https://www.vetsurgeon.org/f/clinical-questions/30414/medetomidine-and-heart-disease I have a colleague who’s terrified of using Medetomidine in dogs with heart murmurs, sh’s convinced it causes progression into active heart failure. I’ve used this drug daily over the past 25 years and can’t think of any actual cases that have endeden-USTelligent Community 10https://www.vetsurgeon.org/thread/239172?ContentTypeID=1Fri, 16 Sep 2022 12:25:24 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:4c0e9b30-a8f3-451f-b4e6-a6068ccd2abbDave Dickson<p>Amen to that.&nbsp;</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/239167?ContentTypeID=1Fri, 16 Sep 2022 11:04:06 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:aca755a4-0002-46dd-a797-cb179d516c3bIan Johnson<p>Hi,&nbsp;</p> <p>Well, I&#39;ll give my opinion on this as well, coming from a middle ground position.</p> <p>I feel it&#39;s&nbsp;<em>really</em> important to select which cases have medetomidine and which to avoid it in. Mitral valve disease cases (middle aged+, small breed dogs with left apical systolic murmur consistent with mitral regurgitation) which have lower grade murmurs (grade 1 or 2, or &quot;mild&quot;) I feel are at very low risk of decompensating with medetomidine; these dogs are very unlikely to have heart enlargement and therefore I feel are more tolerant of the cardiac-depressive effects of medetomidine. Those with a grade 3 murmur (&quot;moderate&quot;) need to be assessed to see what the heart is like - at the very least, check left atrial size. If the left atrium is enlarged, or this is not a skill you possess, then I would avoid using medetomidine. Anything with a murmur louder than a grade 4...avoid! I think these cases are at risk of progressing to congestive heart failure if they are close to that stage already. Of course, there will be exceptions in all these cases and limitations to my generalisation!</p> <p>Any anything which could have DCM (low grade left apical systolic murmur in a medium/large breed dog, or atypical DCM breed eg Springers) - avoid. Anything with an arrhythmia - avoid. Any dog with a gallop rhythm - avoid.&nbsp;</p> <p>A big thing I consider is the dose. There&#39;s medetomidine and there&#39;s medetomidine. I am against the standard pre-med charts (where everything gets 10 mcg/kg!). I find I can get away with very low doses as a premed/sedative (especially if given intravenously), e.g 1-3 mcg/kg; for sedations (abdominal ultrasonography), I will give the medetomidine to effect to just give enough to keep the patient quiet, rather than a 10 mcg/kg dose as a one-off. This then hopefully reduces (of course not eliminating) the risks associated with giving it.&nbsp;</p> <p>Careful monitoring of these patients is essential, especially blood pressure monitoring.&nbsp;</p> <p>That&#39;s my opinion anyway, based on absolutely no evidence-based medicine!</p><div style="clear:both;"></div>