Download Cardiology Case Study: Third Degree Atrioventricular Block

November 2013
Cardiology Case Study: Third Degree Atrioventricular Block
placed in the right ventricle of her heart, while the
battery was implanted on the back of her neck. Four
liters of fluid was drained from Misty’s abdomen during
the procedure. The pacemaker was set to pace her heart
rate at 80 beats per minute when Misty is resting but
can increase her heart rate to 140 beats per minute
when she is active.
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- Case Study: Cardiology
Third Degree Atrioventricular Block
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- Specialty Service Overview:
Internal Medicine
- Did you know?
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- Continuing Education
Lunch ‘N Learn
- Team Member Highlight:
Dr. Victoria Heffelman
- Technician Tip:
Catheter Site Cleanliness
History: Misty, a 12-year old female spayed Border
Collie, was taken to her primary care veterinarian for
lethargy and distention of her abdomen. Physical
examination revealed a large amount of free fluid
in her abdomen and a lower than normal heart rate
(35-40bpm). One and half liters of fluid was drained
from Misty’s abdomen. Due to her low heart rate and
the presence of free fluid in her abdomen, she was
referred to DVMS for cardiac evaluation.
Presentation: Misty presented to Dr. Hodge four days
after seeing her primary care veterinarian. Her abdomen
was very distended with free fluid, heart rate was ~30
beats per minute, and femoral pulses were fair. Mucous
membranes were pale pink. Lung sounds were normal.
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- Testimonial:
Morgan
dvmspecialists.com
Diagnostics: An echocardiogram and electrocardiogram
(ECG) were performed. The echocardiogram showed that
Misty’s heart was structurally and functionally normal.
The ECG showed an arrhythmia called third degree
atrioventricular block (complete heart block).
Treatment: A pacemaker is the standard treatment
for dogs with third degree AV block. A permanent
transvenous pacemaker was implanted through Misty’s
right jugular vein. The lead wire of the pacemaker was
Outcome: One week after pacemaker implantation,
Misty was doing well and all of the fluid in her belly was
gone. Her incision sites were completely healed and her
activity and attitude were much improved.
Take Away: Third degree AV block occurs when the
normal impulse that causes the heart to beat is blocked
and does not reach the ventricles of the heart. The
ventricles are the part of the heart responsible for
pumping blood to the body and lungs. Luckily, the
ventricles have a back-up plan and can generate their
own impulse that causes them to beat. Unfortunately,
the ventricles beat at a much slower rate than the
normal heart rate. This slower rate leads to weakness,
lethargy, and fluid backup. Third degree AV block can
also lead to organ failure and these dogs have a high
rate of sudden death. To prevent sudden death, a
permanent pacemaker is highly recommended in dogs
with third degree atrioventricular block.
Timothy Hodge, DVM
Diplomate ACVIM (Cardiology)
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Specialty service: INTERNAL MEDICINE
Complex, Chronic, and/or Concurrent CONDITIONS
Melissa Riensche, DVM
Diplomate ACVIM
Committed to partnering with veterinarians across the
Valley, you can count on our Internal Medicine team
of specialists to diagnose and manage all types of
diseases found in companion animals. Our internists,
Dr. Melissa Riensche and Dr. Janet Bailey, perform
advanced and therapeutic procedures including:
Janet Bailey, DVM
Diplomate ACVIM
AutoImmune Diseases
• Hemolytic Anemia
• Thrombocytopenia
• Polyarthritis
Respiratory
• Rhinoscopy
• Bronchoscopy
• Bronchoalveolar lavage
Hematology
• Blood transfusion therapy
• Bone marrow aspirates
Endocrinology
• Diabetes mellitus
• Cushing’s disease
• Thyroid disorders
Gastroenterology
• Endoscopy for biopsy of intestines, stomach, colon,
retrieval of foreign bodies
• Esophageal feeding tube and Peg tube placement
We pride ourselves on being accessible and enjoy working closely with you, accommodating each
client and their pet according to their individual need. We welcome your call at 480.635.1110 x7
should you want more information or to discuss a case for referral consideration.
