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Case 35
Primary clinician:
Patrizia Knafelz, DVM
Supervising clinician: Mark D. Kittleson,
DVM, PhD,
DipACVIM (Cardiology)
Eight-year-old neutered male Boxer dog ("Dante")
 | Periods of collapse |
| Dante is an 8 year old MC Boxer presented to
Cardiology Service with the primary complaint of episodic
collapse. |
| The owner is a registered
veterinary technician. The owner states that the episodes began a
couple of weeks ago and have increased in frequency. |
| He had one episode
3 days ago and 4 two days ago.
Most of the episodes have started while Dante is
asleep on the bed or lying on the ground. He jumps
up and then falls over on his
side with his legs stiff. One time Dante
walked through the kitchen and collapsed. He does
not appear to lose consciousness and does not urinate or defecate.
There is no clonic motion. The episodes last less
than 1 minute and he regains normal mentation immediately afterward.
|
| The
owner has taken Dante's heart rate and recorded
it to be approximately
40 bpm every time one of the episodes occurred. After one episode, the owner
gave Dante 0.5 ml atropine intramuscularly. A few
minutes later she recorded a heart rate of 60 bpm. |
| The owner checked Dante's heart rate yesterday and
recorded 80 bpm. |
| The owner reports
polydipsia/polyuria (PU/PD).
He was also observed drinking a lot of water in
the Cardiology Service exam room. |
| Past medical history includes hypothyroidism, anterior
uveitis and a broken femur with neurological damage. Due to the neurological
damage to the right hind leg, the toes required amputation and now Dante
must wear a bootie on the foot. |
| Current medication: thyroxine -
0.7 mg BID |
| Gen: BARH, T = 103.2, HR = 80, RR = panting, BW = 26.2
kg |
| Integument: No abnormalities noted |
| EENT: Fractured teeth |
| MS: No
abnormalities noted; BCS 4/9
|
| CV: Irregular rhythm;
no other abnormalities noted |
| Resp: No
abnormalities noted |
| GI: No
abnormalities noted |
| NS: No
abnormalities noted |
| LN: No
abnormalities noted |
| Episodes of collapse
|
| PU/PD |
| ECG: The ECG showed a sinus arrhythmia and periods of
high grade 2:1 2nd degree AV block with an average
heart rate of 80 beats per minute. Occasional supraventricular premature
complexes noted. |
| Echocardiogram: Mild
tricuspid insufficiency and mild aortic insufficiency.
All measurements were within normal limits (IVSd = 0.7 cm, LVIDd =
3.9 cm, LVPWd = 1.2 cm, IVSs = 0.9 cm, LVIDs = 2.6 cm, LVPWs = 1.4
cm, Ao root diameter = 2.2 cm, LA dimension = 3.4 cm, LA:Ao = 1.5, SF = 34%,
pulmonic velocity = 1.4 m/s (PG = 7.6 mmHg),
tricuspid velocity = 2.3 m/s (PG = 20 mmHg), Ao
velocity = 1.7 m/s (PG = 12 mmHg).
|
| Atropine test: 2.6 ml (0.04 mg/kg) of atropine
was injected SQ. 30 minutes later
the ECG was repeated
with no change in ventricular rate noted which is suggestive of a conduction
problem; high grade 2nd degree AV block was 3:1 and 4:1 after atropine
because of an increase in sinus rate. HR approximately 86 bpm prior
to and after atropine. Event monitor will be placed. |
| Abdominal ultrasound: WNL with the exception of "thumb
prints" on spleen noted. |
| Urinalysis: Urine sample collected by cystocentesis
(ultrasound guided) and submitted to the lab for analysis:
Hazy turbidity; pH 7.0;
specific gravity = 1.012;
1+ bilirubinuria (Ictotest)
which is within normal range for a male dog; rare
RBC; few lipid droplets. |
| Periods of high
grade 2nd degree AV block. |
| We are placing an event monitor on Dante
to determine his cardiac rhythm during one of his episodes. When you
see an episode of collapse, push the button
on the monitor, as soon as you see Dante collapse.
The event monitor records 2 events. Please contact the
Cardiology Service when an event has been
recorded. The ECG signal recorded on the monitor
can be transmitted over the telephone line to us
during our regular business hours. |
| Dante has been drinking a lot of water and urinating a
lot (PU/PD). Therefore, an abdominal ultrasound was performed on Dante.
Everything looked normal on the abdominal ultrasound.
A urine sample showed that his kidneys may not be
concentrating the urine normally. |
| Thank you for bringing Dante to Cardiology Service. He
was a pleasure to work with, a very sweet and polite gentleman!
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