Hi
What I see is pronounced

Hi

What I see is pronounced sinus arrhythmia with intermittend premature complexes which differ in their morphology in a way that the main amplitude is negative in lead II and the T waves are    positive as opposed to the remaining complexes. P-waves are missing in front of these complexes. Yet, they are no extremely wide. Based on these findings, they are very likely of ventricular origin.

Possible explanations are:

• cardiac: Myocardial damage due to chonic volume overload or independent of the valvular disease seen. Genetic. arrhythmia extremely unlikely based on the patient’s age.
• extracardiac: neoplasia, inflammationl, pain, electrolyte abnormalities, ….

My personal algorithm/treatment would be:

• Abdominal sonogram, check electrolytes
• If Holter-ECG feasible: Base treatment on results. If <1000/day without any coupling or bigemini: Add Magnesium at 200 mg/day and keep potassium high normal, then recheck. If > 1000/day and/or coupling/bigemini: Start with Mexiletine or Flecainide
• If Holter-ECG not feasible/affordable: If no clinical signs like episodic weakness or syncope, no couplings or bigemini visible,  start with Magnesium, keep potassium high normal and re-chek with 5 min ECGs. If couplings/bigemini visible and/or clinical signs,start with Mexiletine or Flecainide. 

Good luck,

Peter

My reasons to supplement Mg/K

My reasons to supplement Mg/K arae:

.) Dogs who receive more than. 4mg/kg Furosemide/day

.) Dogs with arrhythmias which are too benign to warrant antiarrhythmic therapy.

Of course, it’s always advisable to check potassium levels before supplementation. But, honestly,  I usually do not check Magnesium 

Peter