Did You Know...
In addition to mobile cardiology services every Thursday in Tucson, our
Cardiologists, Dr. Church and Dr. Hodge, also see additional patients at
these locations: - 6677 W. Thunderbird Road, L-188, Glendale, AZ 85306
- 22595 N. Scottsdale Road, Scottsdale, AZ 85255
To schedule an appointment at either one of these locations, please
call 480.635.1110 x7.
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Continuing
Education
Lunch and Learn with the Specialists
We offer a variety of topics on state-of-the-art diagnostic tips, treatment
options, and advances being made in cardiology, internal medicine, and
diagnostic imaging, such as:
• Adrenal Disease
• Advanced Imaging
• ECG Interpretation & Management
• Identifying CHF on Thoracic Radiographs
• Radiology Techniques and Positioning
• Immune Mediated Disease
• Liver Failure
• Metabolic Disease
• Mitral Valve Disease
• And much more...
Call Practice Manager, Kathy Wilson, at 480.635.1110 x7 to arrange lunch – at your place or ours.
TEAM MEMBER
Highlight
victoria heffelman, DVM, DACVr
Dr. Heffelman is a native of Colorado and received her Doctor of Veterinary Medicine degree
from Colorado State University in 2004, where she quickly discovered her love for all things
in radiology. After graduation, she completed a small animal medicine and surgery rotating
internship at a private practice in Colorado, followed by an additional year in private practice as
an associate veterinarian. Dr. Heffelman then completed a Radiology residency at Michigan State
University in 2009, and became board certified later that year. She and her husband moved back
to the West for the mountains, sun, and great climate. She was excited to join Arizona Veterinary
Specialists and, soon thereafter, to become a partner in Desert Veterinary Medical Specialists.
Her special areas of interest include abdominal ultrasound, CT, and nuclear medicine.
Dr. Heffelman lives with her husband Richard, Quinn, a Welsh Corgie, and a tabby cat, Piccolo. She enjoys traveling, spending
time with family, movies, hiking, and loves all that Arizona and the southwest has to offer!
Technician
tip
Catheter Site Cleanliness
by Candace Olin, CVT
It is essential to keep your I.V. catheter site clean otherwise you may run the risk of contaminating
the site. Common signs of contamination are redness, swelling, or tenderness in the area. The
catheter site should be checked regularly, paying close attention to the insertion site, and
the tape should be checked regularly for tightness especially while administering I.V. fluids.
Keeping the catheter area clean can be especially problematic with a patient that is vomiting,
salivating excessively, or is having diarrhea. I have two tips to help keep the area clean. First,
cut a potty pad to an appropriate size to cover the area, fold in the edges, cover the site, and
then fasten it to the patient with medical tape. Second, when using a T-port, take an exam
glove and cut the fingers off, leaving the thumb. Then snip a small hole into the tip off the
thumb. You can now slide the glove up over the catheter site, fasten with medical tape, and
pull the T-port through the thumb. I hope this helps you to maintain a clean catheter site for
your convenience and the safety of the patient.
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Located inside Arizona Veterinary Specialists
86 W. Juniper Avenue • Gilbert, AZ 85233
Cardiology* • Internal Medicine • Radiology
* Select services also available in Glendale, Scottsdale, and Tucson
dvmspecialists.com • 480.635.1110 x7
I just wanted to let you folks at Desert
Veterinary Medical Specialists know
that you went above and beyond any
expectations we had. The doctors and staff
were wonderful, caring, and compassionate
with our girl, Morgan. You provided us with
two wonderful additional months and,
when the time came, treated her and us
with dignity and respect.
Your actions, services, as well as attitudes
exceeded any provider we had used in the
past. It’s difficult to put into words the love
we have for Morgan and the loss felt, but
knowing the care she received makes a
heart a little more restful. Thank you all
so very, very much.
Chuck Spaulding / Papa
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