Anti-arrhythmics

Re: Anti-arrhythmics

Mike Martin — Thu, 05 Mar 2009 14:05:43 GMT

Good. FYI we're putting up some echo movies on this website

http://www.vetsurgeon.org/media/19/default.aspx

And I have one of my ECG courses coming up. I only run these once every few years.

http://www.vetsurgeon.org/events/veterinary-cpd/archive/2009/01/08/08-Jul-09-09-30-ecgs-with-mike-martin.aspx

Re: Anti-arrhythmics

Rudolph — Thu, 05 Mar 2009 12:34:02 GMT

[quote user="Mike Martin"]

So in summary: if the dog is very well I would continue the status quo. Sometimes its more important that the dog is happy rather than you being happy

[/quote]

To be honest, I'm happy just hearing that! Thanks for the information, it's been really helpful. The dog is due in again next week for a check-up so I'll review everything then and see if I can classify things further. I guess I need to brush up on my cardiology generally. Off to look for some CPD!

Thanks again!

Re: Anti-arrhythmics

Mike Martin — Thu, 05 Mar 2009 12:22:17 GMT

Assuming the loud murmur in the age and breed of dog is due to MVD; the most common arrhythmias would be atrial fibrillation (AF) and supraventricular- or ventricular- premature complexes (SVPCs and VPCs)

In AF: the heart rate is typically fast, and in heart failure often 150-200/min with a 50% pulse deficit (so a pulse rate of 70-100/min). The rhythm sounds chaotic on auscultation - "slippers in a tumble drier". So your description fits for the chaotic rhythm but not the rate.

For SVPCs and VPCs: these create more of a "tripping in the rhythm" when not too frequent, but the more extra beats there are - the more irregular to chaotic the rhythm can sound. Typically in heart failure the heart rate would often be faster than 100/min. The pulse rate will depend upon the number of extra beats and thus pulse deficits. eg. If the heart rate is 150/min with only a handful of extra beats then the pusle rate may be somewhere between 100 to 140/min.

So I'm not sure if you can review the dog and help decide which category the arrhythmia might best fit?

More importantly however if the dog is "clinically quite well" then I would probably not institiute any antiarrhythmic drug (on the 'first do no harm' principle) without a definitive diagnosis of the arrhythmia and thus good justification for additional medication.

So in summary: if the dog is very well I would continue the status quo. Sometimes its more important that the dog is happy rather than you being happy

Re: Anti-arrhythmics

Alex Avery — Wed, 04 Mar 2009 14:55:46 GMT

If the dog has settled well and appears stable on the treatment you are giving then I would be inclined to keep going as you are as any anti-arrhythmic agents can go very wrong if used inappropriately, ruling out trial treatments. If there are significant pulse deficits then the clinical significance of the arrhythmia is likely to be increased and so sourcing the nearest ECG is likely to be the best option. will be interesting to hear other suggestions too as this is mainly me thinking out loud!

Re: Anti-arrhythmics

Rudolph — Wed, 04 Mar 2009 11:38:28 GMT

Hi Mike,

The HR was approximately 100bpm at the last check but I find it very difficult to count because the rhythm is pretty chaotic. The pulse is quite strong and feels more regular than the heartbeat - I haven't noted the pulse rate on his records - sorry!! His murmur is probably Grade 4, quite loud, easily auscultated. Things have improved a bit on treatment and the dog is clinically quite well but I'd feel happier having his heart rate a bit more normal.

I've given a pretty guarded prognosis but both the owner and I would like to make the dog as comfortable as possible while he's still around!

Re: Anti-arrhythmics

Mike Martin — Wed, 04 Mar 2009 09:42:50 GMT

Rudolph, would you be able to give a bit more detail on the arrhythmia? What is the HR? what is the pulse rate? Is the arrhythmia a "tripping in the rhythm" occasionally or frequently? Or is it completely chaotic? Also, on the heart failure - how loud is his murmur?

Re: Anti-arrhythmics

Rudolph — Wed, 04 Mar 2009 09:02:06 GMT

Truthfully, I don't think so! We're a bit remote and I don't think our neighbours are much better equipped than we are. I haven't asked though, to be honest.

Re: Anti-arrhythmics

Emma Jarratt — Tue, 03 Mar 2009 15:35:13 GMT

Is there a neighbouring practice that could run an ECG for you?