Pancreatitis and AV block.

Re: Pancreatitis and AV block.

Christopher Saul — Mon, 08 Nov 2010 16:39:04 GMT

good stuff; glad things getting better. It's just I would want to exclude mass-occupying lesions ( eg tumours, particularly in the head of the spleen) before putting it down to the pancreatitis. Having said that, if imaging is clear and she's improving....

Re: Pancreatitis and AV block.

Jillian Hall — Mon, 08 Nov 2010 15:14:14 GMT

She's still quiet but a bit brighter than yesterday. The block is still there but a a much lesser frequency. She was having a missed beat or two for every 2-3 normal beats. Now it's about 1 in 10 and the heart rate is around 100. Still pretty reluctant to eat - just syringing baby rice. Imaging (rads and scan) has been done at the branch practice and as we work on old-school films rather than digital so I haven't had a look at them. She got shipped back to the branch this morning. I decided to charitably send the ECG machine from our main centre with her. I thought the vet there might appreciate it!

Re: Pancreatitis and AV block.

Christopher Saul — Mon, 08 Nov 2010 14:57:49 GMT

How is the dog today Jillian-has the block resolved? Did you image the abdo?

Re: Pancreatitis and AV block.

Martin Atkinson — Mon, 08 Nov 2010 12:58:04 GMT

I've found AV blocks and VPC's on ECG to be one of the more useful diagnostic tools in the diagnosis of dogs with abdominal masses especially GSDs with splenic tumours. I've not knowingly seen it associated with pancreatitis but that then begs the question, that considering pancreatitis is probably grossly underdiagnosed: how many dogs with cardiac arrythmias have undiagnosed pancreatitis and not primary cardiac disease? Food for thought.

Re: Pancreatitis and AV block.

Jillian Hall — Sun, 07 Nov 2010 20:43:58 GMT

Thanks guys. I'm popping back into work to check on her now.

I'm hoping that as the pancreatitis seems to be improving the heart will sort itself out soon. (just had a single dose of Atropine so far). I just need the dog to jump up and start eating properly.

It would be lovely to write up some of my weird cases but we don't have any official record of measuring her heart rate or rhythm during the first few days of treatment. I don't think that's something I can admit to on paper! Of course she wasn't at my branch then so I'm pleading innocence . (I'm actually quite chuffed that I picked it up.)

Re: Pancreatitis and AV block.

Richard Fox — Sun, 07 Nov 2010 18:46:25 GMT

I did find this in Pubmed - its human medicine but:

Eur J Emerg Med. 1999 Mar;6(1):27-9.

Electrocardiographic abnormalities in acute pancreatitis.

Pezzilli R, Barakat B, Billi P, Bertaccini B.

Emergency Department, Sant'Orsola Hospital, Bologna, Italy.

Abstract

It has been reported that electrocardiographic abnormalities may be associated with acute pancreatitis. However, the data are lacking or sketchy. The aim of this study was to assess the frequency and type of electrocardiographic abnormalities present in patients with acute pancreatitis. Fifty-six consecutive patients with acute pancreatitis and without previous history of heart disease were studied. Eleven patients had arterial hypertension. Forty-one patients had mild pancreatitis and 15 had the severe form of the disease. On admission, all patients underwent a standard 12-leads electrocardiogram and a serum electrolyte determination. Nineteen healthy subjects were also studied as controls. Twenty-seven patients (48.2%) (10 with severe pancreatitis and 17 with mild pancreatitis) had a normal electrocardiogram. In the remaining 29 patients (51.8%), one patient with severe pancreatitis had atrial extrasystoles and eight had bradycardia (less than 60 beats/minute) (two with severe pancreatitis and six with mild pancreatitis); 14 patients had changes of the T-wave and/or the ST-segment (two with severe pancreatitis and 12 with mild pancreatitis); seven patients showed disturbances of the intraventricular conduction (one with severe pancreatitis and six with mild pancreatitis): four had left anterior hemiblock, two had complete left bundle branch block and one had left anterior hemiblock and incomplete right bundle branch block; one patient with mild pancreatitis had atrioventricular block (first degree). No differences in heart rate, RR interval, PR interval and QT interval were found when patients with acute pancreatitis were compared with healthy subjects, nor when patients with severe pancreatitis were compared with those having the mild form of the disease. Seventeen of the 29 patients with electrocardiographic abnormalities (52.6%) also had serum electrolyte alterations. More than 50% of the patients with acute pancreatitis had electrocardiographic abnormalities and electrolyte alterations were also present in about one-half of these.

And also :

Turk J Gastroenterol. 2009 Dec;20(4):295-7.

T-wave depletion and bradycardia possibly secondary to acute pancreatitis: review of the literature.

Türkay C, Aydoğan T, Karanfil A, Uyar ME, Selçoki Y, Kanbay M.

Department of Gastroenterology, Fatih University, School of Medicine, Ankara.

Abstract

Acute pancreatitis has frequently been reported to be associated with transient electrocardiography changes mimicking myocardial infarction despite normal epicardial coronary arteries. Although the origin of these findings is poorly understood, suggested mechanisms have included electrolyte abnormalities, a vagally mediated reflex, coronary vasospasm, and myonecrosis because of the release of pancreatic proteolytic enzymes. We report a case of acute pancreatitis with new-onset electrocardiography changes and bradycardia despite no evidence of coronary artery disease. After resolution of inflammation in the pancreas, T-wave depletions in V1-V6 derivations in electrocardiography disappeared and the rhythm was sinus with 70/min. 201-Tl myocardial perfusion scintigraphy revealed no evidence of significant coronary artery disease.

Would seem you theory maybe likely :)

Re: Pancreatitis and AV block.

Christopher Saul — Sun, 07 Nov 2010 18:45:04 GMT

yes any abdominal pathology can in theory cause a vagally mediated bradycardia. Your positive atropine response test means the AV node is working ok so the block must be extracardiac in origin.

I have not seen it due to pancreatitis myself but I do not see any reason why it should not do so . However I would probhably sound a note of caution; you need to be sure it doesn't have any other cause for it's high vagal tone; I would strongly advocate abdominal imaging ( US and radiography at least) to try and eliminate other intra-abdominal pathology ( eg tumours)