Presenter – Hannah Stephenson BVMS (Hons) CertSAM Dip ECVIM-CA (Cardiology) MRCVS, of Specialist Veterinary Cardiology
The Webinar Vet’ has organised veterinary webinars in the past which provided an overview of advances in specific areas of veterinary practice. I believe our very own Anthony Chadwick covered advances in dermatology a while ago and I remember getting so much out of it. So I was delighted that, although not planned, Hannah Stephenson stepped in at the last minute to provide us with a veterinary webinar covering advances in veterinary cardiology.
Hannah started the webinar by discussing the progress we have made in diagnosing cardiac disease by using markers such as NT-proBNP and troponin I. Although these markers are not to be used as a stand-alone diagnostic they are very useful when used in combination with other diagnostics and taking the overall clinical picture into consideration. NT-proBNP is a natriuretic peptide which is released in response to atrial and ventricular stretch and is an excellent marker for differentiating cardiac and non-cardiac dyspnoea.
Hannah cited a recent study performed in Pennsylvania where five cats presented with congestive heart failure (CHF) and five cats presented with respiratory disease. Diagnostics were performed on all these cats and these results were shown to clinicians asking their opinion as to whether the origin of their disease was respiratory or cardiac. NT-proBNP was also measured in all these cases and only shown to the clinicians after they made a decision about the underlying cause. Once they had been shown the proBNP results, their diagnostic accuracy significantly improved. NT-ProBNP can also be useful in determining the prognosis for dogs with mitral valve disease particularly when combined with troponin I .
Hannah also discussed the treatment of congestive heart failure (CHF) and although she was very aware that we were likely to be up-to-date on the standard approach to treating CHF, she wanted to give us some ideas on other drugs that could be useful when our standard combination therapy no longer works. Quadruple therapy is now seen as the standard approach, treating with frusemide, pimobendan, ACE-inhibitors and spironolactone. However patients can develop frusemide resistance and it may be necessary to use additional diuretics which work on different areas of the nephrons.
Moduret is an example of an additional diuretic and is a combination of hydrochlorthiazide and amiloride. A low dose of Moduret should be used as it is a potent diuretic and it appears to be very useful in treating refractory ascites. An alternative is torasamide, a loop diuretic and aldosterone antagonist which is ten times more potent than frusemide and appears to work well in cases of frusemide resistance. However as torasamide is so potent, Hannah advices seeking advice prior to using this particular drug.
Hannah went on to cover advances in the treatment of congenital disease and arrhythmias in the dog as well as future surgical solutions to structural disease such as MVD, already being routinely used in the human field. This veterinary webinar provided some fascinating detail on what is happening at the forefront of veterinary cardiology and what could be happening in the future . It is learning about these advancements and watching the development of veterinary medicine which keeps me interested and loving my job, and I would wholeheartedly recommend taking the time to watch this webinar.