Syncope secondary to transient atrioventricular block in a German shepherd dog with dilated cardiomyopathy and atrial fibrillation

This case report describes transient atrioventricular block as the etiology for syncopal events in a 6-year-old male German shepherd dog with atrial fibrillation and dilated cardiomyopathy. The arrhythmia diagnosis was obtained via Holter monitoring. Medical treatment with a sustained-release preparation of theophylline, as an additive to the standard congestive heart failure treatment (benazepril, furosemide and pimobendan) may have contributed to temporary remission of the syncopal events. However, the congestive heart failure progressed and the dog was euthanized. Veterinarians should be aware of the possibility of transient atrioventricular block causing syncope in dogs with DCM and AF and should be careful in empirically lowering the ventricular response rate if these dogs present with syncopal episodes.     

Temporary transvenous cardiac pacing in a dog with diltiazem intoxication

Objective: This case report presents the clinical findings of a dog with diltiazem intoxication and the utilization of temporary transvenous pacing for management of high‐grade second‐degree atrioventricular (AV) block with associated bradycardia and hypotension. Case summary: A nine‐year‐old spayed female Basset Hound, who ingested between 95 and 109 mg/kg of sustained‐release diltiazem exhibited clinical signs of cardiac arrhythmias, bradycardia, hypotension, mental depression and gastrointestinal (GI) upset. Bradycardia was present initially, then was followed by high‐grade second‐degree AV block with ventricular escape. Traditional medications to treat calcium channel blocker (CCB) intoxication, including atropine, calcium gluconate, dopamine and glucagon were initially successful in managing the cardiac rhythm disturbances and hypotension. Twenty‐two hours post‐ingestion, however, the dog became refractory to these medications following sedation for GI decontamination and a temporary transvenous pacemaker was placed. The dog was paced for 19 hours. Transvenous pacing effectively increased heart rate, which increased blood pressure into an acceptable range. The dog was successfully discharged from the hospital following treatment. New or unique information provided: The use of a temporary pacemaker should be considered an acceptable treatment for bradycardia, AV block and hypotension associated with CCB intoxication when conventional medical therapy fails.     

Transvenous pacemaker placement in a dog with atrioventricular block and persistent left cranial vena cava

The case reported herein describes the placement of a permanent transvenous pacemaker in an older dog with a previously undiagnosed persistent left cranial vena cava (PLCVC) and recent onset symptomatic third-degree atrioventricular (AV) block. On presentation the dog was found to have atrial flutter and third-degree AV block and echocardiography demonstrated evidence of chronic valvular disease and pulmonary arterial hypertension. The persistent left cranial vena cava was discovered via angiography when difficulties were encountered with pacemaker placement. Successful right ventricular pacing necessitated passage of the lead through the coronary sinus. The attendant complications in pacemaker placement in the presence of a PLCVC are well-described in man but, to the authors' knowledge, have not been described in companion animals.     

Exploration of a third degree atrioventricular block by standard echocardiography, tissue Doppler imaging, and treatment with a cardiac pacemaker in a German wire-haired pointer

A nine-year-old intact male Drathaar was evaluated for syncope and extreme weakness, and was found to have a third degree atrioventricular (AV) block. As there were no biochemic, serologic, organic (thoracic radiographs, abdominal echography, standard and tissue Doppler echocardiographies) and histologic (interventricular septum biopsy) anomalies, the dog was treated with a permanently implanted cardiac pacemaker.     

Gerbode type defect and third degree atrioventricular block in association with bacterial endocarditis in a dog

Gerbode type defects are rare left ventricular outflow tract–right atrial communications in people that may be congenital or acquired; they have been reported only once previously in dogs. Acquired forms in humans have been reported secondary to bacterial endocarditis, trauma, and valve replacement surgery, among other causes. We report a case of left ventricular outflow tract to right atrium and right ventricle communications (Gerbode type defect) in association with aortic and tricuspid valve bacterial endocarditis in a geriatric dog. The dog also developed third degree atrioventricular block and had underlying subaortic stenosis. The authors hypothesize that the Gerbode type defect in this case was acquired secondary to invasion and destruction of the membranous interventricular septum due to bacterial endocarditis.     

