strange ecg

Re: strange ecg

Dagmar Steele — Wed, 29 Feb 2012 11:51:03 GMT

[quote user="Lorna McHardy"]

an edition of - drat, I've not seen it for so long I've forgotten the magazine's name!! Good grief, I'm getting old; not In Practice, t'other one - anyway, the one that's forever telling you about the ailments of camels in Oman.

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Vet Record!

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;-) I only remember the one about donkeys in Jemen..... ;-)

Re: strange ecg

Lorna McHardy — Wed, 29 Feb 2012 11:37:14 GMT

[quote user="Lorna McHardy"]

[/quote]

Vet Record!

Re: strange ecg

Lorna McHardy — Wed, 29 Feb 2012 10:48:11 GMT

[quote user="james herriot lied"]

Ah well, at least I know what the treatment is for haemochromatosis in toucans now (never seen one; never will), so the morning hasn't been a dead loss.

[/quote]

That sounds like something from an edition of - drat, I've not seen it for so long I've forgotten the magazine's name!! Good grief, I'm getting old; not In Practice, t'other one - anyway, the one that's forever telling you about the ailments of camels in Oman.

That said, many thanks, as I do feel that no vet should die without knowing of the existence of haemochromatosis in toucans. It's one of those utterly essential bits of information, like the fact that a baby echidna is called a puggle.

Re: strange ecg

james herriot lied — Wed, 29 Feb 2012 10:29:48 GMT

Ah well, at least I know what the treatment is for haemochromatosis in toucans now (never seen one; never will), so the morning hasn't been a dead loss.

Re: strange ecg

HMC — Wed, 29 Feb 2012 10:07:43 GMT

[quote user="james herriot lied"]Was the dog on opoid analgesia? [/quote]

I believe she was on zantac and cerenia only. I'm sorry to be vague but she was one in-patient of many and I was only working there one day so I was not the one to set up the tx plan. It had been decided that she would go home that day and I was just doing a routine exam on her and noticed the bradycardia.

Re: strange ecg

Kate Richardson — Wed, 29 Feb 2012 10:03:47 GMT

[quote user="james herriot lied"]

D'Oh. Something did just occur to me, Hannah. Was the dog on opoid analgesia? Drug / dose? I was idly flicking through the formulary this morning during a quiet spot, and reading up on glycopyrronium, which reminded me about opoid-induced bradyarrhythmias.....

Anybody else find the formulary completely fascinating?

[/quote]

Saddo

Re: strange ecg

james herriot lied — Wed, 29 Feb 2012 09:40:17 GMT

Anybody else find the formulary completely fascinating?

Re: strange ecg

Mike Martin — Wed, 29 Feb 2012 09:20:19 GMT

[quote user="Anthony Todd"]And there seems to be a large S-T junction [segment?] shift[/quote]

Its partly a reflection of the aberrant and prolonged QRS in this instance. There's arguably a bit of ST coving/slurring in some leads. But not too important in dogs. ST segment deviation can reflect myocardial hypoxia/ischaemia.

Re: strange ecg

Mike Martin — Wed, 29 Feb 2012 09:17:10 GMT

[quote user="Anthony Todd"]Mike, Is it still true that moving the position of the fore-legs can radically change the appearance and height of the P wave, and the QRS as well, so that if the P wave is small or the end point is indistinct you can just bring the leg forward or back to get a better defined Pwave?[/quote]

Yes. The amount of variation in the whole complex on a 24 hour Holter recording is quite dramatic, as a dog lies in various position. Position of the legs and dogs can make a difference. But its not that important anymore, as we primarily use ECGs for arrhythmia diagnosis not cardiomegaly.

Re: strange ecg

HMC — Tue, 28 Feb 2012 17:32:07 GMT

[quote user="Anthony Todd"]Is it still true that moving the position of the fore-legs can radically change the appearance and height of the P wave, and the QRS as well, so that if the P wave is small or the end point is indistinct you can just bring the leg forward or back to get a better defined Pwave?[/quote]

To me it looks like the P wave is biphasic in leads I and aVL (and likewise the t wave is biphasic in lead II).

Re: strange ecg

james herriot lied — Tue, 28 Feb 2012 16:58:03 GMT

[quote user="Anthony Todd"]

And there seems to be a large S-T junction [segment?] shift, or am I way off ?

Used to be regarded as evidence of performance decline associated with recent cardiac damage in horses and ischaemic changes in humans.

[/quote]

Is that what's also sometimes known as a slurred ST? It did strike me a little, but wasn't consistent and I disrergarded it. It seems to be incidental in some leads

Re: strange ecg

Anthony Todd — Tue, 28 Feb 2012 16:50:14 GMT

And there seems to be a large S-T junction [segment?] shift, or am I way off ?

Used to be regarded as evidence of performance decline associated with recent cardiac damage in horses and ischaemic changes in humans.

Re: strange ecg

Anthony Todd — Tue, 28 Feb 2012 16:21:01 GMT

[quote user="Mike Martin"]P waves are present[/quote]

Mike, Is it still true that moving the position of the fore-legs can radically change the appearance and height of the P wave, and the QRS as well, so that if the P wave is small or the end point is indistinct you can just bring the leg forward or back to get a better defined Pwave?

