https://www.vetsurgeon.org/f/clinical-questions/23204/use-of-pimobendan-in-mmvd-prior-to-onset-of-clinical-signs-of-chf I am aware of the EPIC trial that has been investigating whether pimobendan can delay time to onset of congestive heart failure in cases of mitral valve disease. I understand the trial was prematurely stopped as they found enough evidence that it diden-USTelligent Community 10https://www.vetsurgeon.org/thread/141587?ContentTypeID=1Mon, 17 Aug 2015 08:45:02 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:039cef48-d3f0-4bcc-ba1d-7d0a255d5922Rob Loxley<p>[quote user=&quot;Hannah Wynne Richards&quot;]as soon as a murmur was detectable[/quote]</p> <p>The inclusion criteria for the EPIC trial, however, required echocardiographic evidence of left atrial dilation and radiographic evidence of cardiomegaly. So not every dog with a murmur</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/141586?ContentTypeID=1Mon, 17 Aug 2015 08:11:02 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:f1058e01-2513-4c58-867e-4314c57ec21fHannah Wynne Richards<p>&nbsp;Round we go in circles. When I was a student we were taught to start treatment (frusemide and digitalis in those days) as soon as a murmur was detectable. The theory was that it prevented irreversible stretching of cardiac muscle. Then the cardiologists said not to treat until the onset of clinical symptoms as human studies had shown no advantage in earlier treatment. My doubt about that approach has always been that humans can say if they&#39;re feeling tired at exercise, whilst owners may not notice in a dog.</p> <p>Now we&#39;re back to early treatment again!</p> <p>Wynne</p><div style="clear:both;"></div>