Episode of collapse in dog-advice please

Re: Episode of collapse in dog-advice please

Rob Loxley — Wed, 11 Sep 2013 18:07:18 GMT

[quote user="Gillian Mostyn"]

[quote user="Mike Martin"](unless the owner is particularly worried and got a gold insurance policy - in which case refer)[/quote]

I know it was only a throw-away comment, and also not a clear-cut situation, but don't you find this kind of thing unethical?

[/quote]

If you said - refer just because insured, then yes. Maybe better worded - if they are particularly worried and have desire and means to pay, refer?

Re: Episode of collapse in dog-advice please

Gillian Mostyn — Wed, 11 Sep 2013 12:39:51 GMT

[quote user="Mike Martin"](unless the owner is particularly worried and got a gold insurance policy - in which case refer)[/quote]

I know it was only a throw-away comment, and also not a clear-cut situation, but don't you find this kind of thing unethical? If our clinical opinion is 'best to wait and see', then sending the dog off for extensive testing and sending the large bill to the insurance company is fraudulent - no?

Re: Episode of collapse in dog-advice please

Mike Martin — Wed, 11 Sep 2013 09:34:53 GMT

Sounds like you have done everything reasonable to screen for medical causes - so I would not go further along that route unless there are more episodes or other medical symptoms. If the pallor is not associated with shock or anaemia - as you have ruled out - then a drop in cardiac output is the remaining differential....

So top differentials would include an intermittent arrhythmia (and vasovagal) such as a profound bradyarrhythmia like sinus arrest or heart block with a ventricular pause, or a tachyarrhythmia such as a ventricular tachycardia. A resting in-clinic ECG when the dog sounds normal and is standing, has a low diagnostic yield, ie. likely to be normal. Really needs an ECG during the next collapse - which means a Holter when it starts to collapse more.

Teaching the owner to feel the apex beat during a collapse sometimes helps - but it is the abnormal rhythm preceeding the collapse that results in collapse - so by the time of collapse, the heart rhythm has often returned to normal. (If that makes sense).

A movie of the collapse can be useful. Opisthotonos is common with cardiac syncope and very often mistaken for seizures in dogs (and in children!). I have some movies of this in my 'collapse' lecture (next is FECAVA next month in Dublin).

In JRTs we have seen complete heart block and vasovagal collapse. Also congenital heart defects, which can result in exertion-associated collapse (ie. inability to increase cardiac output on exercise) - but then there should be a murmur - so this seems unlikely.

In summary and based on what you have done, I would 'wait and see' if more collapses occur (unless the owner is particularly worried and got a gold insurance policy - in which case refer).

Good luck.

Re: Episode of collapse in dog-advice please

Busybee — Tue, 10 Sep 2013 21:27:44 GMT

Had an almost identical one this weekend. This dog was 7yrs old. It had had episodes like this occasionally when it was younger and no cause was found (don't think it had particularly extensive work up though). It had not had one for 5 years until this weekend, however the owner found the dog as it was 'coming round' so was unsure how long the episode lasted. Again, nothing found on clinical exam 30mins later and by the end of the consult, the dog was running round fine and eating gravy bones :) We have decided to monitor as before and if becoming frequent, will start work up.

Re: Episode of collapse in dog-advice please

Anthony Dennison — Tue, 10 Sep 2013 17:22:58 GMT

Could be vaso-vagal related?

Re: Episode of collapse in dog-advice please

Nicola Cole — Tue, 10 Sep 2013 14:27:24 GMT

Thanks for all your replies. To answer Martin's questions-dog wasn't overly exerting self-had just gone into garden and mooching around (owner mentioned trying to eat grass). Difficult to say how long the episode truly lasted for as dog was scooped up by owner after a few seconds so time from when went down to when could get up unknown. Was apparently wandering around vacantly after about a couple of minutes (but whether that was just when owner put dog down to see what would do). I think the main reason I'm asking is because I have recently changed practices and in my old practice if clin exam ok I would have done baseline bloods for anaemia, glu and if ok probably just waited to see whether happens again. Just making sure that how we did things at my old practice (which will inevitably have influenced how I work cases up as there for 6 years starting as a recent grad) is fairly consistent with general opinion (as it was a lovely practice but fairly old-fashioned)! After seeing the dog I was sat at home worrying 'Would other vets have done more work up at this stage?!'

Re: Episode of collapse in dog-advice please

Gillian Mostyn — Tue, 10 Sep 2013 12:31:58 GMT

I would have given the dog a full clinical exam but, as it was AOK, I wouldn't have done any testing at all unless it happened again. I certainly wouldn't be repeating bloods or doing an ECG and thoracic rads at this stage.

It sounds like it 'went woozy/fainted' - could be due to any number of factors. Happens to us all sometime!

Re: Episode of collapse in dog-advice please

Martin Atkinson — Tue, 10 Sep 2013 11:51:31 GMT

You've not said how long the original episode lasted or if it was tearing around when it occurred. Those facts may give better clues as to whether it was a seizure or syncope. Can't see the point in bile acids or repeating bloods if no other symptoms and first bloods were normal. Not likely to be Addisons if Na, K and Glu are normal and would be more episodic. I'd do an ECG if you can but as John says it will likely be normal. I'd also wait and see what happens. I'd go with seizure at present especially with your delayed recovery despite your apparently pale mm.

Re: Episode of collapse in dog-advice please

John Flynn — Tue, 10 Sep 2013 00:52:45 GMT

To be honest, I don't normally investigate something like this if first occasion unless owner particularly keen, but only comment i have is re ecg:

A 10minute ecg trace in this dog if no arrhythmia noted, electrolytes normal and is not showing clinical signs at the time is going to have a pretty low diagnostic yield i'm guessing and while obviously no harm it might not be worth bothering about? If worth doing, i'd think about a 24hr holter (eg http://www.holtermonitoring.co.uk/ or refer if local specialist).

If the patient was having repeated but sporadic events, then getting event monitor (eg SC Reveal device) might be only way to establish what heart doing at time - but i certainly wouldn't do that after a single episode!

Asking them to video the next event if occurs is always helpful i feel.

Re: Episode of collapse in dog-advice please

Nicola Cole — Mon, 09 Sep 2013 23:44:55 GMT

P.S. Sorry for the lack of paragraphs and line spacing-they were there but looks like the ipad won't allow me to post it like that!