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Liz Bode

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  • Liz Bode
    Keymaster
    17:32 05/09/21

    Hi everyone,

    Following on from Scott’s post I also wanted to say hello. Scott has worked really hard to curate this course and I think it looks amazing! We really hope you enjoy it and please do remember that you can ask questions/ post cases etc on the forum and we will do out best to help you out. All feedback is welcome on what you enjoyed about the course and other topics you would want us to cover in future.

    We look forward to meeting you at the live Q and A sessions too.

    Liz 🙂

    • This reply was modified 3 years, 5 months ago by Liz Bode.
    Liz Bode
    Keymaster
    08:20 01/09/21

    Replying to scott@vtx-cpd.com 31/08/2021 - 16:59

    I agree, thanks for your input Austeja. I am definitely going to be keeping an eye out for more cases. this dog wasn’t on any other medication, but microloss of blood certainly makes sense.

    Liz

    Liz Bode
    Keymaster
    12:29 30/08/21

    Replying to scott@vtx-cpd.com 28/08/2021 - 09:18

    Hi Scott,

    Yes, it appeared that most of them did. My initial thoughts on the whippet I saw was to repeat the haematology and smear in 4-6 weeks. Other blood work was unremarkable, PLI normal, CRP <10 (WNL) and nothing exciting on echo. Of course, doesn't mean there isn't or wasn't something going on, especially given the clinical signs noted by the owner.

    I will keep you posted if anything more comes of it.

    Liz

    Liz Bode
    Keymaster
    17:23 28/06/21

    Replying to Nathalie Cunha 22/06/2021 - 06:55

    Hi Nathalie,

    This was indeed what we thought in this case – a focal atrial tachycardia for the reasons you have stated above 🙂 We controlled it with diltiazem and the heart remodelled back to normal (apart from the mass!).

    Liz

    Liz Bode
    Keymaster
    17:21 28/06/21

    Replying to Camilla Edwards 24/06/2021 - 20:41

    Hi Camilla,

    Sorry, this did cause some problems as we switched part way through the course to the new website. The link was on lesson 10, but you had to force completion of lesson 9 (I didn’t realise this until after the session). I will post it soon.

    Everyone will have 6 months from the start of the course to access the videos so no rush with those.

    Liz

    Liz Bode
    Keymaster
    17:19 28/06/21

    Replying to Gabriela Gonzalez-Ormerod 25/06/2021 - 21:01

    Hi Gabriela,

    Great questions also. In terms of management of RCHF the best way to monitor successful treatment is via a FAST scan to see if I can still see fluid. I would expect almost complete resolution after a week and by 2 weeks post furosemide there should be no fluid there at all. It is more tricky to monitor than LCHF though. You could also weigh them serially (as you point out ideally you would have the pre-CHF weight) or measure abdominal girth, but ultrasound is going to be most accurate. Similar to LCHF you are looking to remove all of the fluid.

    Hope that helps 🙂

    Liz

    Liz Bode
    Keymaster
    20:58 21/06/21

    Hi Nathalie,

    That really depends on if the flow has fully reversed or is still bidirectional. If bidirectional I would expect that the velocities will start to drop in both systole and diastole. Then you will lose the diastolic component and then both components if the PA pressure increases enough. I would start sildenafil if I documented pulmonary hypertension on echo (or had a high suspicion following the consensus statement). Sometimes there are anomalous vessels called aberrant bronchoesophageal arteries that enter the PA in a similar location to a PDA but have much lower flow around 3 m/s. You can get a murmur but not always – Geoff Culshaw published a case series in JSAP in 2013. In this case the pulmonary artery pressure is normal so there is no evidence of hypertension.

    Have you seen a suspicious case?

    Liz

    Liz Bode
    Keymaster
    20:49 21/06/21

    Replying to Liz Bode 21/06/2021 - 20:43

    Final ECG for your thoughts – I can bring some to live Q and A too…

    This is from a 10 yo Chocolate Lab with a right atrial mass. It is a tricky one, but you have been spot on so far!!!

    https://drive.google.com/file/d/1fgdpTfhpq_1vhj7vRv3tf6Z0kG7dUuoP/view?usp=sharing

    Liz

    Liz Bode
    Keymaster
    20:43 21/06/21

    Replying to Liz Bode 21/06/2021 - 20:40

    Sorry, thought I could edit my message but you can’t (note for developers!)

