Acute, Unilateral Transverse Sinus Occlusion During Craniectomy in Seven Dogs With Space-Occupying Intracranial Disease

Objective- The purpose of this study was to determine the effect of acute, unilateral transverse sinus occlusion on intracranial pressure (ICP) and postoperative mortality in dogs with structural intracranial disease.
Study Design- Affected dogs had a single transverse sinus occluded during craniectomy for intracranial mass biopsy or removal.
Animals- Seven dogs with space-occupying intracranial disease in the cerebellopontine angle area.
Methods- The ipsilateral transverse sinus was permanently occluded during the surgical approach to the intracranial lesion to increase surgical exposure by allowing a caudal lateral rostrotentorial craniectomy to be combined with a suboccipital craniectomy. In five dogs, intracranial pressure was monitored during surgery using a fiberoptic intracranial pressure monitoring device.
Results- Initial ICP varied among dogs, ranging from 7 to 21 mm Hg. Intracranial pressure, however, decreased in all dogs after craniectomy and durotomy ( P <.05). No increase in intracranial pressure occurred after transverse sinus occlusion ( P =.42). All dogs survived the surgical procedure.
Conclusions- Acute, unilateral transverse sinus occlusion during craniectomy in dogs with space-occupying intracranial lesions did not result in significant increases in ICP or intraoperative mortality.
Clinical Relevance- Acute, unilateral transverse sinus occlusion during craniectomy can be used to increased surgical exposure to the caudal fossa of the brain without increased risk of increasing ICP.     

Morphological Variations in the Transverse Venous Sinus Anatomy of Dogs and its Relationship to Skull Landmarks

We characterized the anatomical morphology of the transverse venous sinus (TVS) of 69 canine adult cadavers belonging to three groups: brachycephalic (B), dolichocephalic (D) and mesaticephalic (M). In addition, we outlined its path over the skull using five classic human craniometric points (CPs): the asterion (ast), the bregma (b), the glabella (g), the stephanion (st) and the pterion (pt). The study aimed to establish anatomical differences in the TVS between groups and in the relationship between the TVS and skull. We found that TVS anatomy and its relationships to skull landmarks vary markedly between the groups, with similar anatomical arrangements in B and M. The TVS length can be ranked as M < B < D (with D being the biggest), whereas the width can be ranked as M < D < B (with B being the widest) with the right side being smaller than the left. In the B and M groups, the TVS assumes a craniocaudal trajectory that is closer to the lateral skull wall than in D, where the TVS presents a caudocranial direction. By documenting the morphological characteristics of the TVS, we can create a set of anatomical references allowing construction of a basic framework to greatly decrease the probability of TVS injury during neuronavigation procedures when supported by a good knowledge of the skull, brain anatomies and their relationships.     

Parenteral Anticholinergics in Dogs With Normal and Elevated Intraocular Pressure

Dogs given parenteral anticholinergic drugs have been thought to be at risk for development or exacerbation of elevated intraocular pressure (IOP). In a randomized, blinded, placebo-controlled study, we evaluated the effect of intramuscular glycopyrrolate (0.01 mg/kg) on pupil diameter and IOP in unanesthetized normal dogs. Treatment with glycopyrrolate did not change pupil diameter or IOP from baseline, nor were there differences between glycopyrrolate and saline-treated (control) dogs. In addition, the authors retrospectively reviewed the medical records of 2,828 dogs undergoing general anesthesia between April 1987 and September 1990 to determine if there was an association between parenteral anticholinergic medication and postanesthetic elevation in IOP. The authors also determined the frequency of bradycardia requiring anticholinergic therapy during anesthesia in dogs with glaucoma. Of the 2,828 cases reviewed, the records of 46 dogs coded for glaucoma were examined in detail. The 46 dogs underwent 62 episodes of anesthesia, with 23 episodes including exposure to an anticholinergic drug. An increase in IOP from preanesthetic to postanesthetic measurement occurred in three dogs. One of these dogs received anticholinergic medication for bradycardia during anesthesia. The postanesthetic elevation in IOP in this dog was probably not drug related. Preanesthetic anticholinergic administration did not affect the incidence of anticholinergic administration for bradycardia during the anesthetic episode. Anticholinergic therapy during anesthesia was more frequent when the preanesthetic medication included an opiate drug. These studies do not indicate an association between parenteral anticholinergic administration and elevations in IOP.     

