ECG Quiz

Abstract

A nine year old intact male Miniature
Pinscher weighing 4.8 kilogram was presented to
veterinarian with signs of severe coughing and exercise
intolerance. He was diagnosed of heart disease and
previously described the angiotensin converting
enzyme inhibitor and diuretic for a period of 6 months.
Neither signs of syncope nor seizure was found.
Physical examination revealed the dog was depressed
and lethargy. The electrocardiography was performed
and shown in Figure 1. The blood test showed normal
complete blood count with normal kidney and liver
blood profiles. The blood parasite was also negative.
The thoracic radiograph revealed the whole heart
enlargement (VHS = 12.5) with pulmonary vessels
distention. The lung field was normal and no evidence
of perihilar lung edema. Echocardiography was
performed and results showed moderate insufficiency
and thickening of both tricuspid and mitral valves. The
right side heart was enlarged while the left atrium was
dilated The left atrium to aortic root ratio (LA/Ao) was
1.79. The averaged mean pulmonary pressure was
higher than 25 mmHg. The sand calculi were also
found in the urinary bladder. The dog was treated with
positive inotrope (pimobendan), angiotensin
converting enzyme inhibitor and furosemide. The
sildenafil was also prescribed. The bronchodilator was
given in case of severe coughing due to bronchial
stenosis. After, medication, the dog was more alert and
was able to maintain normal activity at home. No sign
of coughing or syncope was found. The blood test
every 6 months showed normal concentrations of
blood urea nitrogen, plasma creatinine as well as
normal complete blood count. The
electrocardiography at 1 month and 6 month thereafter
showed the same pattern as on the first recording.
Unfortunately, the dog died one and a half year later
with unknown cause of acute kidney injury although
previous blood test was still within normal limit 1
week before passing away.