Page 1905 - Cote clinical veterinary advisor dogs and cats 4th

Systemic Lupus Erythematosus 955

• Bradyarrhythmias: medically refractory SSS, Behavior/Exercise ECG event monitoring are simple, noninva-
high-grade second-degree AV block, third- Limit exertion/excitement in cases of outflow sive tests that greatly help differentiate the
VetBooks.ir • Tachyarrhythmias (p. 1033) decompensated left-sided congestive heart • Syncope, although uncommon in cats, occa- Diseases and Disorders
two.
degree AV block: permanent pacemaker
obstructions, cyanotic heart disease, impending/
• Severe outflow obstructions: limit exertion
sionally occurs with hypertrophic obstructive
failure, ventricular arrhythmias, and neuro-
in all cases.
○ Subaortic stenosis (SAS [p. 948]): cardiogenic syncope. cardiomyopathy and with bradyarrhythmias
(e.g., third-degree AV block).
beta-blockers if severe ± cutting balloon Drug Interactions • In SSS, bradyarrhythmias (e.g., sinus arrest)
valvuloplasty Beta-blockers, diuretics, and vasodilators can typically cause syncopal episodes but seldom
○ Pulmonic stenosis (p. 844): ± balloon exacerbate hypotension. result in death (p. 915).
valvuloplasty and beta-blockers if severe • In 40% of human cases, a cause is never
○ Hypertrophic obstructive cardiomyopathy Possible Complications identified; similar percentages are suspected
(p. 505): beta-blocker or calcium channel Sudden death in veterinary medicine.
blocker
○ Heartworm disease with secondary Recommended Monitoring Prevention
pulmonary hypertension (pp. 415 and Depends on cause • Tussive syncope: cough suppressant,
418) bronchodilator, treatment with diuretics if
• Pulmonary hypertension: sildenafil (p. 838) PROGNOSIS & OUTCOME pulmonary edema is present
• Cyanotic heart disease–induced erythrocy- • Autonomic dysfunction: anticholinergics,
tosis: phlebotomy or hydroxyurea 50 mg/kg Highly dependent on underlying cause: beta-blocker
PO q 48-72h, adjusted based on response • Excellent for bradyarrhythmias treated with
• Congestive heart failure (p. 409) pacemaker implantation Technician Tips
• Neurologic syncope: treat underlying cause • Fair to good with supraventricular tachycardia • In-house ECG telemetry is useful for identify-
• Metabolic syncope: treat underlying cause responsive to medical therapy ing bradyarrhythmias and tachyarrhythmias.
• Tussive syncope: cough suppressant (e.g., • Guarded with ventricular tachycardia treated • Seizure bells can be placed on hospitalized
butorphanol 0.1-0.5 mg/kg PO q 8-12h), medically; poor if systolic dysfunction/dilated patients presenting for syncope to help alert
bronchodilator (aminophylline 10 mg/kg cardiomyopathy present the staff when an animal has an episode.
PO q 8h), treatment with diuretics (e.g., • Varied prognosis for outflow obstructions
furosemide 2 mg/kg IV, SQ) for pulmonary (i.e., severe SAS has a poor long-term Client Education
edema prognosis) Distinguishing between seizures and syncope is
• Autonomic dysfunction: anticholinergics • Good with tussive syncope if cough responds crucial but not always obvious. Discuss unique
(e.g., propantheline bromide 0.5-1 mg/kg well to medical therapy features of each, and encourage videorecording
PO q 8h if bradycardia related), beta-blocker • Prognosis is good for autonomic dysfunc- of events.
(e.g., atenolol 0.25-1 mg/kg PO q 12h if tion. Treatment is usually unrewarding.
tachycardia related). Treatment modalities Fortunately, sudden death is not common. SUGGESTED READING
are aimed at maintaining heart rate and/ Davidow EB, et al: Syncope: pathophysiology and
or preventing sympathetic surge. Medical PEARLS & CONSIDERATIONS differential diagnosis. Compend Contin Educ Pract
management fails to address hypotensive Vet 23(7):609-618, 2001.
component of reflex arc, and animals may Comments
continue to faint, potentially requiring a • Syncopal episodes may be difficult to dif- AUTHOR: Sarah J. Miller, DVM, DACVIM
EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
pacemaker. ferentiate from seizures. Videorecording and

Systemic Lupus Erythematosus Client Education
Sheet

BASIC INFORMATION GEOGRAPHY AND SEASONALITY • Nonseptic, nonerosive polyarthritis
Exposure to UV light may trigger cutaneous • Glomerulonephritis
Definition lesions. • Hemolytic anemia and/or thrombocytopenia
A multisystemic autoimmune disease affecting • Leukopenia
at least two different organ systems ASSOCIATED DISORDERS • Polymyositis or myocarditis
See Disease Forms/Subtypes below. New clinical • Serositis (nonseptic inflammatory effusion in
Epidemiology signs may be due to additional manifestations the abdominal, pleural, or pericardial cavity)
SPECIES, AGE, SEX of SLE or complications of treatment. • Neurologic disorder (seizures, psychosis, or
More commonly reported in dogs than Clinical Presentation polyneuritis)
cats; young to middle-aged animals are • Significant serum antinuclear antibody
predisposed. DISEASE FORMS/SUBTYPES (ANA) titer
The diagnosis of SLE is made when any three
GENETICS, BREED PREDISPOSITION of the following occur concurrently or over HISTORY, CHIEF COMPLAINT
• Systemic lupus erythematosus (SLE) is any period: • Lameness is the most common primary
heritable in dogs; experimental SLE colonies • Cutaneous lesions, especially skin exposed to complaint in dogs.
have been established. sunlight and/or at mucocutaneous junctions • Nonspecific lethargy and poor appetite
• German shepherds may be overrepresented. • Oral mucosal ulcers • Skin lesions

www.ExpertConsult.com