Irish Wolfhound with DCM/atrial fib.

RE: Irish Wolfhound with DCM/atrial fib.

Matt Hilary — Wed, 13 Jun 2018 20:54:00 GMT

Many thanks everyone, lots of good advice.

RE: Irish Wolfhound with DCM/atrial fib.

Martin Atkinson — Tue, 12 Jun 2018 08:55:03 GMT

[quote user="David Mills"]In humans recent work has shown rate control may be superior to rhythm in AF. May be. [/quote]I know this is little to do with the OP but out of interest, this is my cardiologist's logic. He originally intended putting me on Bisoprolol until I reminded him that I suffer from Raynauds' Syndrome and beta blockers can cause peripheral vasoconstriction which would not be helpful so he changed it to Diltiazem.

[quote user="David Mills"]Diltiazem will do nothing for vpcs, just increase av conduction time and so reduce rate. [/quote]I has certainly slowed my ventricular rate and virtually eliminated the VPC's probably because they were driven by the AF but then I've suffered from palpitations all my life and the AF is a new phenomenon.

RE: Irish Wolfhound with DCM/atrial fib.

David Mills — Mon, 11 Jun 2018 21:16:27 GMT

In humans recent work has shown rate control may be superior to rhythm in AF. May be.

In dogs, digoxin and Diltiazem concurrently have been shown to be superior to either alone for rate control. Diltiazem will do nothing for vpcs, just increase av conduction time and so reduce rate.

I start most dogs with hypocontractility on beta blockers. It's widespread in humans and has been shown to improve both qol and survival. It seems counterintuitive but it is antagonising sympathetic drive, which improves cardiac myocyte blood flow, oxygenation, reduces ischaemia, fibrosis, and improves contractility by slowing heart rate slightly in addition to above. So I would trickle these in, weekly increments over 4 to 6 weeks. Choose whichever, I normally use atenolol bid.

Amiodarone is a fascinating drug and safer than what you would believe but needs very careful monitoring. It can cariovert AF in dogs iv. But oral therapy can have profound beneficial effects for these dogs.

Lidocaine won't do anything for AF as AF is atrially mediated, lidocaine works against excitable ventricular cells.

Otherwise, yes, increase pimo dose, though may be a slight increase in rate (AV node mediated). Maximise frus (more times per day better than more at once). Add beta blockers. And realise that whilst most DCM patients will be on a lot of drugs, they won't be on them for long.

RE: Irish Wolfhound with DCM/atrial fib.

Martin Atkinson — Mon, 11 Jun 2018 18:58:52 GMT

[quote user="Anthony Dennison"]

I would agree with what has been mentioned earlier - increase the pimobendan dose. Boehringer had a meeting with us a couple of weeks ago and suggested that would help in terminal cases (can go above the dose range given).

[/quote]Yes, it was advice given by a cardiologist (our own Mike Martin IIRC). Its a last throw of the dice when you've used everything of the pharmacy shelf!

RE: Irish Wolfhound with DCM/atrial fib.

Anthony Dennison — Mon, 11 Jun 2018 17:56:26 GMT

RE: Irish Wolfhound with DCM/atrial fib.

Robin Grimmer — Mon, 11 Jun 2018 17:23:38 GMT

I would be very cautious about upping the dig as easy to overdose especially in a giant breed. I would check blood dig levels first. I would probably go for a beta blocker. Start low - you need to get the heart rate down. You've got nothing to lose, prognosis poor anyway. Just make owner aware etc

RE: Irish Wolfhound with DCM/atrial fib.

Martin Atkinson — Mon, 11 Jun 2018 10:49:47 GMT

Double the dose of Pimobendan, +/- try Sildenafil?

You may be struggling to control the AF - I have it, albeit the rest of my heart is healthy, and despite attempted cardioversion it is persistent so I live with it. Diltiazem slows it to some extent but mainly controls the VPC's. AF itself it is not an issue so your treatment should be aimed at reducing the risk of a ventricular arrhythmia and improving the function of the heart which it sounds as though you are doing. I just wonder if it is worth also adding an anti-coagulant like Clopidogrel as there may be a risk of clot forming in the atria.

RE: Irish Wolfhound with DCM/atrial fib.

Edward Jones — Mon, 11 Jun 2018 10:11:54 GMT

How about more digoxin? It's the only thing that has a hope of doing anything meaningful, I would think.

RE: Irish Wolfhound with DCM/atrial fib.

Sarah Keir — Sun, 10 Jun 2018 18:44:29 GMT

[quote user="Utlendigur"]

[quote user="Sarah Keir"]

Digoxin?

[/quote]

It's already on it by the sounds of it

[/quote]

Oh yeh, trying to read too quickly! Sounds like on everything so likely terminal!

RE: Irish Wolfhound with DCM/atrial fib.

Utlendigur — Sun, 10 Jun 2018 12:47:12 GMT

[quote user="Sarah Keir"]

Digoxin?

[/quote]

It's already on it by the sounds of it

RE: Irish Wolfhound with DCM/atrial fib.

Sarah Keir — Sun, 10 Jun 2018 11:03:54 GMT

Digoxin?