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Lakhdhir S, Viall A, Alloway E, Keene B, Baumgartner K, Ward J. Clinical presentation, cardiovascular findings, etiology, and outcome of myocarditis in dogs: 64 cases with presumptive antemortem diagnosis (26 confirmed postmortem) and 137 cases with postmortem diagnosis only (2004-2017). J Vet Cardiol 2020; 30:44-56. [PMID: 32668360 PMCID: PMC7256493 DOI: 10.1016/j.jvc.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study describes presentation, cardiovascular abnormalities, etiology, and outcome of canine myocarditis in geographic areas not endemic for Trypanosoma or Leishmania. ANIMALS Sixty-four (presumed antemortem diagnosis) and 137 (postmortem diagnosis only) client-owned dogs at two tertiary care facilities were included. MATERIALS AND METHODS Medical records of dogs with clinical or histopathological diagnosis of myocarditis were reviewed retrospectively. RESULTS Common examination findings in dogs with a presumed antemortem diagnosis included fever (21%) and heart murmur (19%). Median cardiac troponin I was 12.2 ng/mL (range: 0.2-808.0 ng/mL), and troponin exceeded 1.0 ng/mL in 26 of 29 (90%) dogs. Ventricular ectopy was the most common arrhythmia (54%), whereas decreased left ventricular systolic function was the most common echocardiographic abnormality (56%). An infectious etiology was diagnosed in 35 of 64 (55%) dogs. Confirmed infectious etiologies included bacterial sepsis (n = 9) or extension of endocarditis (3), toxoplasmosis or neosporosis (3), parvovirus (2), and one case each of bartonellosis, trypanosomiasis, leptospirosis, and dirofilariasis. Median survival time was 4 days (range: 0-828 days) for all dogs vs. 82 days for dogs who survived at least 2 weeks after diagnosis. Presence of pericardial effusion or azotemia was a significant predictor of non-survival. The most common inflammatory infiltrate on histopathology was neutrophilic (47%), and 20 of 137 (14.5%) dogs had concurrent bacterial endocarditis on postmortem. CONCLUSIONS Bacterial infection was the most common confirmed etiology of myocarditis in this study. Prognosis for canine myocarditis is guarded and similar to that reported for infective endocarditis. Criteria for the antemortem diagnosis of canine myocarditis are suggested.
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Affiliation(s)
- S Lakhdhir
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 S. Riverside Drive, Ames, IA 50011, USA
| | - A Viall
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, 1809 S. Riverside Drive, Ames, IA 50011, USA
| | - E Alloway
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - B Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - K Baumgartner
- VCA Veterinary Specialists of Northern Colorado, 201 W. 67th Court, Loveland, CO 80538, USA
| | - J Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 S. Riverside Drive, Ames, IA 50011, USA.
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Indications for permanent pacing in dogs and cats. J Vet Cardiol 2019; 22:20-39. [PMID: 30709617 PMCID: PMC7185536 DOI: 10.1016/j.jvc.2018.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/25/2022]
Abstract
Pacemaker implantation is considered as a standard procedure for treatment of symptomatic bradycardia in both dogs and cats. Advanced second-degree and third-degree atrioventricular blocks, sick sinus syndrome, persistent atrial standstill, and vasovagal syncope are the most common rhythm disturbances that require pacing to either alleviate clinical signs or prolong survival. Most pacemakers are implanted transvenously, using endocardial leads, but rarely epicardial leads may be necessary. To decide whether a patient is a candidate for pacing, as well as which pacing modality should be used, the clinician must have a clear understanding of the etiology, the pathophysiology, and the natural history of the most common bradyarrhythmias, as well as what result can be achieved by pacing patients with different rhythm disturbances. The goal of this review was, therefore, to describe the indications for pacing by evaluating the available evidence in both human and veterinary medicine. We described the etiology of bradyarrhythmias, clinical signs and electrocardiographic abnormalities, and the choice of pacing modality, taking into account how different choices may have different physiological consequences to selected patients. It is expected that this review will assist veterinarians in recognizing arrhythmias that may require permanent pacing and the risk-benefit of each pacing modality and its impact on outcome.
