The Thai Journal of Veterinary Medicine

Article Title

ECG Quiz


A nine year old intact male Miniature Pinscher weighing 4.8 kilogram was presented to veterinarian with signs of severe coughing and exercise intolerance. He was diagnosed of heart disease and previously described the angiotensin converting enzyme inhibitor and diuretic for a period of 6 months. Neither signs of syncope nor seizure was found. Physical examination revealed the dog was depressed and lethargy. The electrocardiography was performed and shown in Figure 1. The blood test showed normal complete blood count with normal kidney and liver blood profiles. The blood parasite was also negative. The thoracic radiograph revealed the whole heart enlargement (VHS = 12.5) with pulmonary vessels distention. The lung field was normal and no evidence of perihilar lung edema. Echocardiography was performed and results showed moderate insufficiency and thickening of both tricuspid and mitral valves. The right side heart was enlarged while the left atrium was dilated The left atrium to aortic root ratio (LA/Ao) was 1.79. The averaged mean pulmonary pressure was higher than 25 mmHg. The sand calculi were also found in the urinary bladder. The dog was treated with positive inotrope (pimobendan), angiotensin converting enzyme inhibitor and furosemide. The sildenafil was also prescribed. The bronchodilator was given in case of severe coughing due to bronchial stenosis. After, medication, the dog was more alert and was able to maintain normal activity at home. No sign of coughing or syncope was found. The blood test every 6 months showed normal concentrations of blood urea nitrogen, plasma creatinine as well as normal complete blood count. The electrocardiography at 1 month and 6 month thereafter showed the same pattern as on the first recording. Unfortunately, the dog died one and a half year later with unknown cause of acute kidney injury although previous blood test was still within normal limit 1 week before passing away.

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