The Effect of Hetastarch on Serum Colloid Oncotic Pressure in Hypoalbuminemic Dogs

The purpose of this study was to determine the duration of action of a single dose of hetastarch, a synthetic colloid, in hypoalbuminemic dogs. Thirty hypoalbuminemic dogs (albumin concentration, 2,0 g/dL) received 1 dose of hetastarch each, with an average dose of 18.1 mL/kg. Doses ranged from 7.7 to 43.9 mL/kg, with the majority of doses (n = 26) in the range of 10 to 25 mL/kg. Dogs were allotted to one of several groups: all dogs, dogs with acute gastrointestinal protein loss, dogs with chronic gastrointestinal protein loss, all dogs with gastrointestinal protein loss, and dogs with nongastrointestinal protein loss. Colloid oncotic pressure was measured immediately before and immediately after hetastarch administration, and 12 hours after hetastarch administration. There was a significant ( P < .001) increase in the mean colloid oncotic pressure after hetastarch treatment in all groups, except in the group with acute gastrointestinal protein loss. Twelve hours after hetastarch treatment, the mean colloid oncotic pressure had decreased significantly ( P < .001) from the immediate post-treatment value in all groups, except in dogs in the groups with acute and chronic gastrointestinal protein loss. Twelve hours after hetastarch treatment the mean colloid oncotic pressure was not significantly ( P < .001) different from the baseline mean colloid oncotic pressure in any of the groups. Twenty-three dogs (77%) survived their illness and were sent home, whereas, 7 (23%) died or were euthanized. The effect of a single dose of hetastarch on raising colloid oncotic pressure in dogs with hypoalbuminemia decreases significantly within 12 hours of administration, and is no longer significantly above baseline values. We conclude that multiple dosing is necessary to prolong the beneficial effects of hetastarch.     

Effect of Desmopresssin in Normal Dogs and Dogs with von Willebrand's Disease

Desmopressin acetate (DDAVP(R)), a synthetic analogue of vasopressin was slowly administered intravenously to 12 healthy dogs of various breeds and 10 Doberman Pinschers with mild-to-moderate type I von Willebrand's disease at a dose of 0.3, 1.0 and 3.0 micro g/kg body weight. Plasma von Willebrand factor:antigen was measured by an electroimmunoassay prior to and 30, 60, 90, 120 and 180 minutes after desmopressin infusion. Desmopressin induced only very modest and statistically insignificant increases in von Willebrand factor in both groups. We conclude that the response to desmopressin as measured by circulating von Willebrand factor is much less pronounced in healthy dogs and in Doberman Pinschers with von Willebrand's disease than in humans.     

Liver Size,Bodyweight, and Tolerance to Acute Complete Occlusion of Congenital Extrahepatic Portosystemic Shunts in Dogs

Objective— To investigate the relationship between preoperative liver size, bodyweight, and tolerance to shunt occlusion in dogs with congenital extrahepatic portosystemic shunt(s) (CPSS). Study Design— Longitudinal cohort study. Animals— Dogs with CPSS (n=35). Methods— Ultrasonography was used to measure preoperative maximum transverse dimension of the liver (TS) of each dog. Intraoperative portal pressures were measured, before and after CPSS occlusion, via a jejunal vein catheter. Tolerance to shunt occlusion was judged on gross visceral observations, and on changes in portal pressure, central venous and mean arterial pressures. Results— TS was significantly related to bodyweight (P<.05). Mean ratios for TS/bodyweight were calculated for dogs tolerant and intolerant of acute complete shunt occlusion. Dogs tolerant to occlusion had significantly higher TS/bodyweight ratios than dogs intolerant to occlusion (P=.025). Dogs with a TS/bodyweight ratio of >7 were more likely to tolerate CPSS occlusion than dogs with a TS/bodyweight ratio of <5 (P=.036). A model was generated to predict portal pressure rise after shunt occlusion, based on liver dimensions and bodyweight (R=0.668). Intestinal oxygenation did not correlate significantly with tolerance to CPSS occlusion (P=.29). Conclusion— In dogs with CPSS, liver size (relative to bodyweight) is significantly greater (P=.025) in dogs that are tolerant of full ligation than intolerant of occlusion. Clinical Relevance— Preoperative measurement of bodyweight and liver size help indicate the likelihood of tolerance to acute complete occlusion of CPSS in dogs.     