Successful use of an acceleration rate response pacemaker with a transvenous steroid-eluting screw-in lead for third-degree atrioventricular block in a labrador retriever

Permanent pacemakers are commonly used in veterinary practice and can have a dramatic effect on the treatment of heart block. A Labrador Retriever dog suffering from exercise intolerance secondary to third degree atrioventricular block was treated with a new pacemaker system. A steroid-eluting screw-in type lead that has the advantage of being more fixed to the myocardial wall without increasing the pacing threshold was used. The heart rate was regulated with an acceleration sensing pacemaker generator that included several automatic modulation systems. Nineteen months after implantation, the dog has a normal level of activity. The present case suggests that this pacemaker design may offer important advantages for canine patients.     

Spontaneous closure of a traumatic acquired Gerbode defect in a dog

A one-year-old female English Springer Spaniel with no previous history of cardiac disease presented to the Queen's Veterinary School Hospital following a blunt traumatic incident with an acquired, direct Gerbode defect and associated third-degree atrioventricular block. Two months after the initial incident, follow-up echocardiography showed a nearly closed Gerbode defect with just trivial residual flow. A 24-h Holter monitor indicated second-degree atrioventricular block with occasional junctional tachycardia. A reassessment 22 months later confirmed spontaneous closure of the previously acquired traumatic Gerbode defect, with 2:1 second-degree atrioventricular block. The dog remained clinically asymptomatic, and free of treatment. To our knowledge, this is the first reported case of spontaneous closure of a previously acquired traumatic Gerbode defect in a dog.     

Histiocytic chorioretinitis in a dog

A 3‐year‐old castrated male mixed‐breed dog presented with an acute bullous retinal detachment and thickened choroid of the right eye. Subretinal cytology revealed an atypical cell proliferation suggestive of neoplasia. The eye was enucleated, and the original diagnosis was a histologically benign choroidal melanocytic tumor. Further diagnostics revealed no other systemic abnormalities other than a nonhealing shoulder wound. Six months later, the left eye developed a bullous retinal detachment. This eye responded well to systemic steroids and the dog regained vision within a few weeks of initiating therapy. Results of immunohistochemistry with Melan‐A and CD204 of the previously enucleated right eye caused a revision of the histologic diagnosis from melanocytic tumor to histiocytic chorioretinitis. This case highlights the subtle and sometimes confusing distinction between neoplastic and inflammatory processes on both cytology and histopathology.     

Surgical management of a canine intracranial abscess due to a bite wound

Objective – To describe the successful surgical management of a brain abscess in a dog secondary to bite wound. Case Summary – A 10‐year‐old neutered female Welsh Corgi/Chihuahua, weighing 5.3 kg, was presented for evaluation of seizures, ataxia, and falling to the left 8 days after a presumptive fight with another dog. On examination at presentation, the dog was alert, responsive, and ambulatory with tetra‐ataxia, falling to the left, left‐sided postural deficits, and absent left menace response. Within 24 hours, the dog progressed to nonambulatory tetraparesis with minimal motor, absent postural reactions of all limbs, left nasal hypalgesia, reduced gag reflex, and depressed mentation. Computed tomographic images of the brain were suggestive of a bite wound fracture of the right parietal bone with secondary meningoencephalitis, right parietal lobe abscessation, and white matter edema adjacent to the bone fracture. A modified right rostrotentorial craniectomy was performed, the abscess was identified, contents of the abscess were removed, and the surgical site was flushed extensively before closing. Corynebacterium spp. was cultured from within the abscess. Within hours of surgery, the dog was quiet but alert, responsive, and sitting up in her cage. In addition to surgical intervention, intensive care, broad‐spectrum IV antimicrobials, and supportive therapy led to significant neurologic improvement with only occasional seizures and mild postural reaction deficits of the left hindlimb remaining. New or Unique Information Provided – Abscess formation within the CNS is uncommon in dogs and cats and is associated with a high mortality rate. In veterinary medicine the management of brain abscesses is controversial with limited information available regarding treatment. This is the first case report that demonstrates surgical intervention in combination with antimicrobial therapy can be used successfully in the treatment of a canine brain abscess.     

