A 5 year old MN Doberman was presented for echocardiogram after 4 VPCs were noted on ECG during preop testing before an MRI for cervical disease.
A 5 year old MN Doberman was presented for echocardiogram after 4 VPCs were noted on ECG during preop testing before an MRI for cervical disease.
This material resembles the picture of Dilated Cardiomyopathy. Given that there are no clinical symptoms present which are related to this disease, this is the occult stage. Long term prognosis is poor, sudden death is possible at any time. Even though there is no evidence available about the efficiacy of certain medications at this stage of the disease I would start with ACEI, Pimobendan, Furosemide and mexiletine. The fact that 4 VPCs were visible on a rhythm strip (if they are of right bundle branch morphology) has a high prositive predictive value. A Holter ECG would be advisable but I would start with mexiletine anyway because even if there were not many couplets/triplets or runs visible on Holter it would not mean that they cannot occur suddenly leading to sudden death at once. But there is still no scientific proof that we can decrease the risk of sudden death by administering antiarrhythmics.
A massively volume overloaded left ventricle with clearly impaired systolic function, a slightly enlarged left atrium and a mild (secondary) mitral insufficiency. M-mode values are clearly out of normal ranges indicating (- in the absence of other underlying heart disease which could cause volume overload – as it is in this case) dilated cardiomyopathy. The fact that VPCs were visible on a rhythm strip confirms this diagnosis (given that they were of left ventricular origin).
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Dilated cardiomyopathy, pericardial effusion VPC’s – incidental, secondary to cervical pain, drugs
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