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PEER REVIEWED 76 JULY/AUGUST 2018 What should you do next? Consider further diagnostics, including thyroid assessment and a 24-hour ambulatory ECG (Holter examination). Hypothyroidism could be a contributing cause for the systolic dysfunction. Holter examination findings could better characterize the frequency and severity of the ventricular arrhythmias and help you determine if there is any need for antiarrhythmic therapy at this time. No antiarrhythmic medication is indicated at this time because the dog is asymptomatic and showed only 1 ventricular premature contraction on a 3-minute ECG. Holter monitoring, whether performed now or in the future, may lead you to alter this decision. Is pimobendan recommended for this dog? Yes, initiation of pimobendan is recommended on the basis of the PROTECT study results. 8 In addition, initiation of an angiotensin-converting enzyme (ACE) inhibitor can be considered according to findings of a retrospective study of Doberman pinschers, which suggests that these drugs delay disease progression. 21 However, before starting an ACE inhibitor, you should assess serum biochemistry. Case 2 You are performing an annual wellness examination of a 9-year-old, 12-kg, spayed female Jack Russell terrier. You auscultate a grade 4/6 systolic, left apical heart murmur. No clinical signs are reported, and the signalment and murmur characteristics support a probable diagnosis of preclinical (stage B1 or B2) DMVD. Thoracic radiography and echocardiography are performed to determine if the dog has cardiomegaly FIGURE 2. Dog with DMVD. (A) Right lateral thoracic radiograph demonstrating measurements for VHS; (B) echocardiogram of the left atrium with the LA/Ao-2D; (C) echocardiogram of the short axis left ventricle M-mode with the LVIDd and LVIDs. B C A Pimobendan added to heart failure therapy (furosemide and benazepril) improves clinical status, delays onset of refractory signs of heart failure, and increases survival times. 10,11

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