Page 77 - Basic Monitoring in Canine and Feline Emergency Patients

patient. Recall that the most common cause of ECG signal acquired by medical devices. Measurement
Science Review 13, 231–236.
atrial standstill is hyperkalemia; in cats, the most Cote, E., Ettinger, S.J. (2017) Cardiac arrhythmias. In:
VetBooks.ir common cause of clinically significant hyper- Ettinger, S.J., Feldman, E.C., Cote, E. (eds) Textbook
kalemia is urethral obstruction. Taken together
th
of Veterinary Internal Medicine, 8 ed. Elsevier,
with physical examination findings of pain on
St. Louis, Missouri, USA, pp. 1176–1200.
abdominal palpation and evidence of circulatory Cote, E., Harpster, N., Laste, N.J., et al. (2004) Atrial fibrillation
shock, this patient likely has a life-threatening ure- in cats: 50 cases (1979-2002). Journal of the American
thral obstruction requiring emergent medical man- Veterinary Medical Association 225, 256–260.
agement and de-obstruction. Additional diagnostic Finster, S.T., DeFrancesco, T.C., Atkins, C.E., et al.
testing that should be performed urgently include (2008) Supraventricular tachycardia in dogs: 65
point-of-care bloodwork to confirm presence and cases (1990–2007). Journal of Veterinary Emergency
severity of hyperkalemia (as well as measurement and Critical Care 18, 503–510.
of other electrolytes, packed cell volume/total pro- Gelzer, A.R.M., Kraus, M.S., Rishniw, M., et al. (2009)
tein, and BUN/creatinine), point-of-care abdominal Combination therapy with digoxin and diltiazem con-
ultrasound to confirm presence of enlarged turgid trols ventricular rate in chronic atrial fibrillation in
bladder, and abdominal radiographs to screen for dogs better than digoxin or diltiazem monotherapy: a
randomized crossover study in 18 dogs. Journal of
presence of urolithiasis. Veterinary Internal Medicine 23, 499–508.
The most urgent immediate treatment for this Gelzer, A.R.M., Kraus, M.S., Rishniw, M., et al. (2010)
patient is calcium gluconate; emergency dose is Combination therapy with mexiletine and sotolol sup-
100 mg/kg (or 1 mL/kg of a 10% solution), given presses inherited ventricular arrhythmias in German
slowly over 5–10 minutes. Calcium gluconate re- Shepherd dogs better than mexiletine or sotolol
establishes the relationship between resting mem- monotherapy: a randomized cross-over study. Journal
brane potential and threshold potential in of Veterinary Cardiology 12, 93–106.
cardiomyocytes, and will improve ECG appearance Kraus, M., Gelzer, A., Rishniw, M. (2016) Detection of
(QRS complexes will become narrower, heart rate heart rate and rhythm with a smartphone-based
will increase, and P waves will begin to reappear). electrocardiograph versus a reference standard elec-
trocardiograph in dogs and cats. Journal of the American
While calcium gluconate treats the life-threatening Veterinary Medical Association 249, 189–194.
cardiac conduction disturbances associated with Marriot, H.J.L., Conover, M.B. (1998) Advanced Concepts
this electrolyte abnormality, further treatment is in Arrhythmias, 3rd ed. Mosby, St. Louis, Missouri, USA.
needed to treat the hyperkalemia itself (dextrose ± Menaut, P., Belanger, M.C., Beauchamp, G., et al. (2005).
exogenous insulin, β2-agonists such as albuterol, Atrial fibrillation in dogs with and without structural or
etc.; see Chapter 8). Additional diagnostic testing functional cardiac disease: a retrospective study of 109
therapy for urethral obstruction (intravenous crys- cases. Journal of Veterinary Cardiology 7, 75–83.
talloid fluid therapy, urethral catheterization and Meurs, K.M., Spier, A.W., Wright, N.A., et al. (2002)
de-obstruction) should be pursued. Comparison of the effects of four antiarrhythmic treat-
Note that recognition of this ECG appearance as ments for familial ventricular arrhythmias in Boxers.
Journal of the American Veterinary Medical Association
atrial standstill (rather than ventricular tachycardia) 221, 522–527.
is vital to appropriate diagnosis and treatment of Miller, M.W. (1999) Electrocardiography. In: Fox, P.R.,
this patient. A misdiagnosis of ventricular tachycar- Sisson, D., Moise, N.S. (eds) Textbook of Canine and
dia might have prompted lidocaine therapy, which Feline Cardiology, 2nd edn. Saunders, Philadelphia,
(in addition to the risk of severe side effects in cats) Pennsylvania, USA, pp. 67–106.
would likely have slowed or extinguished this Moise, N.S. (1999) Diagnosis and management of
patient’s ventricular depolarization completely, lead- canine arrhythmias. In: Fox, P.R., Sisson, D., Moise,
ing to cardiac arrest. The key to recognition of atrial N.S. (eds) Textbook of Canine and Feline Cardiology,
standstill is the heart rate of 120 bpm in a cat, allow- 2nd ed. Saunders, Philadelphia, Pennsylvania, USA,
pp. 331–385.
ing the operator to focus on differentiating among Rishniw, M., Porciello, F., ERb, H.N., Fruganti, G. (2002)
bradyarrhythmias, rather than tachyarrhythmias. Effect of body position on the 6-lead ECG of dogs.
Journal of Veterinary Internal Medicine 16, 69–73.
Bibliography Santilli, R.A., Perego, M., Crosara, S., et al. (2008) Utility
of 12-lead electrocardiogram for differentiating parox-
Buczkowski, T., Janusek, D., Zavala-Fernandez, H., et ysmal supraventricular tachycardias in dogs. Journal
al. (2013. Influence of mobile phones on the quality of of Veterinary Internal Medicine 22, 915–923.

Electrocardiography 69