Submaximal Exercise Testing Using Lactate Threshold and Venous Oxygen Tension as Endpoints in Normal Dogs and in Dogs With Heart Failure

Twelve normal dogs and 7 dogs with experimentally induced heart failure were chronically instrumented to measure hemodynamic variables and blood gas tensions at rest and during graded treadmill exercise. Three groups of 4 normal dogs each (group 1, 15 to 20 kg; group 2, 21 to 30 kg; group 3, 31 to 40 kg) were exercised on a treadmill at a 16% grade at 1, 2, and 3 miles per hour, and at a 22% and a 26% grade at 3 miles per hour (5 total exercise levels) until blood lactate concentration increased to a value greater than 1 mmol/L. Blood lactate concentration and blood gas tensions were measured 5 and 15 minutes after starting exercise, and cardiac output was measured between 8 and 10 minutes of exercise. Results indicated that the same exercise protocol could be used for dogs ranging in size from 15 to 40 kg. Blood lactate concentration increased in normal dogs at varying workloads, but always at or above a workload of 3 miles per hour at a 16% grade. Dogs with class IV heart failure always experienced an increase in blood lactate concentration when walked at 1 mile per hour at a 16% grade for 5 minutes. A femoral vein Po₂ between 21 and 24 mm Hg in normal dogs, and between 16 and 22 mm Hg in dogs with heart failure was always associated with an increase in blood lactate concentration. The primary problem with this exercise protocol was the unwillingness of some dogs to walk on the treadmill during the preselection phase. We conclude that we have devised a submaximal exercise test that can be used to evaluate exercise capability in dogs ranging in size from 15 to 40 kg, that the described exercise protocol can be used to identify decreased flow reserve in dogs with class IV heart failure induced by rapid ventricular pacing, and that either femoral vein oxygen tension or blood lactate concentration can be used as the endpoint for submaximal exercise testing in dogs. J Vet Intern Med 1996;10:21–27. Copyright©1996 by the American College of Veterinary Internal Medicine.     

Effect of Thyrotropin Storage on Thyroid-Stimulating Hormone Response Testing in Normal Dogs

The stability of reconstituted, refrigerated thyrotropin was evaluated. Thyrotropin (TSH) was reconstituted at the start of the study and stored at 4 degrees C. A TSH stimulation test was performed in eight healthy, euthyroid dogs at weekly intervals for 1 month. In seven of eight dogs, there was no significant difference (P less than 0.05) between the post-TSH T3 concentrations and the post-TSH T4 concentrations for the duration of the study. For one dog, the post-TSH T4 concentration was below the normal post-TSH T4 range following the administration of reconstituted TSH that had been stored 4 weeks. The T3 response to the TSH, however, was normal. This dog responded normally to freshly reconstituted TSH. The results of this study suggest that reconstituted bovine TSH can be stored at 4 degrees C for at least 3 weeks without loss of biologic activity in the dog.     

Peripheral and Central Venous Blood Glucose Concentrations in Dogs and Cats with Acute Arterial Thromboembolism

Background

Acute limb paralysis because of arterial thromboembolism (ATE) occurs in cats and less commonly in dogs. ATE is diagnosed based on physical examination findings and, occasionally, advanced imaging.

Hypothesis/Objectives

Peripheral, affected limb venous glucose concentration is decreased in ATE, whereas its systemic concentration is within or above reference interval.

Animals

Client‐owned cats and dogs were divided into 3 respective groups: acute limb paralysis because of ATE (22 cats and 9 dogs); acute limb paralysis secondary to orthopedic or neurologic conditions (nonambulatory controls; 10 cats and 11 dogs); ambulatory animals presented because of various diseases (ambulatory controls; 10 cats and 9 dogs).

Methods

Prospective observational, clinical study. Systemic and local (affected limb) blood glucose concentrations were measured. Their absolute and relative differences (ΔGlu and %ΔGlu, respectively) were compared among groups.

Results

ΔGlu and %ΔGlu were significantly higher in the ATE cats and dogs groups, compared to both of their respective controls (P < .0001 and P < .001, respectively). No significant differences were observed between the control groups. Receiver operator characteristics analysis of ΔGlu and %ΔGlu as predictors of ATE had area under the curve of 0.96 and 0.99 in cats, respectively, and 1.00 and 1.00, in dogs, respectively. ΔGlu cutoffs of 30 mg/dL and 16 mg/dL, in cats and dogs, respectively, corresponded to sensitivity and specificity of 100% and 90% in cats, respectively, and 100% in dogs.

