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Management Tree / CARDIOLOGY Peer Reviewed Common Cardiac Arrhythmias Barret Bulmer, DVM, MS, DACVIM (Cardiology) Tufts University NORMAL HEART RATE (dogs, 70–160 bpm; cats, 140–220 bpm) Are all QRS complexes supraventricular? No Underlying sinus rhythm with VPCs Accelerated idioventricular rhythm Yes Normal P wave preceding all QRS complexes? No • Rule out cardiac/ systemic disease • Rule out infectious agents producing myocarditis • Treat underlying cause • 24-hour Holter monitoring to determine need for treatment and/or therapeutic efficacy • Rapid suppression achieved via IV lidocaine or procainamide (bolus, may require CRI) • Oral maintenance therapy via sotalol, mexiletine, or less commonly amiodarone Yes Identify and treat underlying cause Underlying sinus rhythm with supraventricular premature complexes Does the underlying R-R interval vary by >10%? No • Identify and treat underlying heart disease • In patients with paroxysms of SVT, treatment with digitalis, calcium-channel blockers, or βblockers may be required to slow heart rate; sotalol or amiodarone may resolve arrhythmia Diagnosis Yes Sinus rhythm (normal for dogs and cats) Sinus arrhythmia (usually normal, especially in dogs) No treatment required; P wave morphology may vary in patients displaying wandering pacemaker Investigate Treatment Results AV = atrioventricular, SVT = supraventricular tachycardia, VPC = ventricular premature complex, VT = ventricular tachycardia FOR MORE… Look for more algorithms on cardiac arrhythmias in the next issue. Management Tree / NAVC Clinician’s Brief / May 2012.........................................................................................................................................................................37