|Christopher presents to the VMTH Cardiology
Service for a two week recheck following pacemaker
|He was previously diagnosed with third degree AV block
and has had a one year history of syncopal episodes that appear to be
precipitated by stress. His condition was initially managed medically with
aminophylline 25 mg PO TID. The syncopal episodes decreased from 10-15 per
day to 0-2 per day. However, they increased again
to 10-15 per day. As a result, a pacemaker was placed. |
|The owners report that Christopher has been doing well.
He has not had any syncopal episodes and his resting heart rate has been
~108 bpm. He has been eating and drinking well, with no V/D/C/S/PU/PD. His
incision site has been healing well, and his course of amoxicillin 150 mg PO
BID was finished yesterday. |
|Gen: BARH. T=not taken, P=80, R=28. MM pink and moist,
CRT 1 sec. |
|Int: Fur growing back at shaved surgical/catheter sites.
Ventral midline incision healed. |
|EENT: OU-cornea, anterior chamber, and lens clear.
AU-clean. Nose-moist, no discharge. Throat-no masses. Mild dental calculus.
|MS: BCS 5/9. Symmetrical musculature. Did not observe
|CV: HR=100, irregular rhythm. |
|Resp: Quiet lung sounds in all fields.
|GI: No masses or organomegaly palpated. Smooth bowel
|GU: Kidneys palpate smooth. |
|NS: Appropriate mentation. Complete neuro. exam not
|LN: Submandibular, prescapular, popliteal nodes < 1 cm.
|Pacemaker placement 11/08/02 |
|Second degree and third degree AV block
|Epicardial pacemaker |
|Supraventricular tachycardia |
|Myocardial failure |
|Thoracic radiographs: Good placement of the epicardial
pacemaker. Static cardiomegaly. |
Plasma = 90 nmol/ml; whole blood = 489 nmol/ml
(both within normal range)|
|ECG: Heart rate variable with
alternating periods of supraventricular tachycardia
(SVT) @ 200-250 bpm and sinus rhythm
@ 110-120 bpm. Pacemaker is
pacing inappropriately (firing during periods of SVT). We adjusted the
pacemaker to pace appropriately by decreasing the refractory period.
Pacemaker was sensing 47% and pacing 53% of the time. Pre-refractory period
was 330ms, and post-refractory period was decreased to 150ms.
|ECHO: IVSd=0.5 cm, LVEDD=1.8
cm, LVESD=1.3 cm, FS=29%, LVFWd=0.5
cm, LA:Ao=1.4:1.1=1.3. Septal bulge.
Left ventricular chamber appears dilated. The
LVEDD and LVESD are still increased from normal, but are decreased since the
previous visit (LVEDD 2.1 cm and LVESD 1.5
cm). Contraction (shortening fraction)
appears adequate, but there is still evidence of myocardial failure
(increased LVESD). |
|Conclusions: Christopher's clinical signs have improved
since placement of the pacemaker. Radiographically, the cardiomegaly appears
static. The pacemaker has been adjusted to depolarize
appropriately during prolonged pauses in conduction (rate=100 bpm).
The heart rate is variable with occurrences of SVT
and normal sinus rhythm. The left ventricle is still enlarged with evidence
of myocardial failure. Christopher was sent home on 7.5 mg of diltiazem PO
TID to control periods of SVT. He will return in ~90 days post pacemaker
placement for a recheck. |
|Christopher presented to the VMTH Cardiology
Service for a two week recheck following
epicardial pacemaker placement. |
|He has had
no syncopal episodes and has had a resting heart rate of 108 bpm at
home. His appetite and attitude have been normal. |
|On physical exam, Christopher was bright and alert. He
heart rate was 100 bpm, and he had an irregular rhythm. His incision site
has healed, so the skin staples were removed. |
|Thoracic radiographs revealed cardiomegaly (heart
enlargement) unchanged from previous radiographs.
The pacemaker was in a good position. ECG revealed runs of supraventricular
tachycardia along with a normal sinus rhythm. The pacemaker was adjusted to
fire appropriately when there were prolonged delays in conduction and not
during the supraventricular tachycardia episodes. Echocardiogram revealed an
enlarged left ventricle with evidence of myocardial failure.
|Bloodwork was performed to assess taurine
concentration. Christopher was started on
diltiazem @ 7.5 mg PO TID to control his bursts of supraventricular
tachycardia. Christopher should return in three months for further pacemaker