Conclusions and Clinical Importance

ΔGlu and %ΔGlu are accurate, readily available, diagnostic markers of acute ATE in paralyzed cats and dogs.     

Effect of Porcine Small Intestinal Submucosa on Acute Full-Thickness Wounds in Dogs

Objective— To evaluate the effects of porcine small intestinal submucosa (PSIS) on the healing of full-thickness wounds in dogs, specifically the appearance of granulation tissue, percent epithelialization and contraction, histologic variables of inflammation and repair, and aerobic culture results.
Study Design— Prospective, controlled, experimental study.
Animals— Purpose-bred, female dogs (n=10).
Methods— Wounds were created bilaterally on the trunk; 1 side as a control and 1 treated with PSIS. First appearance of granulation tissue was recorded. Total wound area, open wound area, and epithelialized area were measured at 21 time points—wound contraction and percent epithelialization were calculated. Aerobic cultures were taken at 4 time points and wound biopsies at 8. Histologic features were graded into an Acute Inflammation Score and Repair Score.
Results— There was no difference in first appearance of granulation tissue between PSIS-treated and control wounds. Wound contraction was significantly faster in control wounds as was percent epithelialization after day 21. Histologic Acute Inflammation Scores were significantly higher in PSIS-treated wounds compared with control wounds on days 2 and 6. There were no differences in Histologic Repair Scores between PSIS-treated and control wounds or in aerobic culture results.
Conclusion— Wounds treated with PSIS contract more slowly, epithelialize less, and have more pronounced acute inflammation after implantation than control wounds.
Clinical Relevance— Acute, full-thickness wounds in dogs do not benefit from treatment with PSIS.     

Effect of Hyposensitization with Irrelevant Antigens on Subsequent Allergy Test Results in Normal Dogs