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Wesselowski S, Cusack K, Gordon SG, Jeffery N, Saunders AB. Artificial cardiac pacemaker placement in dogs with a cohort of myocarditis suspects and association of ultrasensitive cardiac troponin I with survival. J Vet Cardiol 2018; 22:84-95. [PMID: 30573438 DOI: 10.1016/j.jvc.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Artificial cardiac pacemakers (APs) are a common treatment for symptomatic bradyarrhythmias in dogs, some of which may be triggered by underlying myocarditis. Severely elevated cardiac troponin I (cTnI) concentrations support a diagnosis of myocarditis. The association of ultrasensitive-cTnI (US-cTnI) concentration with survival in a large cohort of dogs receiving APs is not described. ANIMALS, MATERIALS, AND METHODS The study included 110 dogs receiving APs over a 5-year period. Medical records were retrospectively reviewed to characterize the entire population receiving APs, with further analysis in dogs with preprocedural US-cTnI concentrations (n = 64) classified as normal/group 1 (n = 11), mildly to moderately elevated/group 2 (n = 27), and severely elevated/myocarditis suspects/group 3 (n = 26). RESULTS Median survival time was 1079 days for the entire population, 1167 days for group 2, 949 days for group 3, and not met in group 1. There was not a statistically significant difference in survival between group 2 and group 3. Overall, US-cTnI had a mild, negative association with survival. Age had a stronger negative association. Infectious etiologies were identified in a minority of group 3 cases. A possible association between severely elevated US-cTnI and a sudden death outcome was noted. CONCLUSIONS The negative association of US-cTnI with survival outcomes was mild, with age having a larger effect. Although a sudden death outcome may be seen more commonly in myocarditis suspects, group 3 survival time was similar to that of the entire canine population. Plausible infectious causes of myocarditis were infrequently identified.
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Affiliation(s)
- S Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA.
| | - K Cusack
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - S G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - N Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
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Oxford EM, Giacomazzi FB, Moïse NS, Santilli RA. Clinical and electrocardiographic presentations of transient trifascicular block in three cats. J Vet Cardiol 2018; 20:204-212. [DOI: 10.1016/j.jvc.2018.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
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Follow-up of troponin I concentration in dogs with atrioventricular block and dual-chamber pacing in a case-matched study. J Vet Cardiol 2017; 19:247-255. [PMID: 28478942 DOI: 10.1016/j.jvc.2017.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/25/2016] [Accepted: 01/18/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Increased cardiac troponin I (cTnI) concentration has been reported in dogs with atrioventricular (AV) block before and shortly following pacemaker implantation. The role of AV dyssynchrony, age, or concurrent cardiac disease on cTnI concentration remains unknown. OBJECTIVES To investigate change in cTnI concentration following dual-chamber pacemaker implantation on short- and long-term follow-up and to compare cTnI values to a case-matched control group. ANIMALS Thirty-eight client-owned dogs with permanent AV block and 38 matched control dogs. METHODS Retrospective review of medical records. Pacemaker group consisted of dogs with AV block and dual-chamber pacing. Control group matched the study population in age and cardiac disease. cTnI was compared between pacemaker and control group on short- and long-term follow-up. Different lead types and influence of arrhythmia on cTnI were tested. RESULTS cTnI was high at presentation (median 0.66 ng/ml; range 0.03-18.6) and showed a significant reduction over time after pacemaker implantation (p < 0.0001). Median cTnI values were significantly different between pacemaker and control group on short-term (p = 0.0004; 0.11 ng/ml, range 0.03-1.36 versus 0.06 ng/ml, range 0.03-0.46), but not on long-term follow-up (p = 0.0547; 0.14 ng/ml, range 0.03-0.73 versus 0.07 ng/ml, range 0.03-0.46). Lead type and severity of arrhythmia did not show a significant correlation to cTnI concentration. CONCLUSIONS On long-term follow-up, cTnI remained mildly elevated in some of the pacemaker dogs but was not significantly different to the matched control group.
