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PEER REVIEWED 74 JULY/AUGUST 2018 with the chewable tablets. Significant overdose has reportedly resulted in pimobendan toxicity, manifested as severe tachycardia and mild changes in blood pressure. 19 Pimobendan should be used cautiously in patients with an outflow tract obstruction, which includes the following: ■ Subaortic stenosis ■ Pulmonic stenosis ■ Systolic anterior motion of the mitral valve ■ Asymmetric septal hypertrophy If pimobendan is given to a patient with outflow tract obstruction or low systemic blood pressure, to ensure that it is well tolerated, you should reassess both blood pressure and heart rate approximately 1 to 2 hours after the first dose of pimobendan is given. Interactions with other drugs have not been reported. TAKE-HOME POINTS ■ Pimobendan is an inodilator labeled for use in dogs with CHF resulting from DCM or DMVD. ■ Pimobendan is recommended for the treatment of DMVD stages B2 (that meet EPIC criteria), C, and D and DCM stages B2, C, and D. ■ Pimobendan can be beneficial used alone or in combination with other cardiac drugs. ■ Beneficial effects for dogs in stage B2 DMVD or DCM include prolongation of symptom-free and overall survival times. ■ Beneficial effects for dogs in stages C/D DMVD or DCM include reduced clinical signs and heart size and increased survival times. ■ Pimobendan should not be used in dogs with ascites resulting from pericardial effusion. CASE SCENARIOS Case 1 You are performing an annual wellness examination of a 7-year-old, 31-kg, spayed female Doberman pinscher. You auscultate a grade 2/6 systolic, left apical heart murmur and an arrhythmia. No clinical signs have been reported. The signalment and auscultation characteristics support a possible diagnosis of DCM. ECG (3 minute) and echocardiography are performed ( FIGURE 1 ). Does this dog have preclinical DCM? Yes, this dog has preclinical DCM (stage B2) on the basis of echocardiographic evidence of left ventricular dilation in systole of 4 cm (reference range 2.9 ± 0.3 cm) and diastole of 4.8 cm (reference range 3.8 ± 0.2 cm), low fractional shortening (16.6%; reference is >24%), left atrial dilation, and normal mitral valve morphology. 20 Mild mitral regurgitation was documented as a consequence of the left ventricular dilation. The ECG demonstrated a sinus arrhythmia with 1 ventricular premature contraction. FIGURE 1. Dog with DCM. (A) Lead II ECG documenting sinus arrhythmia with a single ventricular premature contraction (25 mm/s; 10 mm/mV); (B) echocardiogram of the left atrium with the LA/Ao-2D; (C) echocardiogram of the short axis left ventricle M-mode with the left ventricular internal dimension in diastole (LVIDd) and in systole (LVIDs). B A C

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