Always used to work for me in horses.

Re: strange ecg

HMC — Tue, 28 Feb 2012 15:56:47 GMT

Thank you very much

Re: strange ecg

Mike Martin — Mon, 27 Feb 2012 09:08:24 GMT

Nice quality ECG and no artifacts - great.

P waves are present - so its a sinus rhythm - although slow, so a sinus bradycardia.

But the PR interval is very short and thus = pre-excitation. Thus there is a bypass tract in this dog and conduction has gone down via this short-cut to excite ventricles prematurely and from an abnormal start location resulting in an abnormal pattern - hence splintered QRS complexes. Therefore in lead II the QRS pattern is RSR's' and biphasic T wave. The P wave is small in lead I, but present.

There are many many variants of pre-excitation. Delta waves are the ones always shown in textbooks and talks. There's no delta wave here per se.

So why has it happened. Well it might be that the sinus bradycardia allows more time for replorisation of the bypass tract and thus it has the opportunity to become active. It would be interesting to see more tracing when the heart rate is faster - does this persist or not? The pre-excitation in this instance is not clinically important (unless there is a history of episodic weaknes or syncope). Or blood pressure was low.

It's the sinus bradycardia that is potentially important and the medical condition of the dog needs attention, so I would assume the bradycardia will resolve when the pancreatitis resolves, but also checking electrolytes is important as mentioned before.

Hope this helps.

Re: strange ecg

nikki — Sun, 26 Feb 2012 19:30:19 GMT

went to a talk by Adrian Boswood on Wed evening on arrhythmias so gonna have a go here. To me they do look a bit like delta waves but if I understood Wed's talk correctly the rate here is too slow for this to be right. The P-waves in lead II look quite clear though so doesn't seem to fit with an escape rhythm either although roughly the right rate for this. So, the conclusion is that despite Wed's talk I still cant interpret ECG's. Where are the cardiologists?

Re: strange ecg

james herriot lied — Sun, 26 Feb 2012 13:12:33 GMT

[quote user="Christopher Saul"]

Have you checked electrolytes? hyperkalaemia?

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Before throwing my hat in the ring, have to admit to being a complete buffoon at ECGs, but figure that if I'm going to be honest, and get better, would be best to put my 'opinion' out there and then wait for the cardiologists to show me how much I have to learn.

In view of the history, I'd definitely be interested in electrolytes, if only because with a dog recovering from shock / dehydration, things like hyperkalaemia would still be in the frame. However, there are recognisable P waves in there, so it's not quite like that classic Addisonian bradycardia. Off a short run like this, it'd be hard to make any concrete assumptions about rhythm and variation in inter-complex periods, but to extrapolate the trace, the rhythm seems constant, and whatever's happening is likely to be an extrinsic factor, as with a HR of 52, the natural ventricular rate of 60 doesn't seem to be trying to exert itself.

My thoughts are an abnormal rate which is being triggered by an extrinsic myocardial depressant factor - possibly electrolytes. I'll get me coat ready for the inevitable embarrassment.

Re: strange ecg

Christopher Saul — Sun, 26 Feb 2012 13:06:07 GMT

Hehe David, now we've talked each other out of our original gut feelings, maybe we need a cardiologist to have the deciding vote.......... Mike....??

Re: strange ecg

David Mills — Sun, 26 Feb 2012 13:01:45 GMT

Mmmmm now you mention it, 54bpm would fit with a junctional escape rhythm...and yes lead 1 does make me question P wave absence/presence...who knows?!

Re: strange ecg

Christopher Saul — Sun, 26 Feb 2012 12:50:31 GMT

[quote user="David Mills"]the spikes between P and QRS do look a bit too spiky to be delta waves?), [/quote]

Hmm I see what you mean David; I couldn't convince myself whether these are P waves or not; they're very small in lead II not visible at all in lead I. I'd initially decided they weren't P waves but maybe you're right.... I'll shut up and leave the ECGs to the cardiologists....

Re: strange ecg

Christopher Saul — Sun, 26 Feb 2012 12:37:56 GMT

I can't decide if there are P waves or not; they appear to be there in lead II but not in Lead I.To me looks like atrial standstill with a junctional ventricular escape rhythm ...... although the QRS complexes aren't as wide and bizarre as you'd normally expect from a ventricluar escape, they can look more upright and 'normal' if they originate from the AV node or bundle of His.

Have you checked electrolytes? hyperkalaemia? Otherwise, if it's paroxysmal and the electrolytes are normal, sick sinus syndrome maybe?

Of course, I'm no cardiologist so I'll be waiting for Mike to come and correct me

Chris

Re: strange ecg

David Mills — Sun, 26 Feb 2012 12:33:53 GMT

This looks like ventricular pre-excitation to me, but not classically (the spikes between P and QRS do look a bit too spiky to be delta waves?), and unfortunately I can't measure the QRS complexes on this computer to see if they're widened. These normally have a normal HR and rhythm so wouldn't explain the bradycarida - any underlying respiratory disease? Fascinating ECG.