Abstract— Five normal greyhounds were evaluated for hypersensitivity to various grasses, weeds, trees and fungi with both an intradermal allergy test and a commercial enzyme-linked immunosorbent assay (ELISA). All dogs were hyposensitized for 6 months with the same mixture of 14 allergens, according to the treatment schedule recommended by the commercial laboratory that provided the ELISA allergy test. Following hyposensitization with irrelevant antigens at a concentration of 1:200 w/v, dogs were reevaluated for hypersensitivity with the intradermal allergy test. No significant increase in intradermal reactions was found after 6 months of hyposensitization, and all dogs remained asymptomatic during the study period. Hyposensitization of normal greyhounds with irrelevant aqueous antigens, administered according to one treatment schedule recommended following ELISA allergy testing, did not appear to cause false positive reactions on subsequent intradermal allergy tests or to induce clinical hypersensitivity. Further studies are required to determine if hypersensitivity to irrelevant antigens is induced in atopic dogs following hyposensitization with nonaqueous extracts or higher concentrations of aqueous antigens. Résumé— Cinq Greyhound sains ont été utilisés pour étudier l'hypersensibilitéà des pollens, des moisissures des arbres et des herbacées en utilisant des intradermoréactions et des tests ELISA du commerce. Tous les animaux ont été désensibilisés pendant 6 mois avec le même mélange de 14 allergènes, en suivant le protocole recommandé par le laboratoire qui commercialise le test ELISA. Après hyposensibilisation à ces antigènes à une concentration de 1/200 p/v, les chiens ont été réévalués par des intradermoréactions. Aucune différence signifaicative avant et après traitement n'a été notée et tous les chiens sont restés asymptomatiques durant la période de l'essai. L'hyposensibilisation chez des Greyhounds sains avec des antigènes auxquels ils ne sont pas sensibles, en suivant le protocole recommandé par la laboratoire producteur, ne semble pas entrainer de fausses réactions intradermiques positives ni une hypersensibilité clinique. D'autres études sont nécessaires pour savour si cette sensibilisation peut être induite chez des animaux atopiques, avec des extraits non aqueux et à de plus fortes concentrations. Zusammenfassung— Fünf gesunde Greyhounds wurden uaf allergische Reaktionen gegenüber verschiedenen Gräsern, Unkräutern, Bäumen und Pilzen sowohl mit einem Intradermaltest als auch mit einem kommerziellen ELISA-Test getestet. Alle Hunde wurden über 6 Monate mit derselben Mischung aus 14 Allergenen “desensibilisiert”. Hierzu wurde ein Therapieschema verwendet, das von dem Labor, das den ELISA-Test durchgeführt hatte, empfohlen worden war. Nach der “Desensibilisierung” mit nicht relevanten Allergenen in einer Konzentration von 1:200 w/v wurden die Hunde erneut mit einem Intradermaltest getestet. Nach der “Desensibilisierung”über sechs Monate gab es keinen signifikanten Anstieg bei den intradermalen Reaktionen. Alle Hunde blieben währen der Untersuchungszeit symptomfrie. “Desensibilisierung” von gesunden Greyhounds mit nicht relevanten wäßrigen Antigenen, die nach dem empfohlenen Therapieschema nach einem ELISA-Allergietest angewendet worden waren, schienen keine falsch-positiven Reaktionen im nachfolgenden Intradermaltest hervorzurufen und keine klinische Allergie auszulösen. Weitere Untersuchungen sind erforderlich, urn zu klären, ob eine Allergie gegenüber nicht relevanten Antigenen bei atopischen Hunden nach Desensibilisierung mit wäßrigen Extrakten order mit höheren Konzentrationen von wäßrigen Allergenen induziert werden kann. Resumen Cinco perros galgos de apariencia clínica normal, se evaluaron con tests de alergia a varias hierbas, árboles y hongos, por medio de inyecciones intradérmicas y también con ensayos comerciales de enzima de inmunoabsorbencia ligada (ELISA). A todos los perros se les admistró tratamiento de hiposensitización por un curso de 6 meses con una mezcla de 14 alergenos, según el protocolo recomendado por el laboratorio comercial proveedores del test ELISA. Después del tratamiento inmunosupresivo con una concentración de antígenos irrelevantes de 1:200 w/v, los animales se volvieron a evaluar por medio del test de inyecciones intradérmicas. Después de 6 meses de terapia inmunosupresiva no se observaron cambios significativos en las reacciones cutáneas, y todos los animales permanecieron asintomaticos durante el periodo de estudio. El tratamiento inmunosupresivo de perros galgos con antígenos en solución acuosa administrados de acuerdo con el protocolo recomendado después del test ELISA, no produjo reacciones falsas positivas en tests intradérmicos posteriores, o reacciones de hipersensitividad alguna. Para determinar si la posibilidad de hipersensitividad con antígenos irrelevantes es inducida en perros que padecen atopia después del tratamiento inmunosupresivo con extractos antigénicos de tipo no acuoso, o mayores concentraciones de antígenos acuosos, más investigaciones son necesarias.     

The Effect of Combined Therapy With Captopril, Furosemide, and a Sodium-Restricted Diet on Serum Electrolyte Concentrations and Renal Function in Normal Dogs and Dogs With Congestive Heart Failure

Captopril, furosemide, and a sodium-restricted diet were administered to 6 normal dogs and 10 dogs with congestive heart failure. Serum electrolyte concentrations and renal function were monitored in both groups. In the normal dogs, no clinically meaningful changes in serum electrolyte, urea nitrogen, or creatinine concentrations developed during therapy with a sodium-restricted diet and 4 weeks each of furosemide alone, captopril alone, or furosemide plus captopril. Three of 6 normal dogs on furosemide and a sodium-restricted diet had at least one serum potassium concentration above the reference range during the 4 weeks of observation. One normal dog on captopril, furosemide, and a sodium-restricted diet developed azotemia, and 2 dogs had serum potassium concentrations above the reference range during the 4 weeks of observation. Ten dogs with congestive heart failure were treated with captopril, furosemide, a sodium-restricted diet, and digoxin.
Etiopathogenesis of the heart failure included valvular insufficiency (n = 6), dilated cardiomyopathy (n = 3), and dilated cardiomyopathy and dirofilariasis (n = 1). Serum electrolyte concentrations and renal function were monitored for 5 consecutive weeks in 7 of the 10 dogs and for 17 weeks or longer in 6. Two dogs were euthanized after 4 weeks because of acute decompensation of heart failure, and one dog developed severe azotemia and uremia. Six of 10 dogs with congestive heart failure had at least one serum potassium concentration above the reference range sometime during the 5 weeks of observation, although the changes in the mean serum potassium concentrations were not statistically significant. Four of 10 dogs with congestive heart failure developed azotemia sometime during the 5 weeks of observation.     

