What's going on on this ECG?

RE: What's going on on this ECG?

David Mills — Mon, 19 Mar 2018 20:25:27 GMT

[quote user="Charlotte Marshall"]Re the original trace. The dog was in right lateral recumbency and the leads were attached on front of elbows and hocks. Knowing this do you feel there is more significance to the small R waves?[/quote]

Interesting, but no, the dog hasn't got a problem with small R waves, deep chested breed etc so heart may have been sat off kilter (moving FL ones to axillae can help but tbh I'm in love with my kardia app so haven't used a proper ecg for years).

In this case, I'd scan it and see where you're at. This is partly being defensive but also best practice. No structural changes? Knock it out and whip off the epuli. Changes? Not with a bargepole, it'll be in worse trouble soon, start your fave anti-arrythmic. Amiodarone is mine, sotalol also a good choice.

If you are ga ing, hook up to an ecg and have lidocaine (plus/minus iv sotalol (used to be cheap as chips, unsure now) to hand. Premed pure opioid iv then propofol and wake up as quick as possible. For once, would avoid acp and alphas.

RE: What's going on on this ECG?

Lucy Fleming — Mon, 19 Mar 2018 12:03:04 GMT

[quote user="David Mills"] It's one of the few organs animals can do without[/quote]

Really? I shall retire my stethosope immediately!

RE: What's going on on this ECG?

Charlotte Marshall — Mon, 19 Mar 2018 09:53:30 GMT

Re the original trace. The dog was in right lateral recumbency and the leads were attached on front of elbows and hocks. Knowing this do you feel there is more significance to the small R waves? I assume you would not be thinking of a GA for it! The owner is concerned that the epuli are affecting the dog's eating.

RE: What's going on on this ECG?

David Mills — Sat, 17 Mar 2018 20:46:41 GMT

[quote user="Anthony Dennison"]

How about a holter monitor over 24 hours?

Hope you don't mind all the questions, I'm considering doing another certAVP in cardiology so trying to learn as much as possible!

[/quote]

Yes can consider but it may not tell you any more than you already know.

The treatment of asymptomatic patients is controversial, especially as may not be beneficial.

Just re read my initial responses. On echo, you can see changes (v reduced functionality RV and reduced wall thickness) but IME these have been in symptomatic cases

Oh and yes definitely do cardiology. It's one of the few organs animals can do without and you can make a huge difference with relatively basic equipment. It also boasts probably the best evidence Base in vet med so you're not in the realms of bullshit!

RE: What's going on on this ECG?

Beats — Sat, 17 Mar 2018 15:01:28 GMT

Boxers with ARVC gives the best ecg traces ;-)

Here's one (well it was a 6 year old boxer with collapsing signs which were fixed by sotalol, I'm assuming was ARVC) of my favourites from the archives (not in right lateral recumbency I'm afraid and done with cheapo ECG recorder):

RE: What's going on on this ECG?

Anthony Dennison — Sat, 17 Mar 2018 10:18:32 GMT

How about a holter monitor over 24 hours?

Hope you don't mind all the questions, I'm considering doing another certAVP in cardiology so trying to learn as much as possible!

RE: What's going on on this ECG?

David Mills — Sat, 17 Mar 2018 00:15:17 GMT

[quote user="Anthony Dennison"]

[quote user="David Mills"]

Yep certainly could be.

How was dog positioned - re R waves - wouldn't be an immediate concern.

Anti arrhythmic would be indicated. Amiodarone is my favourite.

[/quote]

David, would you move on to an Echo after seeing this ECG to check for any structural changes to determine whether other cardiac drugs would be necessary?

[/quote]

Yes ideally but with ARVC there are normally no changes. You'd be looking to rule out say a mass lesion or evidence of infarcts or myocarditis.

May be worth running bloods on this Esp troponin and haematology and acute inflammatory markers.

Arvc is a tricky diagnosis. All we have here is an asymptomatic dog with regular singular VPCs. Its breed is predisposed. Normally the RV VPCs are narrower than LV ones but from the ECG I suspect this dog was difficult to position or restrain as the orientation seems to be a bit out. It would be a nice one to use the kardia kit on.

There is a big debate about when to treat. A huge human study showed treating asymptomatic people with VPCs with an antiarrhythmic actually massively increased mortality vs placebo.

I only skim read the post and this dog is asymptomatic so at this stage with isolated VPCs and normal rhythm between I would wait and see (if myocarditis ruled out as much as possible)

RE: What's going on on this ECG?

Anthony Dennison — Fri, 16 Mar 2018 22:59:20 GMT

[quote user="David Mills"]

Yep certainly could be.

How was dog positioned - re R waves - wouldn't be an immediate concern.

Anti arrhythmic would be indicated. Amiodarone is my favourite.

[/quote]

David, would you move on to an Echo after seeing this ECG to check for any structural changes to determine whether other cardiac drugs would be necessary?

RE: What's going on on this ECG?

David Mills — Fri, 16 Mar 2018 00:40:01 GMT

Yep certainly could be.

How was dog positioned - re R waves - wouldn't be an immediate concern.

Anti arrhythmic would be indicated. Amiodarone is my favourite.

RE: What's going on on this ECG?

Charlotte Marshall — Thu, 15 Mar 2018 22:37:13 GMT

Here's the ECG.

RE: What's going on on this ECG?

Charlotte Marshall — Thu, 15 Mar 2018 16:53:01 GMT

Oops sorry forgot to attach it. Not at the computer with it on at the moment will do it later today.

RE: What's going on on this ECG?

Julie Innes — Thu, 15 Mar 2018 16:08:10 GMT

Sorry, I can't see the ECG!