Pheochromocytoma Presenting as Acute Retroperitoneal Hemorrhage in a Dog

Objective: This report describes the perioperative management of a dog with a right adrenal pheochromocytoma that presented with acute retroperitoneal hemorrhage, cardiac arrhythmia and hypertension. Additionally, a summary of pheochromocytoma and the idiosyncrasies of perioperative management of a pheochromocytoma are provided.
Summary: A 7-year old male, neutered, Dalmation was presented for acute collapse, abdominal pain and tachycardia. Physical examination findings were consistent with hypoperfusion concurrent with multiple cardiac arrhythmias and hypertension. Abdominal ultrasound revealed retroperitoneal effusion and a right adrenal mass intimately associated with the caudal vena cava. Incomplete right adrenalectomy was performed. Histopathology confirmed a pheochromocytoma.
Unique information provided: To the authors' knowledge, this is the first definitive report of acute retroperitoneal hemorrhage as the initial clinical manifestation of histologically confirmed adrenal pheochromocytoma in the dog. ( J. Vet Emerg Crit Care 2001; 11(3): 221–227 )     

Sinoatrial arrest associated with primary atrial myocarditis in a dog

The clinical findings in a dog with sinoatrial arrest, atrioventricular block and multifocal idioventricular escape beats are described. The clinical findings were associated with a primary myocarditis involving the sinoatrial node, the left and right atrium and atrioventricular node. The differentiation between sinoatrial arrest, sinoatrial block and sinoventricular conduction is discussed.     

Enucleation or exenteration in two dogs with previous parotid duct transposition: parotid duct ligation versus reverse parotid duct transposition

Two dogs with previous parotid duct transpositions presented with unrelated ocular disease. In both cases, ophthalmic examination revealed the need for enucleation or exenteration. In case 1, systemic coccidioidomycosis was diagnosed with panuveitis and secondary glaucoma of the left eye. In this case, the parotid duct was ligated at the time of enucleation to stop salivary secretions. This dog encountered morbidity in the form of a sialocele that did not resolve for 11 months. In case 2, ultrasound and computed tomography revealed a discrete mass within the left medial orbit that was suspected to arise from the nictitating membrane. A combination of exenteration and parotid duct transposition reversal was performed to avoid morbidity associated with ligation of the parotid duct. The dog encountered no complications from this novel procedure. This case report represents the first report of re‐routing a transposed parotid duct from the ventral conjunctival sac back to the mouth at the time of enucleation or exenteration in the dog.     

Colonic,ureteral, and vascular injuries secondary to stick impalement in a dog

Objective – To report the surgical repair, case management, and outcome of a dog with sepsis and severe intraabdominal trauma secondary to a penetrating stick injury. Case or Series Summary – A 1.5‐year‐old, spayed female, mixed‐breed dog was presented to the emergency service after incurring a small laceration on the medial aspect of the left pelvic limb while running in the woods. The wound was surgically explored and a primary closure achieved. The patient was discharged the same day with oral antimicrobial therapy. The following morning the dog was represented to the emergency service for acute vomiting. Abdominal radiographs were performed and demonstrated loss of serosal detail and pneumoperitoneum. An emergency celiotomy was performed and revealed distal colonic perforation, left ureteral laceration, and lacerations of the left common iliac vein. Ureteronephrectomy, as well as primary closure of the distal colonic perforation and left common iliac vein lacerations, were performed. The patient recovered and was ultimately discharged from the hospital 5 days later. Follow‐up 1 year later revealed no significant physical exam or biochemical abnormalities. New or Unique Information Provided – A seemingly benign penetrating stick injury initially deemed to be superficial in nature was later demonstrated to have resulted in sepsis following severe intraabdominal trauma that included lacerations of the distal colon, left ureter, and left common iliac vein in a dog. Successful surgical management and intensive care led to a full recovery without any residual impairment noted a year later.     