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Dutton E, Dukes-McEwan J, Cripps P. Serum cardiac troponin I in canine syncope and seizures. J Vet Cardiol 2017; 19:1-13. [DOI: 10.1016/j.jvc.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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Ward J, DeFrancesco T, Tou S, Atkins C, Griffith E, Keene B. Outcome and survival in canine sick sinus syndrome and sinus node dysfunction: 93 cases (2002–2014). J Vet Cardiol 2016; 18:199-212. [DOI: 10.1016/j.jvc.2016.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 03/29/2016] [Accepted: 04/08/2016] [Indexed: 12/01/2022]
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Santilli RA, Porteiro Vázquez DM, Vezzosi T, Perego M. Long-term Intrinsic Rhythm Evaluation in Dogs with Atrioventricular Block. J Vet Intern Med 2015; 30:58-62. [PMID: 26572234 PMCID: PMC4913642 DOI: 10.1111/jvim.13661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/23/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022] Open
Abstract
Background Atrioventricular block (AVB) is a conduction abnormality along the atrioventricular node that, depending on etiology, may lead to different outcomes. Objectives To evaluate variations of intrinsic rhythm (IR) in dogs that underwent pacemaker implantation (PMI). Animals Medical records of 92 dogs affected by 3rd degree atrioventricular block (3AVB), advanced 2nd degree AVB (2AVB), paroxysmal 3AVB, 2:1 2AVB, or 3AVB with atrial fibrillation (AF) were retrospectively reviewed. Method The patient IR was documented with telemetry on the day of 1 – (95% CI, 1–2), 33 – (95% CI, 28–35), 105 – (95%CI, 98–156), and 275 days (95%CI, 221–380) after PMI. According to AVB grade at different examinations, AVB was defined as progressed, regressed, or unchanged. Results In 48 dogs, 3AVB remained unchanged, whereas in 7 it regressed. Eight cases of 2AVB progressed, 3 regressed and 2 remained unchanged. Eight cases of paroxysmal 3AVB progressed and 3 remained unchanged. Four dogs affected by 2:1 2AVB progressed, 2 regressed, and 1 remained unchanged. All cases with 3AVB with AF remained unchanged. Regression occurred within 30 days after PMI, whereas progression was documented at any time. Variations in IR were associated with type of AVB (P < .03) and time of follow‐up (P < .0001). Conclusions and clinical importance The degree of AVB assessed at the time of PMI should not be considered definitive because more than one‐third of the cases in this study either progressed or regressed. Additional studies would be necessary to elucidate possible causes for transient AVB in dogs.
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Affiliation(s)
- R A Santilli
- Clinica Veterinaria Malpensa, Samarate, Varese, Italy
| | | | - T Vezzosi
- Ospedale Didattico Veterinario "Mario Modenato", Dipartimento di Scienze Veterinarie, Università di Pisa, San Piero a Grado (Pisa), Italy
| | - M Perego
- Clinica Veterinaria Malpensa, Samarate, Varese, Italy
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Smith KF, Quinn RL, Rahilly LJ. Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 1 - Cardiac diseases and pulmonary hypertension. J Vet Emerg Crit Care (San Antonio) 2015; 25:311-29. [DOI: 10.1111/vec.12318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/22/2015] [Indexed: 12/18/2022]
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Tater G, Eberle N, Hungerbuehler S, Joetzke A, Nolte I, Wess G, Betz D. Assessment of cardiac troponin I (cTnI) and tissue velocity imaging (TVI) in 14 dogs with malignant lymphoma undergoing chemotherapy treatment with doxorubicin. Vet Comp Oncol 2015; 15:55-64. [PMID: 25664927 DOI: 10.1111/vco.12135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 11/23/2014] [Accepted: 11/23/2014] [Indexed: 11/27/2022]
Abstract
Doxorubicin has been shown to be cardiotoxic at high doses but is an efficacious chemotherapeutic agent in the treatment of canine lymphoma. Echocardiographic measurements and serum ultrasensitive cardiac troponin I (cTnI) levels were obtained before and after doxorubicin administration in 14 dogs diagnosed with lymphoma. The aim of this prospective study was to evaluate changes in cTnI concentrations and tissue velocity imaging (TVI) values in dogs with lymphoma undergoing chemotherapy with doxorubicin. A total of 182 cTnI and 1017 TVI measurements were performed. Standard echocardiographic parameters, tissue Doppler indices and cTnI concentrations did not differ at any time point within a 12-week cyclic combination protocol. In conclusion, the use of doxorubicin at standard doses in the treatment of canine lymphoma may not be associated with significant myocardial damage.