Anatomy and Cholinergic Innervation of the Sinus paranalis in Dogs

Conventional methods have been used to study the general configuration of the wall of the Sinus paranalis in dogs. Apocrine tubular glands, elastic fibres and smooth-muscle fibres are the more significant elements of the wall, together with the epithelium and connective tissue. By means of the immunohistochemical method described in this paper, the results provide histochemical evidence for the presence of an AChE-positive reaction, and supposedly cholinergic nerve fibres in the wall of the dog anal sacs, mainly associated with subepithelial smooth muscle, vessels, and glands.     

The Treatment of Acute Glaucoma in Dogs and Cats

Objective: Glaucoma is an optic nerve disease that may result in rapid loss of vision. Early detection of acute glaucoma and aggressive treatment is important to preserve vision. Continued treatment is indicated in chronic glaucoma to alleviate discomfort associated with chronic elevated intraocular pressure.
Etiology: In primary glaucoma, an abnormal iridocorneal angle results in obstruction to outflow of aqueous humor. In secondary glaucoma, an otherwise normal iridocorneal angle is obstructed by abnormalities such as a luxated lens, neovascular membranes or inflammatory material.
Diagnosis: The diagnosis is made by a combination of clinical signs such as corneal edema, mydriasis, decreased vision, episcleral hyperemia, and confirmed by measuring an elevation in intraocular pressure. Complete ophthalmic examination, knowledge of breed predisposition to various ocular diseases and gonioscopy will aid in distinguishing between primary and secondary glaucoma
Therapy: Aggressive medical management is important in acute glaucoma. Surgical procedures are often indicated after initial emergency medical treatment of acute glaucoma. Chronic, painful blind eyes are best treated with one of various surgical procedures.
Prognosis: The prognosis for maintaining vision or regaining temporarily lost vision in acute glaucoma is related to numerous factors including time between onset of clinical signs and appropriate treatment, etiology of the glaucoma, initial response to therapy and client compliance.     

Dorsal Approach to the Caudal Pelvic Canal and Rectum Effect on Normal Dogs

A dorsal surgical approach to the perineal area and rectum was made on 10 healthy, adult dogs. The rectococcygeal muscle was incised and the levator ani and external sphincter muscles were separated to the level of the caudal rectal nerve. All dogs were clinically normal throughout a 3 week postoperative observation period.     

Acute Effect of Pimobendan and Furosemide on the Circulating Renin-Angiotensin-Aldosterone System in Healthy Dogs

Background: The renin-angiotensin-aldosterone system (RAAS) is activated in states of decreased cardiac output and by certain cardiovascular therapeutic agents, such as loop diuretics and vasodilators.
Hypothesis: Short-term treatment with the inodilator, pimobendan, will not activate the circulating RAAS because its vasodilatory action will be offset by its positive inotropic property, thereby ameliorating RAAS stimulation at the juxtaglomerular apparatus. Furthermore, pimobendan will suppress RAAS activation produced by furosemide.
Animals: Nine healthy laboratory dogs were used in this study.
Methods: Experimental, cross-over study. Dogs were administered pimobendan (0.5 mg/kg q12h) for 4 days followed by furosemide (2 mg/kg q12h) and then, after a wash-out period, a combination of the drugs. Aldosterone : creatinine (A : Cr) was measured at the end of each treatment cycle.
Results: There was no significant increase in the average urinary A : Cr with the administration of pimobendan (control urinary A : Cr = 0.46, standard deviation (SD) 0.33; pimobendan A : Cr = 0.48, SD 0.28). There was a significant increase in the average urinary A : Cr after administration of furosemide (urinary A : Cr = 1.3, SD 0.70) and with the combination of furosemide and pimobendan (urinary A : Cr = 2.9, SD 1.6).
Conclusions and Clinical Relevance: Short-term administration of high-dose pimobendan, does not activate the RAAS in healthy dogs. Pimobendan did not prevent RAAS activation associated with furosemide therapy. These results in healthy dogs suggest that furosemide therapy, with or without pimobendan, should be accompanied by RAAS suppressive therapy.