Concurrent renal amyloidosis and thymoma resulting in a fatal ventricular thrombus in a dog

Thymoma‐associated nephropathies have been reported in people but not in dogs. In this report, we describe a dog with thymoma and concurrent renal amyloidosis. A 7‐year‐old castrated male Weimaraner was presented for progressive anorexia, lethargy, and tachypnea. The dog was diagnosed with azotemia, marked proteinuria, and a thymoma that was surgically removed. Postoperatively, the dog developed a large left ventricular thrombus and was euthanized. Necropsy confirmed the presence of a left ventricular thrombus and histopathology revealed renal amyloidosis. We speculate that the renal amyloidosis occurred secondary to the thymoma, with amyloidosis in turn leading to nephrotic syndrome, hypercoagulability, and ventricular thrombosis. This case illustrates the potential for thymoma‐associated nephropathies to occur in dogs and that dogs suspected to have thymoma should have a urinalysis and urine protein creatinine ratio performed as part of the pre‐surgical database.     

Third degree atrioventricular block and sudden death secondary to acute myocarditis in a dog

Third degree atrioventricular (AV) block in dogs is thought to be most frequently characterized by non-specific fibrotic changes in the AV node. However, it may occur secondary to an undiagnosed inflammatory process. We report a case of third degree AV block in a dog, secondary to acute lymphocytic-plasmacytic myocarditis that resulted in sudden death. This dog had cardiac troponin I levels of 44.65 ng/mL (normal <0.11 ng/mL). The serum cardiac troponin I level was five times higher than any other AV block patient measured in our laboratory, and was also substantially higher than in dogs with chronic valve disease or dilated cardiomyopathy. The severe myocardial necrosis observed at necropsy correlated with the degree of cardiac troponin I elevation. This report suggests that measurement of cardiac troponin I may be an indicated test before pacemaker implantation in dogs with third degree AV block.     

Electroretinographic changes after intravenous lipid emulsion therapy in a dog and a foal with ivermectin toxicosis

This case report describes ivermectin‐induced blindness in a dog and a foal with normal ophthalmic fundic examinations and attenuated electroretinography (ERG). Subsequent recovery in ERG was noted following intravenous lipid emulsion (ILE) therapy. A dog and a foal were evaluated for ivermectin‐induced blindness. Clinical signs included dull mentation, absent pupillary light reflexes (PLRs), and absent menace on presentation. The animals had normal fundoscopic examinations; however, in both cases ERG was consistent with neurosensory retinal dysfunction. Following ILE therapy for ivermectin toxicosis, return of menace, PLRs, and normal mentation were noted, as was improvement in ERG and serum ivermectin levels. These are the first documented cases of ivermectin‐induced blindness in a dog and a foal with normal fundic examinations and attenuated ERG. ERG improved in both animals after ILE therapy. ERG may assist in the diagnosis of ivermectin toxicosis in dogs and horses. ILE therapy may hasten recovery in treatment of ivermectin‐induced blindness.     

Third degree atrioventricular block following non-penetrating chest trauma in a dog

A two-year-old mixed breed dog was referred to the University of Florida Veterinary Medical Teaching Hospital for the management of post traumatic ventricular arrhythmias. Electrocardiography revealed third degree atrioventricular (AV) block. An echocardiogram demonstrated an echogenic, pedunculated mass arising from the caudoventral aspect of the atrial septum. The mass was believed to represent a haematoma or a thrombus associated with trauma to this region of the atrial septum. The patient was managed conservatively; third degree AV block was still pre- sent five days after trauma. The owner of the dog refused specific therapy of the arrhythmia. The patient was discharged and, unfortunately, lost to follow-up. Third degree AV block has not previously been reported following accidental, blunt thoracic trauma in the dog.     

