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Patients with CVS experience frequent and intense episodes of nausea that may last for several hours

Nat Cell Biol 11(6):747752

The reasons for delaying the start of pimobendan treatment until the dogs reached CHF has been due to prior peer-reviewed veterinary studies finding harmful side-effects if the dogs were treated before the need for the positive inotropic support of their hearts' contractility, which pimobendan provides