- 11 yr old FS pitbull presented for mast cell tumor removal on dorsum
- Patient had a collapsing episode in the clinic (fell down and urinated)
- ECG showed 2nd degree AV block
- Echocardiogram shows normal cardiac measurements, trace MVI, small TVI with velocity of 2.8m/s. No masses or effusions are seen. Concurrently run ECG shows 2nd degree block
- Rule outs include AV node fibrosis, myocarditis, electrolyte imbalance, vagal stimulation, and benign (assuming that collapse episode was unrelated).
- 11 yr old FS pitbull presented for mast cell tumor removal on dorsum
- Patient had a collapsing episode in the clinic (fell down and urinated)
- ECG showed 2nd degree AV block
- Echocardiogram shows normal cardiac measurements, trace MVI, small TVI with velocity of 2.8m/s. No masses or effusions are seen. Concurrently run ECG shows 2nd degree block
- Rule outs include AV node fibrosis, myocarditis, electrolyte imbalance, vagal stimulation, and benign (assuming that collapse episode was unrelated).
- Not sure if they will agree to cardiology consult. I have also recommended chest rads and bloodwork. Any suggestions for premends/anesthetic choice, and treatment if any for this ECG abnormality?
Comments
Hi!
My suggestions:
.) record
Hi!
My suggestions:
.) record an ECG, see what type of AV Block II it is (increasing PQ-Intervals or constant PQ-intervals) and to check the degree of the AV Block II high-grade/low grade
.) as the patient is attached to the ECG, perform an Atropine-response test (0,04 mg/kg Atropine IM or IV) – see if the AV-Block disappears within 5-10 min. If it does, it is caused by an increased vagal tone
.) if the AV-Block responses to Atropine – add Atropine to premedication and keep Atropine ready at hand during anesthesia
.) If the AV-Block does not diseappear after Atropine, lots of different DD come into play (as you mentioned: fibrosis, degeneration, inflammation, neoplastic infiltration, …). In this case you should have a possibility to pace the patient during anesthesia if required (external, better internal), particularly, if it’s a high grade AV-Block II
.) NEVER use alpha-2-agonists in these guys!!!
Thanks for posting and regards from Austria!
Peter