ECG of a cat with arrhythmia

RE: ECG of a cat with arrhythmia

Kate Richardson — Sat, 15 Jul 2017 21:59:51 GMT

[quote user="David Mills"]I don't agree with the specialists advice. He also wrote an article recently about treating ATE cats and they could have a "good" prognosis. It's all opinion and healthy deviate of course. [/quote]

I haven't read this but would like to- where was it published. he spoke about ATE at ISFM congress, and was very realistic about it and said that euthanasia was never the wrong thing to do, but presented some cases where cats did do well for a significant length of time, essentially there were certain criteria that had to be filled for him not to consider euthanasia, but in the right cases he felt justified in treating. I have always been in the 'not giving false hope' camp that you sit in and I would still probably euthanase most of these cases but this just gave another perspective for those cases where pain is controllable and cat and client are compliant. Is it any worse than a tail pull injury which you give time to see if it recovers? Poss these cases can cause more suffering in management than an ATE cat that is comfortable.

RE: ECG of a cat with arrhythmia

Chris Barker — Sat, 15 Jul 2017 11:43:05 GMT

It does not augur well for the value of this forum for the discussion of clinical practice, or more generally for evidence based medicine itself, when those who post most regularly on the subject appear to be the more dogmatic and intransigent of contributors. Of course it is interesting to hear that their last 10,20, or 30 cases have been treated in this way or that way and have survived, but until such experiences are tested against the results achieved in animals treated in different fashion, or not treated at all, then we are dealing with anecdote not evidence. Ultimately our patients deserve more than to be treated simply on the basis of good ideas and good intentions.

Ten years ago many of us were encouraged to reduce the heart rate of those cases of feline HCM where the rate exceeded 180 bpm by using atenolol. Seemed a good idea at the time. But now we have a five year study which shows no difference in survival/outcome for animals given/not given the beta blocker. I’m sure that there are many clincians are still using these drugs as they seem to represent ‘a good idea’ but the evidence does not support them in so doing.

Perhaps we are at a similar place with ACE inhibitors? We know they work in dogs, surely they must work the same way in cats… ? Perhaps they do, but currently evidence for this belief is weak; to simply assume equivalence is wrong.

With pimabendan the situation is somewhat different and in some ways more contentious. But when at ISFM Congress there are two experts (not just one, Virginia Luis Fuentes was of a broadly similar view) expressing concern that the use of pimabendan in cats with murmur/outflow obstruction was potentially dangerous, that they would restrict the drug’s use to cases without a murmur or for which other therapies had failed, then I for one am ready to accept their opinion.

I recognise that until suitable studies are complete much of what is presented by experts tends to be their version of anecdote… But unlike many practitioners they do not work in isolation, they collaborate with colleagues and discuss options/treatment protocols/end points etc, and they see far more cases than any of us in practice. So while their opinion may be based on anecdote, it is anecdote of a quality far greater than anything I can offer!

RE: ECG of a cat with arrhythmia

David Mills — Fri, 14 Jul 2017 21:14:58 GMT

Atko and I have been here as nauseum before so I won't repeat the argument.

Interestingly, pimobendan is the only drug that has evidence of benefit. There were a couple of studies a couple of years back. These included cats with SAM.

I don't agree with the specialists advice. He also wrote an article recently about treating ATE cats and they could have a "good" prognosis. It's all opinion and healthy deviate of course.

My standard tx for chf in cats is pimobendan sid 1.25mg per cat (half life a lot longer) and frusenide. Don't forget it's lusitropic effects which may be particularly useful in hcm.

RE: ECG of a cat with arrhythmia

Kate Richardson — Fri, 14 Jul 2017 13:41:46 GMT

[quote user="Martin Atkinson"]

[quote user="Kate Richardson"]ACE inhibitors have no proven benefit in pre clinical or clinical cases[/quote]Because no-one has done the research. You will all screem anecdote but from my experience I have no doubt that pre-emptive treatment with Benazepril prevents, or at least delays, the onset of cardiac failure in cats with asymptomatic HCM and I will continue to recommend this to my clients.

[/quote]

There is so much variability between cats in terms of which ones will develop clinical signs and which ones won't that it's hard to know if they haven't developed c/s because of the treatment or despite the treatment. I agree that research would be great or even a retrospective study. Personally although it is a fairly benign drug, it's not totally without possible side effects, I'm in the 'risks outweigh proven benefits' camp unless proven beneficial.

I suspect even if a proper study supported the lack of benefit you wouldnt believe it anyway

Maybe we can run a study once 'my' new cat clinic is up an running and do some longer term comparisons. Depending on how long you plan to continuing working for.....

RE: ECG of a cat with arrhythmia

Martin Atkinson — Fri, 14 Jul 2017 11:09:44 GMT

RE: ECG of a cat with arrhythmia

Kate Richardson — Fri, 14 Jul 2017 09:48:27 GMT

[quote user="David Mills"]

[quote user="Maciej Głębicki"]

You should firstly check on echo what is going on with that heart, if there is hcm with dynamic sas pimobendan can kill this cat. Hr 145 is very nice efekt if you had 220 on this patient. Screening echo exam should be Ok, especialy if Its a senior cat.

