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DCM Supplementary Treatment
Dilated cardiomyopathy in dogs: ancillary therapy
L-carnitine deficiency has been documented in 40 - 50% of dogs with dilated cardiomyopathy, although the mechanism is not clearly understood. Measurement of plasma carnitine is insensitive (although specific) and obtaining tissue samples (endomyocardial biopsy) requires considerable skill and, furthermore, the assay is prohibitively expensive and not available in the UK. Keene’s clinical impression is that L-carnitine supplementation (at 50mg/kg tid) is a useful addition to current therapy, especially in Boxers, American Cocker Spaniels and Dobermanns. However, only a proportion of dogs deficient in carnitine will respond. The first response is usually within 1-4 weeks with a generalised clinical improvement (particularly in appetite and activity) followed by improved echocardiographic parameters over 2 to 8 months.
In one study plasma taurine concentrations were found to be low in 13 out of 76 dogs with dilated cardiomyopathy - seven of these were Cocker Spaniels or Golden Retrievers. Whether supplementing taurine (at a suggested dose of 500mg bid) will be of benefit is unclear at this point.
Fish oil supplementation
Canine heart failure secondary to DCM is associated with cachexia, alternations in fatty acids and reduced caloric intake. In a recent study, fish oil supplementation demonstrated a decrease in the cytokine interleukin-1β and improved cachexia. An increase in survival was also suspected in this study.
The recommended dosages for dogs with CHF and cachexia are: 40mg/kg eicosapentaenoic (EPA) and 25mg/kg docosahexaenoic (DHA).
In animals receiving diuretics there is the potential for urinary loss of water-soluble vitamins. In people, one study showed that 90% of patients with CHF being treated with furosemide had a thiamine deficiency. It seems prudent to therefore recommend B vitamin supplementation in animals in heart failure and receiving furosemide.
Recommended reading:Martin & Corcoran (2006) Notes on: Cardiorespiratory disease of the dog and cat, 2nd ed. Blackwell Science. ISBN 0-632-03298-7.