariette asselbergs&quot;]hypertrophic cardiomyopathy, then that is one of the few (the only) heart condition in which vetmedin is actively contra-indicated, supposedly because its inotropic effect might cause more obstruction of the diastolic function[/quote]</p> <p>I&#39;ve&nbsp;see a number of cats that develop systolic dysfunction, often late on in their congestive stage, that wouldn&#39;t truly be classed as primary DCM, that have improved with Vetmedin. There are larger scale case reports <a target='_blank' href="http://www.sciencedirect.com/science/article/pii/S1760273411000725">http://www.sciencedirect.com/science/article/pii/S1760273411000725</a>&nbsp;also, but agree&nbsp;I&#39;m not sure I&#39;d have it as a first line drug (cf dogs)?</p> <div style="clear:both;"></div> <p>[/quote]</p> <p>&nbsp;</p> <p>But the article only talks about congestive heart failure without specifying the cause. &nbsp;If the cause is HYPERTROPHIC cardiomyopathy, with failing diastolic filling, then pimobendan is supposed to be contraindicated. &nbsp;It is stated as a contra-indication in the BSAVA Formulary, and was explained on my ECC course as potentially obstructing diastolic filling even further. &nbsp;This sounds more or less logical to me, although I haven&#39;t seen any7 disasters from therapeutic trial therapy with pimobendan of cats which turned out to have HCM. &nbsp;(Not DCM).</p> <p>Mariette</p> <p>&nbsp;</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/120146?ContentTypeID=1Tue, 02 Sep 2014 16:47:34 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:0fa6bf4a-84fd-46bb-92c5-18dc7f98273bRob Loxley<p>[quote user=&quot;mariette asselbergs&quot;]hypertrophic cardiomyopathy, then that is one of the few (the only) heart condition in which vetmedin is actively contra-indicated, supposedly because its inotropic effect might cause more obstruction of the diastolic function[/quote]</p> <p>I&#39;ve&nbsp;see a number of cats that develop systolic dysfunction, often late on in their congestive stage, that wouldn&#39;t truly be classed as primary DCM, that have improved with Vetmedin. There are larger scale case reports <a target='_blank' href="http://www.sciencedirect.com/science/article/pii/S1760273411000725">http://www.sciencedirect.com/science/article/pii/S1760273411000725</a>&nbsp;also, but agree&nbsp;I&#39;m not sure I&#39;d have it as a first line drug (cf dogs)?</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/120139?ContentTypeID=1Tue, 02 Sep 2014 10:44:12 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:218fbee4-78cb-448e-b0cd-a4019ef3d289mariette asselbergs<p>[quote user=&quot;Iain McAllister&quot;]</p> <p>thanks for all that - would iv vetmedin be helpful do you think?</p> <div style="clear:both;"></div> <p>[/quote]</p> <p>If hypertrophic cardiomyopathy, then that is one of the few (the only) heart condition in which vetmedin is actively contra-indicated, supposedly because its inotropic effect might cause more obstruction of the diastolic function.</p> <p>Mariette</p><div style="clear:both;"></div>