Ahead of Dave Dickson’s webinar Tetralogy of Fallot is not as common as you think! A practical approach to small animal congenital cardiology on Friday the 10th of February at 20:00 GMT during Virtual Congress 2023, I have taken a look back at one of his most popular webinars on The Webinar Vet, “Every last drop: squeezing the most from your diuretics ” which is now free to watch in the “Meet our VC2023 Speakers” collection when you register for Virtual Congress 2023.

Dave Dickson B.Vet.Med. Cert AVP DVC MRCVS RCVS Recognised specialist in veterinary cardiology

Dave Dickson qualified from the RVC in 2004 and spent some time in practice in the UK and New Zealand before undertaking specialist training in cardiology, leading first to the Cert AVP and then the RCVS Diploma in veterinary cardiology. He joined heart Vets in 2011, where he is currently a director. He has lectured extensively home and abroad, is an award winning clinical researcher on feline dyspnoea, and one of the speakers at the 2023 virtual congress. He spoke previously for the WebinarVet in 2020 and I have briefly reviewed that webinar to give you an idea of what you can expect from his latest veterinary webinar in February 2023.

Every last drop: squeezing the most from your diuretics Dave Dickson Recorded 17th.November 2020

We are spoilt for choice with WebinarVet cardiology webinars. There are a total of 45 in the small animal section going back to 2010.  I never cease to be amazed by the huge worldwide footprint that these webinars cover. This one, on the live session, included colleagues from Malaysia, Croatia, Norway, Lebanon, Netherlands, various parts of the USA, the Philippines, Slovakia, Portugal, Iceland, Romania, Greece, Poland and Denmark-apart from many in the UK, just to mention a few! The feedback was overwhelmingly positive. 

The outline of the webinar is as follows: 

  • What is congestive heart failure?
  • What do diuretics do?
  • What is the difference between Frusemide and Torasemide?
  • How can I monitor the response to diuretics?
  • How do I change a patient from one to the other?
  • My patient isn’t responding to diuretics-what to do?

The description of left-sided congestive failure and right-sided failure is undoubtedly the best I have ever seen. It combines colour graphics of the normal ‘plumbing’ of the left and right heart, with further graphics depicting congestive failure. Along with these excellent illustrations we are shown the corresponding radiographs of clinical cases.

Dave uses an analogy of a leaking rowboat to describe how diuretics work and it works really well. The diuretic is depicted as a bucket used to bale out water leaking into the boat. The effect of various doses and dosing regimes of frusemide is very clearly shown in this way. As an aside the original trade name for frusemide was Lasix-so called because it lasts for six hours. For some quirky reason I love information like that, and it always stays in my memory.

There is information on the alternative diuretic torasemide, including a meta analysis from the human literature comparing it with frusemide for congestive heart failure. Two veterinary articles describe the use of torasemide in dogs. It has been shown to be non-inferior to frusemide but has a significant advantag of only needing once daily dosing.

Regarding the correct dose to give, Dave opts for a pragmatic approach – the dose that gives the best quality of life without clinical signs. Getting the client to measure (and monitor) the sleeping respiratory rate, (SRR), is a very useful procedure, also used for hospitalised dogs.  There is an information sheet describing this for owners on the HeartVets website. Other signs such as exercise intolerance are also important.

A frequently asked question is how do I change a patient from one drug to another? But before answering this question it is considered important to answer another-are they in CHF? A video of a clinical case of airway disease is shown, which was masquerading to the unwary as a case of CHF. The importance of getting good diagnostic, correctly positioned radiographs is emphasised with some educational examples. Secondly are you giving enough diuretic? Maximum doses are given, followed by a suggested regime of changing gradually.

Some practical advice concerning ascites emphasises checking the jugular veins, and its causes are revised again with the addition of a discussion of cardiac tamponade. The importance of diagnosing this is that diuretics in this situation will make matters worse. This section also has information on atrial fibrillation.  

Dave summarises the webinar: 

  • Diuretics are to treat heart failure-so make sure they are in heart failure
  • Run bloods for renal values and electrolytes BEFORE you start diuretics and BEFORE and AFTER you make a big change
  • Use the MINIMAL EFFECTIVE DOSE based on clinical signs (SRR)
  • Use the lowest dose needed to relieve congestion, regardless of azotaemia
  • Never use cough alone to rule in or rule out heart failure
  • Be careful with ascites –don’t just chuck diuretics at them
  • Torasemide as a first line diuretic is safe and appears to be at least as good as frusemide-plus it is easier to give as only once daily is required.

Vetoquinol generously sponsored the webinar. The company adds further information on torasemide, with the addition of a very useful SRR Pet Owner App (www.uplife.uk/srr.)  It also has an UpLife CPD platform supporting colleagues in the diagnosis and management of CHF cases.  There is additionally an abundance of help and advice on the HeartVets website www.heartvets.co.uk 

As mentioned at the beginning of this review, the webinar attracted a large live worldwide audience and they were treated to a quarter of an hour of questions at the end. It is thoroughly recommended for its clarity and first class images and the upcoming webinar by the same speaker at the online world conference is definitely one not to be missed.

r Tetralogy of Fallot is not as common as you think! A practical approach to small animal congenital cardiology on Friday the 10th of February at 20:00 GMT during Virtual Congress 2023, I have taken a look back at one of his most popular webinars on The Webinar Vet, “Every last drop: squeezing the most from your diuretics ”

P.S. Every last drop: squeezing the most from your diuretics by Dave Dickson is available as an additional resource to VC2023 in the “Meet our VC2023 Speakers” collection, which is unlocked once you register to attend the event, find out more about registration below, and once you have registered remember to mark Friday 10th February in your diary, as Dave will be presenting his webinar Tetralogy of Fallot is not as common as you think! A practical approach to small animal congenital cardiology at 20:00 GMT.