Page 2250 - Cote clinical veterinary advisor dogs and cats 4th

1120 Holter/Cardiac Event Monitoring

• Quantify daily water intake to help determine 2 weeks. Because the FrAm concentrations in identifying brief hypoglycemic episodes
if patient regulated or change in regulation in well-controlled diabetics vary from one that would be missed with a BGC.
VetBooks.ir • When initial insulin begun at low dose • FrAm concentrations are not reliable indica- Pearls
occurs.
patient to the next, it is most useful to
monitor the trend in individual patients.
• Do not adjust insulin therapy purely based
(0.25 U/kg for dogs and 1 U/CAT, q 12h)
and clinical signs of hyperglycemia are
tors of hypoglycemia.
unabated, can increase dose without prior Continuous blood glucose monitoring on increased BG concentrations but only
in concert with clinical signs (e.g., PU/PD,
BGC. (CBGM): polyphagia, weight loss or gain).
• Do not exceed dose of 0.5 U/kg in dogs and • CBGM devices have been used in human • Decrease the insulin dose in any patient with
2 U/CAT before performing a BGC. medicine for around 20 years and are being confirmed hypoglycemia.
At-home monitoring: used with increased frequency in veterinary • Minimize patient stress by performing blood
• At-home monitoring is frequently recom- patients, typically within the referral hospital sampling in a quiet, relaxing environment.
mended so as to avoid the stress of a hospital setting.
visit. • A sensor is placed in the subcutaneous tissue SUGGESTED READING
• Home BG monitoring also is indicated to by means of a 22-guage needle, and BG Reusch CE: Feline diabetes mellitus. In Feldman EC,
allow the owner to check a BG whenever is measured every few minutes. The sensor et al, editors: Canine and feline endocrinology, ed
hypoglycemia is suspected. Owners should is connected to a transmitter that sends 4, St. Louis, 2015, Saunders.
be cautioned not to increase the insulin dose data to the monitor that displays real-time AUTHORS: Harry Cridge, MVB; Patty Lathan, VMD, MS
without consulting with their veterinarian. data. EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Monitoring fructosamine concentrations: • The CBGM devices can be left in place for Thompson, DVM, DABVP
• Fructosamine (FrAm) concentrations indicate days. This allows for more detailed data on
average glycemic control over the previous insulin regulation and is particularly helpful

Video
Holter/Cardiac Event Monitoring Available

Difficulty level: ♦♦ • Gauze squares or cotton balls diaries are usually sent with the monitor. When
• Cardiac electrode adhesive patches the monitoring period is over, the monitor is
Synonyms (cutaneous) mailed back or transmitted by transtelephonic
Ambulatory electrocardiography, cardiac telemetry • Ultrasound gel signal (event monitor), and findings and
• Holter vest or one can be made with interpretations are reported back. Some mail-
Overview and Goal bandage material: Esmarch-type bandage out programs (mostly veterinary colleges) also
Allows assessment of cardiac rhythm during an material (e.g., Vetrap), 1- or 2-inch, white provide consultation on the case as part of the
extended period. The monitor may record the medical tape +/− cast padding, roll gauze, service, along with the written Holter/event
cardiac rhythm continuously for 24-48 hours stretch adhesive cotton bandage (e.g., monitor report.
(Holter monitor) or only when triggered to Elastoplast)
record over a period of days to weeks (event • Holter or event monitor, including wires Anticipated Time
monitor, loop recorder). With these devices, to connect to animal, new batteries, and a • Installation: 10 minutes (event monitor) or
the pet is able to be at home, and the owner blank digital card (Holter only) 20 minutes (Holter)
is able to observe pet behavior. • Interpretation system and printer or access • Monitoring period: 24 or 48 hours (Holter);
to such a system 7-30 days (event monitor, longer if battery
Indications NOTE: Monitors are expensive systems not is replaced; weeks to many months for
• Syncope (p. 953) routinely owned by general practices. They surgically implanted event monitors/loop
• Episodic clinical signs of uncertain type but are available for rental from many sources, recorders)
that might represent syncope including www.vetheart.com, www.idexx.com,
• Screening of breeding or at-risk animals and pet-cardiology.com. Some veterinary college Preparation: Important
(boxers, Dobermans) for latent arrhythmia cardiology services have mail-out Holter pro- Checkpoints
(arrhythmia not causing overt clinical signs) grams (subject to change). In North America, If the reason for using cardiac monitoring is the
• Monitoring of antiarrhythmic drug effects examples include occurrence of sporadic clinical signs, a complete
(Holter monitor only) • Cornell University: www.vet.cornell.edu; medical evaluation is usually indicated first:
607-253-3060 • CBC, serum biochemistry panel, urinalysis:
Contraindications • North Carolina State University: cardiolo- to investigate for electrolyte/metabolic disor-
• Animals likely to damage a portable monitor gycarenetwork.com; 919-513-6975 ders (e.g., hypoglycemia, hypocalcemia [p.
• Animal that will be bathed or will be Veterinary sources are preferred because 515]) as alternative cause of signs
swimming knowledge of common veterinary diseases, • Serum preprandial and postprandial bile
• Animal too small to carry monitor (monitor- normal veterinary findings (sinus arrhythmia, acids (if consistent with case): hepatic
ing may still take place, but animal stays sinus tachycardia, sinus pauses during daytime encephalopathy (p. 440)
mainly in pet carrier or cage for recording rest), and common veterinary artifacts (purring, • Electrocardiogram (ECG; standard, in-
period) panting, shaking) are important parts of hospital): all cases; the diagnosis may be
interpretation. apparent without the need for Holter or
Equipment, Anesthesia The monitor itself is typically sent by courier cardiac event monitoring
• Clippers for hair to the hospital for placement on the animal. • Thoracic radiographs, echocardiogram:
• Isopropyl alcohol Instructions for placement, and patient daily all cases; assessment of cardiac structure,

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