    So there is a slight slurring of the ST segment but not of note. It is relevant (a sign of hypoxia/ ischaemia) when it is elevated/ depressed >0.2mV.

    You can get marked right axis deviation with any right-sided disease, but pulmonic stenosis does seem to do it more consistently. That said, I saw a French bulldog today with normal axis and severe PS, so shows that MEA is not very reliable.

    I will post one more ECG for consideration.

    Liz

    Liz Bode
    Keymaster
    20:43 21/06/21

    Replying to Liz Bode 21/06/2021 - 20:40

    Sorry, thought I could edit my message but you can’t (note for developers!)

    So there is a slight slurring of the ST segment but not of note. It is relevant (a sign of hypoxia/ ischaemia) when it is elevated/ depressed >0.2mV.

    You can get marked right axis deviation with any right-sided disease, but pulmonic stenosis does seem to do it more consistently. That said, I saw a French bulldog today with normal axis and severe PS, so shows that MEA is not very reliable.

    I will post one more ECG for consideration.

    Liz

    Liz Bode
    Keymaster
    20:40 21/06/21

    Replying to Alice L 20/06/2021 - 21:38

    Hi both,

    Thanks for great answers, once again. You should be able to subscribe to topics when you reply to a thread and that way you will get an email notification. There are a few glitches with the website which we are working through but PLEASE flag any you come across as we have 20 days to get the changed for free 🙂

    In terms of the ECG – spot on this is a dog that had tricuspid valve dysplasia. There is a publication that reports the splintered QRS complexes that we see here are frequently found in cases with marked dysplasia. There is also P pulmonale (increased P wave height) suggestive of right atrial enlargement.

    Liz Bode
    Keymaster
    20:48 18/06/21

    Hi Scott,

    Good post! I had heard that it has now been linked to several well known brands of food, or at least that is what they are investigating. A friend of mine had 2 cats die from this, it really is very tragic.

    Liz

    Liz Bode
    Keymaster
    22:15 17/06/21

    Hi all,

    Here is another ECG for your thoughts, this time from a 1yo Labrador.

    Calvin

    What is your ECG diagnosis (and thoughts) and what is the most likely cardiac disease process in this dog?

    Enjoy!

    Liz

    Liz Bode
    Keymaster
    22:08 17/06/21

    Replying to Alice L 17/06/2021 - 21:35

    Hi both,

    Thanks for your answers, both excellent. It was indeed a tricky one (and is made harder by the video as I like to count boxes/ do the paper mark test to see how regular the P waves are etc).

    It is a bradyarrhythmia with splintered QRS complexes that are indicative of some sort of myocardial abnormality meaning conduction is not taking the usual path. There are some positive P waves and these can be seen both in the ST segment, in the T wave and occasionally look like they have the right relationship with the QRS (so therefore could be causing the QRS). There are also some negative P waves later on, which suggest a different part of the atrium is generating the P wave.

    3rd degree AV block, at least in the first portion is a consideration. We would also need to look at the paper trace in better detail to determine if some of the P waves are captured and cause the QRS complexes. My interpretation is that the sinus rate is VERY slow and that we have an escape rhythm associated with this slow sinus rate. Sometimes the P waves occur and capture the rhythm but other times they happen just after the ventricle has decided to stop waiting and fire. In 3rd degree AV block I would expect a much faster P wave rate as the baroreceptors will be telling the sinus node that the heart rate needs to be speeded up. The rhythm at the end seems to suggest a new atrial focus taking over from the sinus node that is at a faster rate than the positive P waves.

    I would agree, you could do an atropine response test, and in act this dog may benefit from atropine! It needs a faster heart rate.

    I suggested that they check acid-base status and electrolytes as hypokalaemia could cause this. I also wondered about the impact of opioids on the rate as I have seen sinus bradycardia with these before. It could also be vagal, but I think this is less likely.

    Hope that all makes sense! I will post a different case now…

    Liz

    Liz Bode
    Keymaster
    21:53 17/06/21

    Hi Nathalie,

    These are generally only used with ventricular premature beats. I think that is because when you have more than 3 escape beats in a row then that would become an idioventricular rhythm (an escape rhythm). I think it would be unusual to see only two escape beats, usually there is just a single one or an idioventricular rhythm. How many did you see together?

    Liz

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