Ventricular tachycardia in English bulldogs with localised right ventricular outflow tract enlargement

Objectives : To describe the electrocardiographic characteristics of ventricular tachycardia arising from the right ventricular outflow tract and the particular association between this arrhythmia and the presence of localised right ventricular outflow tract enlargement in English bulldogs. Methods : Five English bulldogs were referred with a history of syncope or cardiogenic shock. In all dogs, 12‐lead surface ECG, thoracic radiograph and echocardiography were collected. In all but one dog 24‐hours Holter monitoring and signal‐averaged ECGs was examined and in one dog electrophysiological study and radiofrequency catheter ablation of the VT substrate was performed. Results : Documented arrhythmias included a single sustained monomorphic wide QRS tachycardia in four dogs, and an alternans of two different monomorphic forms in one dog. Mean QRS duration during tachy‐cardia was 91·6 ±9·83 milliseconds. QRS complexes manifested a left bundle branch block morphology and an inferior axis (81 ±13·73°). R wave notching was present in the caudal (inferior) leads in three tachy‐cardias. Lead I was negative in 3 of 6, positive in 1 of 6 and isodiphasic in 2 of 6. Lead aVL was negative in 5 of 6 and positive in 1 of 6. Signal‐averaged electrocardiograms revealed late potentials in three dogs. Echocardiography showed a localised right ventricular outflow tract enlargement in all dogs. Cardiac map‐ping established two sites of origin of ventricular tachycardia within the right ventricular outflow tract in one dog: caudal free‐wall and cranial‐septal. Clinical Significance : The presence of a localised right ventricular outflow tract enlargement and ventricular tachycardia with left bundle branch block morphology could suggest segmental arrhythmogenic right ven‐tricular cardiomyopathy in the English bulldog.     

Implantation of permanent transvenous endocardial pacemaker in a dog with atrioventricular block

A 10-year old male mongrel dog was presented to the University Veterinary Teaching Hospital with a two-month history of episodic syncope. Twenty-four hr Holter electrocardiographic (ECG) recording revealed frequent episodes of advanced atrioventriculer block with long periods of ventricular asystole. The cause of syncope was determined to be Adams-Stokes syndrome exhibited bradyarrhythmia. After the animal failed to respond to medical therapy, permanent transvenous pacemaker implantation was performed. Postoperative Holter ECG showed 100 beat per min programmed pacemaker rhythm, which indicated successful capture of the artificial pacing. The dog recovered smoothly from the operation and syncopal episodes completely disappeared. Six months after the surgery, no complications were observed and the dog's quality of life has dramatically improved.     

Suspected lily-of-the-valley (Convallaria majalis) toxicosis in a dog

Objective: To describe successful treatment of third-degree atrioventricular (AV) block using temporary noninvasive transthoracic pacing and placement of a permanent transvenous pacemaker in a case of suspected lily-of-the-valley ( Convallaria majalis ) intoxication in a dog.
Case summary: A 2-year-old neutered male Beagle weighing 17.8 kg was presented to the emergency service for treatment of bradycardia, vomiting, and lethargy. An electrocardiogram revealed third-degree AV block that was nonresponsive to atropine. Ten hours after admission, the dog became obtunded. Treatment initially consisted of temporary noninvasive transthoracic pacing and eventually placement of a permanent transvenous pacemaker. The initial history did not suggest that the dog had access to any known cardiotoxins. However, C. majalis , which contains cardiac glycosides, was identified within the dog's environment and the dog's serum did contain digoxin or an immunologically cross-reactive compound.
New or unique information provided: This is the first reported successful management of C. majalis toxicosis in a dog. Temporary noninvasive transthoracic pacing was used in the management of this case as a safe and effective bridge to permanent pacemaker implantation.