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Affiliation(s)
- G Tater
- Small Animal Hospital, University of Veterinary Medicine, Hannover, Germany
| | - N Eberle
- Small Animal Hospital, University of Veterinary Medicine, Hannover, Germany
| | - S Hungerbuehler
- Small Animal Hospital, University of Veterinary Medicine, Hannover, Germany
| | - A Joetzke
- Small Animal Hospital, University of Veterinary Medicine, Hannover, Germany
| | - I Nolte
- Small Animal Hospital, University of Veterinary Medicine, Hannover, Germany
| | - G Wess
- Clinic of Small Animal Internal Medicine, LMU-University, Munich, Germany
| | - D Betz
- Small Animal Hospital, University of Veterinary Medicine, Hannover, Germany
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Saunders AB, Gordon SG, Rector MH, DeMaster A, Jackson N, Clubb FJ, Fosgate GT, Miller MW. Bradyarrhythmias and pacemaker therapy in dogs with Chagas disease. J Vet Intern Med 2013; 27:890-4. [PMID: 23662590 DOI: 10.1111/jvim.12098] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 01/11/2013] [Accepted: 03/20/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Chagas disease (Trypanosomiasis) is a cause of myocarditis in the southern United States causing cardiac conduction abnormalities, arrhythmias, and heart failure. OBJECTIVES To report clinical findings and outcome in Chagas positive (CP) dogs requiring pacemaker implantation for bradyarrhythmias. ANIMALS One hundred and forty-four client-owned dogs requiring pacemaker implantation. METHODS Retrospective case series. Information regarding history, physical exam, laboratory and diagnostic imaging findings, treatment, and survival were obtained from medical records, with additional follow-up information obtained by contacting referring veterinarians and owners. RESULTS Of the 144 dogs requiring pacemaker implantation from January 2001 to May 2010, 83 (57.6%) had a Chagas titer performed and 9 (10%) were CP. Concurrent ventricular arrhythmias (odds ratio 1.61, P = .005) or atrioventricular (AV) block (odds ratio 4.18, P < .001) increased the likelihood that a Chagas titer was submitted. Median age for CP dogs was 6.2 years (range, 0.3-10); 7 were male. Bradyarrhythmias included high-grade 2nd or 3rd degree AV block (n = 8) and sinus bradycardia with 1st degree AV block (n = 1); 5 had concurrent ventricular arrhythmias. A positive Chagas titer had a negative impact on survival (hazard ratio 4.04; 95% CI 1.36-12.1, P = .012) with a reported median survival time of 365 days (interquartile range, 84-973 days). CONCLUSIONS AND CLINICAL IMPORTANCE Bradyarrhythmias can result in clinical signs requiring pacemaker implantation in CP dogs, and although the diagnosis negatively impacts survival, pacemaker therapy is a viable treatment option.
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Affiliation(s)
- A B Saunders
- Department of Small Animal Clinical Sciences and, Michael E. DeBakey Institute for Comparative Cardiovascular Sciences and Biomedical Devices, College Station, TX 77843-4474, USA.
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