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CLINICAL INSIGHTS JULY/AUGUST 2018 71 and venous vascular smooth muscle. Additional endothelial-mediated vasodilation mechanisms may also contribute to this action and may be linked to the medication's beneficial effect in the treatment of pulmonary hypertension. 3 Anticoagulation and Other Properties In platelets, PDEIII inhibition mediates antithrombotic properties, leading to reduced platelet aggregation. This effect has been investigated in other pyridazinone-based compounds as well as pimobendan. 4 In a study of healthy dogs, pimobendan mildly inhibited platelet aggregation but at a concentration well above a clinically relevant dose.5 In mice in heart failure, pimobendan reduced some of the adverse cytokine concentrations.6 INDICATIONS Pimobendan is used to treat preclinical and clinical DCM and DMVD ( TABLE 1, BOX 1 ). Left-Sided and Right-Sided CHF CHF can develop for reasons other than DMVD or DCM. To justify initiation of pimobendan when the underlying CHF etiology is unclear or for symptomatic patients when standard therapy has failed (stage D) ( TABLE 1 ), echocardiography is typically indicated. When in doubt, consultation with a cardiologist is recommended. Other Indications ■ Congenital heart disease with volume overload (e.g., patent ductus arteriosus, ventricular septal defect, atrial septal defect, mitral or tricuspid valve dysplasia) complicated by CHF. ■ Congenital heart disease characterized by obstruction (e.g., subaortic stenosis, pulmonic stenosis) with secondary myocardial failure in a patient with symptoms refractory to standard therapy. For these cases, we strongly recommend consultation with a cardiologist before initiation of pimobendan. TABLE 1 Pimobendan Use in Dogs with Heart Disease HEART DISEASE PIMOBENDAN INDICATION Dilated cardiomyopathy Stage B2 • Recommended for Doberman pinschers and Irish wolfhounds a,b • Consider for other dog breeds with definitive diagnosis a,b Stages C and D Recommended Degenerative mitral valve disease Stage B2 Recommended in dogs that meet EPIC entry criteria 13 Stages C and D Recommended Congenital heart disease with volume overload complicated by congestive heart failure Consider b Congenital heart disease characterized by obstruction with secondary myocardial failure refractory to standard therapy Consider a,b Pulmonary hypertension resulting in right-sided CHF refractory to standard therapy Consider b Pericardial effusion that requires pericardiocentesis and results in ascites Contraindicated a Diagnosis based on echocardiography. b Consultation with a cardiologist is recommended before starting pimobendan. Pimobendan seems to be safe and well tolerated. Reported adverse effects are relatively rare and are typically limited to gastrointestinal upset associated with the chewable tablets.

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