Atrial dissociation in a boxer with  a carcinoma of the middle ear

Brunner, Alfred; Kovačević, Ana

doi:10.17236/sat00260

Cited by 1 publication

(6 citation statements)

References 23 publications

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“…12 Even more uncertainties exist in dogs owing to the paucity of pertinent scientific literature, currently limited to 4 case reports. [2][3][4][5] Nevertheless, it is interesting to note that all these reports documented AD as an incidental finding in dogs without apparent clinical consequence, [2][3][4][5] as in the present case.…”

Section: Discussionsupporting

confidence: 41%

“…1,9,10,12,13 Nevertheless, the combination of ECG and echocardiographic findings from our dog provided visual evidence supporting the existence of an ectopic atrial focus capable of producing mechanical atrial systole, allowing us to rule out pseudo-dissociated waves due to artifacts. 2,5,6 In humans, the clinical relevance of AD remains controversial and appears to be somewhat related to the patient's age. In adults, AD often develops in critically ill patients 9,10,13 and is, therefore, generally considered an ominous sign.…”

Section: Discussionmentioning

confidence: 99%

Section: Ecg Interpretationmentioning

confidence: 99%

“…1 Given these findings, atrial dissociation (AD) was diagnosed. [1][2][3][4][5] The dissociated rhythm was suspected to be atrial tachycardia arising from an atrial roof ectopic focus. 1 In light of the ECG abnormality, transthoracic echocardiography was performed to further explore the dog's cardiac status.…”

mentioning

confidence: 99%

“…These findings were judged to be caused by abnormal active atrial contractions mediated by dissociated P' waves. 2,5,6 On the basis of previous veterinary reports describing AD in dogs as a benign entity, 2-5 the dog underwent splenectomy on the same day.For the anesthetic procedure, a multiparameter monitor (Datex Ohmeda S5; GE Healthcare) was used to monitor the dog's cardiac rhythm. The dog was sedated with acepromazine (10 µg/kg, IM), dexmedetomidine (1 µg/kg, IM), and methadone (0.2 mg/ kg, IM).…”

mentioning

confidence: 99%

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A 9-year-old 31-kg castrated male mixed-breed dog was referred to the Veterinary Teaching Hospital of the University of Bologna for treatment of a 4 X 4-cm splenic mass incidentally identified by the referral veterinarian. The dog was otherwise healthy; its past medical history was unremarkable. On presentation, cardiac auscultation revealed an irregular heart rhythm with a heart rate of 80 to 120 beats/ min. The femoral pulses were strong and synchronous with the heartbeat. The remaining physical findings were normal. Preanesthetic screening included routine blood tests (CBC, serum biochemical panel, and restricted coagulation panel) and thoracic radiography, which yielded unremarkable results. A 6-lead ECG was obtained (Figure 1). ECG InterpretationAn irregular rhythm with a mean heart rate of 120 beats/min was present. Narrow QRS complexes (duration, 0.07 seconds) with normal morphology and mean electric axis (89°) were evident. Two distinct P-wave configurations coexisted. The first configuration was characterized by P waves of normal amplitude (0.15 mV), duration (0.04 seconds), and axis (72°). They were constantly associated with a QRS complex and normal PQ interval (0.11 seconds). On the basis of these features, they were considered sinus in origin. The second configuration included smaller P' waves (amplitude, 0.05 mV; duration, 0.025 seconds) with a fast and irregular coupling interval (0.18 to 0.22 seconds). They occurred independently from the QRS complexes and were occasionally superimposed on the QRS complexes, T waves, and sinus P waves. The P' waves were almost isoelectric in lead I, positive in the inferior leads, and negative in the remaining leads, suggesting an atrial vector with a superior-to-inferior direction. 1 Given these findings, atrial dissociation (AD) was diagnosed. [1][2][3][4][5] The dissociated rhythm was suspected to be atrial tachycardia arising from an atrial roof ectopic focus. 1 In light of the ECG abnormality, transthoracic echocardiography was performed to further explore the dog's cardiac status. Cardiac dimensions and functional parameters were normal, and no valvular insufficiency was found. Intriguingly, 2-D and M-mode analysis through the mitral valve revealed simultaneous leaflet opening with the P' waves. Additionally, pulsed-wave Doppler ultrasonographic interrogation of the mitral inflow documented abnormal diastolic waves induced by P' waves (Figure 2). These findings were judged to be caused by abnormal active atrial contractions mediated by dissociated P' waves. 2,5,6 On the basis of previous veterinary reports describing AD in dogs as a benign entity, 2-5 the dog underwent splenectomy on the same day.For the anesthetic procedure, a multiparameter monitor (Datex Ohmeda S5; GE Healthcare) was used to monitor the dog's cardiac rhythm. The dog was sedated with acepromazine (10 µg/kg, IM), dexmedetomidine (1 µg/kg, IM), and methadone (0.2 mg/ kg, IM). Ten minutes after premedication, AD with a slow ventricular response rate (minimum heart rate, 45 beats/min) was stil...

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