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Syncopy

Sonopath Forum

  • 10 year old Dalmation with history of collapse, started 6 months ago
  • Was diagnosed with stage B2 MMVD at that time and started on pimobendan. Intermittent VPCs also seen on ECG so ful bloods/abdominal screen recommended
  • Now coughing and further episodes of syncopy with exercise/collapse, owner says heart bounding/fast at home
  • G 4/6 murmur, bounding apex beat, HR 140, sinus rhythm/tachycardia during scan, progression of heart disease with further dilation of LV and LA, no pulmonary hypertension
    • 10 year old Dalmation with history of collapse, started 6 months ago
    • Was diagnosed with stage B2 MMVD at that time and started on pimobendan. Intermittent VPCs also seen on ECG so ful bloods/abdominal screen recommended
    • Now coughing and further episodes of syncopy with exercise/collapse, owner says heart bounding/fast at home
    • G 4/6 murmur, bounding apex beat, HR 140, sinus rhythm/tachycardia during scan, progression of heart disease with further dilation of LV and LA, no pulmonary hypertension
    • Abdominal scan showed small splenic nodule/mass (cytology pending), bloods normal
    • My query is do you think this collapse is due to structural cardiac disease +/- primary cardiac arrhythmia or is splenic nodule significant?
    • Unlikely to progress to holter monitor
    • Would you start on sotalol given VPCs seen during scan 6 months ago?

     

Comments

EL

I think there is enough

I think there is enough volume overload and cardiac disease to justify syncope. Holter is great but I would volume reduce as well. Even “cough drop” syndrome is possible owing to vagal tone issues. So 3 justifications for the syncope….

I always believe in treating what I see first so I would tx lasix and pimobendan here. Run routine ecg or holter and see if the arrythmia diminish with a happier myocardium with less wall stretch after tx. Maybe an ACE-i as well because i live in north america and that’s what we do 🙂 This is an advanced B2 so even if wet lung isn’t present I tx tthese guys with triple tx and get solid results. Rescan in a week and the heart should be happier and check BP as well. If high then ace-i justified in any arena.