English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

Re: English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

Yantha Smyth — Thu, 14 Nov 2013 14:19:42 GMT

An update and thank you all for your input,

I saw the dog yesterday for an attempt at re-exam, ecg and bloods. I went outside with him to the front of the surgery (unfortunately alot of traffic noise, but dog calmer!) He actually started to have a bit of an episode just after walking on the lead out of the waiting room and onto the forecourt. He didnt become recumbent or lose consciousness in this case, but stopped and swayed a bit and had his head down and drooling for about 40 seconds. I still couldnt palpate femoral pulses, but his mms were dusky pink with prolonged CRT, and is resps were deeper and more forceful, with some crackles. The heart rate at this time had dropped to about 60/min, and then I heard it 're-start' at the rapid tachyarrhymic rate and rhythm.

It was not possible to carry out the ecg in forecourt, but I was able to get a pretty decent trace with the dog standing. The machine prints leads i, ii, and iii in a row, so did have to decrease the mV and also have the speed at 50mm/s to get separate complexes and no overlapping.

The HR was ranging 248-270/min!! which fits with my auscultation. Supraventricular, no P-waves. No VPCs. Pretty certain atrial fibrillation. I wondered if the syncopal episodes may correlate to an atrial standstill or AV block with ventricular escape rhythm or something like that, when it dropped to as low as 60 during the episode. Unfortunately this event was not caught on the ecg, so will be speculation!

Electrolytes are pending, but PCV, renal, protein, and hepatic enzymes were WNL.

I have decided to change the treatment, but also given the owners a very guarded prognosis advising he could die at any point with the severity of his condition. ( I am amazed he has made it this far!)

I am withdrawing the vetmedin reducing to 50% for last 4 days until they run out of their current meds. Starting on benazepril 10mg sid, frusemide 20mg bid, and lanoxin 0.125mg bid. 30kg dog. I thought a beta blocker could be too risky in this case as seems so on brink of CHF, though I am not sure if the owners will be that keen to test digoxin levels as they should be.

On the plus side, I got the ecg and bloods done for less than the cost of a pot of vetmedin tablets, and their collection of 3 meds still works out £20/month cheaper than the vetmedin as sole agent.....but will he survive???

Thanks again, and especially Mike Martin

Re: English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

Anthony Todd — Wed, 13 Nov 2013 09:52:13 GMT

Why not get the owner to sedate the dog first; I used ACP but I'm sure there will be all sorts of authentic reasons why not these days....?

Could get the owner to count the heart rate and rhythm at rest and then during the faint, even lend the owner a stethoscope to use at home when the dog is asleep ?

Teach the owner to measure or assess femoral pulse pressure?

What about exercise tolerance when he's not fainting? Should tell you whether it's a circulatory insufficiency or a straight electrical mis-fire?

Blowed if I can understand how this could be related to an unrelated pathology in the total absence of other signs.

Once recorded an ECG on a poodle whose heart went into complete asystole for 26 seconds. Difficult to know what to do as the flat line spewed out......but then it started.

All that seemed to happen was that the dog got a bit restless after 20 seconds or so [and so did I]

Re: English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

Mike Martin — Wed, 13 Nov 2013 09:19:45 GMT

Any chance you could get a movie recording of the collapsing as he is doing so 6 x a day at present? Has this become worse on pimo?

The collapse in this instance falls into one of two types:

1. Limited cardiac output, and unable to increase this on exercise/exertion/excitement, thus a drop in BP and collapse. These are due to structural heart disease, in EBT differentials would be congenital disease such as AS & mitral dysplasia and adult disease such as DCM or pericardial effusion. So these cases collapse less suddenly, more of a recumbency, after some form of exertion.

2. A profound intermittent arrhythmia that causes the BP to drop leading to collapse. Examples would include a sustained ventricular tachycardia. This would ideally need an ECG during the collapse and this would need a Holter. These cases collapse suddenly without warning, maybe a little prior ataxia, or associated with excitement, sometimes with opisthotonos.

If the heart already has an arrhythmia, then there is likely underlying structural disease (1), thus XR & echo would be most useful. Pimo might not be beneficial if there is some form of stenosis such as AS or mitral stenosis, but would help if there is DCM (along with frusemide, ACEi and spironolactone). The the arrhythmia is AF, then additionally digoxin.

If you are wanting to get an ECG in a dog with bad trembles, then perform it where the dog is not so bad, eg. in the car park or owners car, but also, don't put the ECG clips on the parts that are trembling (ie. the legs). Instead put them, on the body, eg. foreleg clips on either side of the neck, and hind leg clips on the flank.

This case sounds like one in which referral should be offered, but I understand that finances may be prohibitive, but cover yourself by ensuring the offer was made.

A movie would be useful.

Good luck.

Re: English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

Michael Woodhouse — Tue, 12 Nov 2013 23:22:27 GMT

Try doing the ECG in the carpark or even the owners car. Sometimes they are a different dog out there and very tolerant. Take off your consulting top or coat.

We have a handful of patients that are fine to examine outside the surgery, but take them inside and they are a nightmare.

Re: English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

Yantha Smyth — Tue, 12 Nov 2013 23:06:10 GMT

Whoops seem to have messed up the quote function there- still a bit of an iPad novice and post novice!

Re: English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

Yantha Smyth — Tue, 12 Nov 2013 23:04:48 GMT

[quote user="Yantha Smyth"]The dog ......... has had a conscious lateral X-ray [/quote]

[quote user="Yantha Smyth"]Unfortunately the dog absolutely hates the vets and is a quivering trembling and panting wreck in the consult room![/quote]

I'm fascinated... how on Earth did you manage the radiography?????

[/quote] Indeed! 'Twas not me, and the vet involved is no longer here to liase with.... No wonder there is movement blur, and I suspect it had to have been manually restrained..... Maybe why it fainted at the last visit?! I will be surprised if I get the ECG clips on, and staying on to get a trace. Fortunately he just seems intent on escape rather than eating people.[quote user="Gillian Mostyn"]

I'm no cardiologist so will leave advice to others but

Re: English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

Claire Fisher — Tue, 12 Nov 2013 22:02:52 GMT

All sounds like a good plan to me.

If they can stretch to it maybe some more extensive bloods and an abdominal xray - a ventricular tachycardia could be secondary to systemic disease. Less likely if he's always had syncopal episodes though.

Re: English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

Gillian Mostyn — Tue, 12 Nov 2013 21:52:21 GMT

I'm no cardiologist so will leave advice to others but

[quote user="Yantha Smyth"]The dog ......... has had a conscious lateral X-ray [/quote]

[quote user="Yantha Smyth"]Unfortunately the dog absolutely hates the vets and is a quivering trembling and panting wreck in the consult room![/quote]

I'm fascinated... how on Earth did you manage the radiography?????

Re: English Bull Terrier with frequent syncope and arrhythmia- cardiac help!

mariette asselbergs — Tue, 12 Nov 2013 21:39:24 GMT

I would suggest a standing ECG. If there is AF you will see it. If that is the case,then get the frequency down with digoxine, and then vetmedin and cardialis will work. If you are careful with dosing I don't think you can do very much harm, and the dog seems to have survived OK up to now, so there is no need to panic over urgent and drastic treatment.

At least that is my tuppence.

(I have a 13 year old EBT myself on vetmedin and cardialis and became a different dog since on medication. No lung symptoms, but was "lifeless and demented before, and is now back to be a normal dog again)