Ventricular Tachycardia Case Study

Ventricular Tachycardia
The Story of Bruce
Advance Medical Terminology
Bruce is a 7 year old, intact male Doberman Pincher that weighs 89 pounds. His Body Condition
Score (BCS) is 5/9. He was presented for dyspnea. Owner noted that Bruce seemed worse after exercise
and that he was not on heartworm prevention.
His physical exam findings:
General appearance: Normal
Temperature: 102.0 Rectal
Skin/coat: Dry/dull
Eyes: Normal
Ears: Normal
Oral cavity: Mild tartar
Musculoskeletal: Normal
Cardiovascular: Severe arrhythmia
Gastrointestinal: Normal
Respiratory: dyspnea
Genitourinary: Normal
Nervous system: Normal
Lymph nodes: Normal
Upon examination, the veterinarian found severe arrhythmia and dyspnea. She strongly
recommended an EKG and a heartworm test. Owner agreed to both recommendations. EKG revealed
ventricular tachycardia, where the AV node need not be activated to generate a QRS complex and where
there is a greater potential for sudden death if the rhythm degenerates to ventricular fibrillation or
asystole. Heart rate was 78-253. Heartworm test was negative. No other abnormalities noted.
Veterinarian stressed hospitalization and the need for an echocardiogram.
Owner left Bruce for hospitalization and echocardiogram after signing all the proper released
forms. Blood was obtained from the Left jugular to perform a General Health Profile (GHP) and a
Complete Blood Count (CBC). GHP showed a few abnormalities: ALP at 377u/l, Glucose at 118mg/dl,
and Sodium at 137mmol/l. The rest of the results were Within Normal Limits (WNL). A 20g IV catheter
was placed in the Left cephalic vein. Veterinarian gave Bruce 8cc Lidocaine slowly though IV to reverse
tachycardia. Normal rhythm was established although heart rate was still rapid. Maintained Bruce on a
75mcg/kg/min Lidocaine (41mls 2% Lidocaine in 1000mls of LRS) Constant Rate Infusion (CRI) given
at a rate of 110mls/hr. Another EKG was done at 4:20pm and normal QRS complexes were seen.
Echocardiogram revealed severe left ventricular and atrial dilation, decreased LV contractile
function, normal right heart structure and function, mildly decreased aortic and pulmonic systolic
velocity, no pleural effusion noted, brief cine loop of left lung field suggestive of pulmonary edema which
is most consistent with severe cardiomyopathy and left hear failure. The veterinarian that reviewed
Bruces case recommended Lasix 2mg/kg/day, Enalapril 0.5mg/kg BID, and Pimobendan 0.25mg/kg BID.
He suggested renal function be monitored 3-5 days after starting diuretics. Rapid ventricular tachycardia
was seen so he also recommended starting Bruce on Sotalol 40mg total dose BID to control his
arrhythmias. Owner should be informed that long term prognosis is guarded.
I maintained Bruce on Lidocaine CRI overnight and started Vetmedin 20mg BID, Lasix 80mg
SID, and Sotalol 40mg BID. I discontinued the Lidocaine CRI the next day and started him on LRS with
5% Dex only and continued his medication regimen. Bruce was anorexic and had nausea throughout
hospitalization. He would drink water but would vomit afterwards. Auscultation of heart was normal
after a couple of days on medial routine. Unfortunately, follow-up GHP showed several abnormalities:
ALP at 523u/l, BUN at 151mg/dl, Phosphorus at 11.0mg/dl, Creatinine at 5.2mg/dl, Glucose at 176mg/dl,
and Total Protein (TP) at 8.2g/dl. Kidney failure and ulcers in oral cavity were noted. The owner was
notified. The veterinarian told her that Bruces kidney function had a slim chance of returning. The
owner decided to give him one more day to see if his kidney function would return. However, the next
day Bruce was very lethargic and would not get up and his owner gave her consent to humanely
euthanize.
References
Bonagura, John D., DVM, DACVIM. "ECG Reading Sessioncardiac Arrhythmias (Proceedings)."
Dvm360.com. N.p., 1 May 2011. Web. 14 Sept. 2014. <http://veterinarycalendar.dvm360.com/ecgreading-session-cardiac-arrhythmias-proceedings?id=&pageID=1&sk=&date=>.

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