Double Peak of R waves on ECG

RE: Double Peak of R waves on ECG

Arlo Guthrie — Mon, 15 Oct 2018 11:58:48 GMT

Anthony Dennison there you go, added to the OP. Halved the file size by optimising for web.

RE: Double Peak of R waves on ECG

Anthony Dennison — Mon, 15 Oct 2018 10:59:47 GMT

[quote user="Martin Atkinson"]Sounds like P mitrale because the left atria is so enlarged it takes time for the the electrical impulse to traverse it so you get a wider P wave with a notch, the same can happen with the R waves so while not normal it is not in itself a concern.[/quote]

Yes that is it, I've had some input from a cardiologist. The splintered R wave (QRS complex isn't widened) is probably due to a microscopic intramural infarction, which he says is irrelevant.

RE: Double Peak of R waves on ECG

Anthony Dennison — Mon, 15 Oct 2018 10:51:46 GMT

[quote user="Arlo Guthrie"]

Anthony Dennison - what is the file size you are trying to upload? In most cases, original images will be far bigger than they actually need to be for the purpose of sharing online, and it is best either to resize smaller, or optimise for web, or both. You can email images to support@vetsurgeo.org and I will resize for you if needs be.

[/quote]

between 5.5 and 6.1MB. I'll email them over.

RE: Double Peak of R waves on ECG

Martin Atkinson — Mon, 15 Oct 2018 10:48:06 GMT

[quote user="Anthony Dennison"]

Currently treating an elderly CKCS with CHF, she has been on treatment for some time but last week the owners brought her in because she was off her food and lethargic. She had an irregularly irregular heart rate, increased abdominal effort with her breathing and femoral pulse deficits.

I attempted an ECG but I had an old machine at my branch with a dodgy lead that wouldn't work, so I increased the pimobendan dose to closer to 0.5mg/kg (already on cardalis and furosemide) with a view to rechecking ECG when I got a working machine over.

A week later, the arrhythmia had gone; still the occasional skipped beat but very few and far between. ECG was a bit weird, with double peaked P and R waves.

When I scanned the dog last week the heart didn't look great, poor contractility with an enormous left atrium, so I suspect we're approaching end stage here. However, what is causing the abnormal appearance of the ECG - should I be worried, and should I add in any more meds?

[/quote]Sounds like P mitrale because the left atria is so enlarged it takes time for the the electrical impulse to traverse it so you get a wider P wave with a notch, the same can happen with the R waves so while not normal it is not in itself a concern.

In these cases I tend to double the max dose of pimobendan and add in sildenail.

RE: Double Peak of R waves on ECG

Arlo Guthrie — Mon, 15 Oct 2018 10:47:32 GMT