This all sounds hopeless, doesn't it? In addition, it is well documented that Dobermans, once signs appear, have a worse prognosis for treatment and survival than do other breeds. The key phrase here is "once signs appear". Larry P. Tilley, DVM, ACVIM of VET MED FAX Consultation Services, has followed Doberman DCM for several years and is reporting a sudden and large increase in incidence of this disease during the last two years. Dr. Tilley believes that Dr. O'Grady's research indicates that a simple EKG of an apparently normal Doberman can lead to possible early detection. And early detection during the occult phase is the key to increasing the quality and the length of life at this time, even though there currently is no cure.

To comprehend how this new research becomes practical, it is first important to understand the diagnostics involved. EKGs are readily available to every veterinarian in the U.S. and Canada. Many veterinary practices have their own machines. If not, a service (Cardiopet) can be subscribed to, so that EKG transmission can be sent over ordinary phone lines to veterinary cardiologists capable of returning interpretation within 30 minutes. Even simple surgery room heart monitors can be utilized on quiet, unsedated dogs while a trained technician watches the screen for abnormal heart beats. Every veterinarian in the U.S. and Canada has access to Dr. Tilley's Vet Med Fax Consultation Services, 22 Decanso Road, Santa Fe, NM 87505-9125, FAX 800-820-6815. While much of what the EKG has to offer can require a great deal of interpretive training and calculation, the presence of the PVC that we are looking for is easily observed and demands little expertise. As an example, in the following diagram, the bottom tracing represents a dog with 2 PVCs (the 4th and 7th heartbeats) with the other 11 being normal. In the top tracing, a simultaneous graph of left ventricular blood pressure represents the devastating effects PVCs have on cardiac output. Frequency of PVCs can range from 1 in 24 hours, to virtually every contraction being premature.

Some researchers have recommended that the Holter monitor should be used for a 24 hour EKG evaluation, but they are expensive, cumbersome for use on dogs, and not readily available. A 3 minute, or even better, 10 minute EKG tracing is more practical until technology provides us with an affordable, less cumbersome and more readily available means of 24 hour testing.

A WORD OF CAUTION. Some well-intentioned but incompletely informed people have stated unequivocally that even one PVC is an indication that a Doberman has DCM. This is a strong statement that must be addressed. While it appears likely at this time that a high percentage of Dobermans exhibiting PVCs will develop the symptomatic (overt) disease, there are other causes of PVCs. Ettinger and Feldman's Textbook of Veterinary Internal Medicine, and Tilley's Essentials of Canine and Feline Electrocardiography lists over 11 primary heart conditions represented by disorders of rhythm. An additional 10 caused by reduced oxygen, 9 are of nervous origin, 14 due to metabolic and endocrine disease, 5 due to electrolyte imbalances, and an unknown number related to drugs and toxins. PVCs in the Doberman should be considered as strongly suggestive of DCM, but in themselves should not be taken as a definitive diagnosis. Anytime PVCs are present, a thorough investigation as to their origin should be instituted. Regardless of their source, they often represent serious disease in any dog. As a practical example, one common cause of PVCs is a disease of the spleen. And these PVCs are indistinguishable from those of DCM. To treat a dog for cardiomyopathy based on the presence of PVCs alone, only to have the dog die of a cancerous spleen that could have been detected by further diagnostic testing and then surgically removed, is hardly in the best interest of the dog! Of course the dog may have both cardiomyopathy and splenic disease at the same time. While examining the heart with an ultrasound probe, it is a simple procedure to move the probe down a little lower and check the spleen as well. Dogs, especially old dogs, often have more than one disease at any one time. The more information gained through diagnostic testing, the more accurate the diagnosis. The more accurate the diagnosis, the more accurate the prognosis. PVCs in any dog DEMAND a thorough medical evaluation.

Okay, assume we have a Doberman with PVCs. What next? In advanced DCM, x-rays may show a greatly enlarged heart. But this may not be the case with early occult DCM. State-of-the-art veterinary medicine at this time requires a thorough cardiac ultrasound evaluation. Procedures have been worked out to measure the thickness of the heart wall and normal ranges have been identified so that a positive diagnosis of DCM can be made or ruled out. Of course there are those borderline situations where re-evaluation may be necessary after a certain period of time. Many veterinarians have ultrasound equipment, but not all are trained in the kind of detailed interpretation and measurement required to make a diagnosis of DCM. It is a procedure that should be performed by a veterinarian with specific advanced training, like a member of the American College of Veterinary Internal Medicine (ACVIM). Such individuals are available on a referral basis at veterinary colleges and in many veterinary practices in mid-sized and larger cities. Suspicion of DCM found on EKG should be confirmed by cardiac ultrasound. And as stated before, the spleen should be checked at the same time.

Those people living in remote areas often suggest that cardiac ultrasound is not readily available to them. Yet those same people would drive hundreds of miles to a dog show. Life is a series of difficult choices, isn't it? Let's get our priorities in order! Those living in more rural locations don't have any less access to innovative and current veterinary medicine for their dogs than they have access to advanced medicine for their own health care needs. If you live in a region where state-of-the-art medicine is lacking, be willing to travel to get it, or don't complain.

Dr. Tilley believes that every Doberman one year old and older should have an EKG evaluation annually as a routine screening procedure, much the same as annual heartworm and fecal exams are recommended.

Once occult dilated cardiomyopathy is diagnosed, what do we do? Much remains to be learned about treatment, but at this time there is no magic cure. The object is to increase the length and quality of life, and there are drugs currently available which can do just that. Enacard (enalapril) and Tonacard (Tocainide HCI), are significantly improving survival time. New drugs and combinations of drugs will likely be of even more benefit in the future. Dogs with DCM must be evaluated individually. Constant monitoring by a veterinarian is a must. As the condition of the heart changes and secondary or concurrent diseases develop, dosages may need to be altered and/or different drugs or combinations of drugs may be employed.

The use of EKG as a screen and cardiac ultrasound to confirm DCM in Doberman dogs and bitches will not eliminate the disease from the breed. Although DNA testing likely will have the potential to facilitate eradication, the disease will not magically disappear overnight. Difficult and judicious breeding decisions will need to be made. The more widespread the condition is shown to be, the harder it will be to eliminate the disease from the breed without losing all those traits that make a Doberman a Doberman. Even after the advent of DNA testing, the annual EKG followed by ultrasound where indicated, will enable us to better treat the afflicted.