[/quote]

I disagree with this, as does the evidence. A retrospective study of pimo in cats with Sam etc showed no increase in mortality.

[/quote]

I liked Maciej Głębicki s post because it was the first one to mention an echo! This cat has 'suspected HCM'- so get a definitive diagnosis before throwing various cardiac drugs at it. There is info out there that pimobendan is a useful drug for cats but there are caveats- Kieran Borgeat is a very keen feine cardiologist, now at Bristol vet school, lectured at ISFM congress this year and his criteria for considering its use are:

1) if there are clinical signs of CHF (not to use it in asymptomatic cats)

2) if there is syncope

3) if there is poor or diminishing response to other drugs (primarily increasing frusemide to less and less effect)

4) no significant LV outflow tract obstruction on echo

5) if no access to echo/doppler, a very loud murmur means it is likely there is some LVOTO

Always adv off licence and limited published info as yet.

Other points were diltiazem has no benefit unless atrial fibrillation or SVT (which i think from memory is sustained ventricular tachycardia?!)

Beta blockers have no identifiable benefit and may worsen heart failure

ACE inhibitors have no proven benefit in pre clinical or clinical cases

Frusemide and clopidogrel are his main treatments

[quote user="David Mills"]I know some do, but I wouldnt treat preclinical cat heart disease with anything. The evidence isn't t there. [/quote]

100% agree, assuming you mean no LA enlargement where I would consider clopidogrel in an asymptomatic cat

RE: ECG of a cat with arrhythmia

David Mills — Wed, 12 Jul 2017 23:53:43 GMT

[quote user="Maciej Głębicki"]

[/quote]

I disagree with this, as does the evidence. A retrospective study of pimo in cats with Sam etc showed no increase in mortality.

They look like ventricular complexes.

A gallop always makes me suspicious of RCM where arrhythmias are common.

I know some do, but I wouldnt treat preclinical cat heart disease with anything. The evidence isn't t there.

RE: ECG of a cat with arrhythmia

Maciej Głębicki — Wed, 12 Jul 2017 11:32:27 GMT

If a middle linE is second lead there is probably rbbb cause there is p wave and rr are similar

RE: ECG of a cat with arrhythmia

Roland Bulkyn-Rackowe — Wed, 12 Jul 2017 10:45:16 GMT

+1 for the echo. Have you checked his blood pressure, T4? I've tried and failed to holter a few tachycardic cats. I have managed to instruct a few owners how to use a stethoscope at home (easier for them than a femoral pulse) and measure the HR at home. It can be completely at odds to findings in the clinic.

RE: ECG of a cat with arrhythmia

Maciej Głębicki — Tue, 11 Jul 2017 23:03:06 GMT

All you said is true, but according to thouse pic of ecg print we cant say top mutch, we dont know what is what( there is no mark of any leads, we dont know what is sweep rate etc, Its looks like bigeminic rythm or a least few things else, not to mutch info about this record of ecg.. echo exam should be done, it can give you more answers.

sorry for my eng, especialy for my phone whitch is making it worse(autocorrect to my lead lenguage)

RE: ECG of a cat with arrhythmia

Catherine Jeanes — Tue, 11 Jul 2017 22:02:10 GMT

I'm not a cardiologist, but I would be leaning to an intermittent 2nd degree AV block with ventricular escapes. I would suggest an echo if possible, might see structural changes that could have caused this, also check left atrium size, contractility etc. The gallop rhythm suggests there is likely to some structural disease. If the cat is otherwise stable I wouln't rush to change treatments, a heart rate of 145 sounds like a big improvement already.

RE: ECG of a cat with arrhythmia

Maciej Głębicki — Tue, 11 Jul 2017 19:40:10 GMT

RE: ECG of a cat with arrhythmia

Martin Atkinson — Tue, 11 Jul 2017 19:03:03 GMT

It looks like a 1st degree heart block to me but it would be interesting to see an ECG from before treatment. If he is clinically well and there was a marked arrhythmia before I'd tend to stick with what you've got but think about adding in some Pimobendan if he starts showing signs of cardiac failure.

I had a cat with a chronic arrhythmia characterised by frequent (1:3-4) VPC's which did well on atenolol and its ECG looked much like this under treatment but with a less spiked R wave and I considered that well controlled. Over several years its requirement gradually decrease so it is now off treatment and normal. However he was much younger and he was diagnosed with chronic triaditis which grumbled on for ages. I just wonder how much that was a contributory factor. So maybe re-visit your 'suspected' HCM, do a general health profile and if its not practical to offer echocardiography try NT-proBNP, I have found that a very reliable marker of cardiac failure.

I'm not a cardiologist but hope that helps.

RE: ECG of a cat with arrhythmia

Maciej Głębicki — Tue, 11 Jul 2017 18:49:20 GMT

sweep speed? And mv/mm? Witch one is 2nd line?