Mixed Arrhythmia Cases – Veterinary ECG Quiz

Dog (Recorded with Beecardia)

Female

Question

Is anything abnormal in this recording, and if so, which interpretation fits?

Sinus rhythm with short runs of ventricular tachycardia

Sinus rhythm with aberrantly conducted atrial premature complexes

Sinus rhythm with occasional isolated ventricular premature complexes

Sinus rhythm throughout, with no ectopic complexes

Cat - Domestic Shorthair (Recorded with Beecardia)

6 years • Male • A loud heart murmur was noted

Question

How would you characterize the ventricular rhythm in this recording?

Cyclically irregular, with R-R intervals waxing and waning

Regular baseline interrupted by occasional early beats

Regular baseline interrupted by intermittent long pauses

Irregularly irregular throughout, with no repeating R-R pattern

Dog (Recorded with Beecardia)

Female

Question

Ectopic activity interrupts the underlying rhythm in this recording - which interpretation of its origin best fits?

Sinus rhythm with ventricular premature complexes

Sinus rhythm with non-conducted atrial premature complexes

Sinus rhythm with junctional premature complexes

Sinus rhythm with atrial premature complexes

Dog - Shih Tzu (Recorded with Beecardia)

7 years • Male • Blood transfusion the previous day; presented for elevated temperature and hematemesis. Concurrent inflammatory bowel disease with active gastrointestinal signs, and a heart murmur was reported

Question

What should you check first to tell a dropped beat from a sinus pause?

Whether the pauses come and go with the respiratory cycle

Whether a P wave falls within the pause with no QRS after it

Whether the QRS complexes bounding a pause differ in shape

Whether the average heart rate is below the normal canine range

Dog - Japanese Spitz (Recorded with Beecardia)

10 years • Male • Concern for a significant bradyarrhythmia at triage. Stage B1 myxomatous mitral valve disease on echocardiography with adequate blood pressure. Concurrent significant gastroenteritis and possible pancreatitis; no medication at this time

Question

How would you judge the clinical significance of this rhythm?

Sinus node dysfunction - significant, and warrants cardiac work-up

High vagal tone from the gastrointestinal illness - recheck once the abdominal disease resolves

Hyperkalemia-induced bradyarrhythmia - significant, but resolves with potassium correction

Isolated first-degree AV block - an incidental finding

Dog - Blue Heeler (Recorded with Beecardia)

9 years • Female • Cough for about two months, with no heart murmur; thoracic radiographs showed a vertebral heart score at the upper end of normal. Concurrent hypoadrenocorticism, under treatment

Question

At times in this recording a pacemaker other than the sinus node drives the rhythm. What mechanism best explains it?

A subsidiary junctional pacemaker emerging when the sinus rate falls below it

An accelerated junctional focus overtaking a normally functioning sinus node

Repeated supraventricular premature complexes breaking into the sinus rhythm

Failure of AV conduction allowing a junctional rhythm to take over

Dog - Labrador (Recorded with Beecardia)

11 years • Male • Under investigation for suspected pancreatitis

Question

Short runs of an ectopic rhythm recur through this recording. How should those runs be classified?

Ventricular escape rhythm

Accelerated idioventricular rhythm

Ventricular tachycardia

Paroxysmal supraventricular tachycardia

Cat - Domestic Shorthair (Recorded with Beecardia)

10 years • Male • Presented for increased appetite; an arrhythmia was noted on examination. Bloodwork including T4 was normal, and conscious echocardiography showed mild left ventricular thickening

Question

Across the whole recording, how would you grade the ventricular ectopy?

Frequent single ectopic beats, none consecutive - substantial burden, low complexity

Ectopy occurring in couplets and short runs - a complex, higher-risk pattern

Rare isolated ectopic beats on a sinus background - an incidental finding

Ventricular bigeminy for long stretches of the tracing - dense, sustained ectopy

Dog - Miniature Schnauzer (Recorded with Beecardia)

10 years • Female

Question

Based on your interpretation of this recording, what is the most appropriate next step for this dog?

Antiarrhythmic therapy to suppress the wide-complex beats

24-hour Holter monitoring to quantify the arrhythmia burden

Prompt referral for pacemaker implantation

Reassurance and a recheck ECG in six months

Cat - DSH (Recorded with Beecardia)

7 years • Male

Question

Paroxysms of a faster rhythm repeatedly interrupt the baseline rhythm here. Which interpretation of those paroxysms fits best?

Supraventricular tachycardia with aberrancy

Paroxysmal ventricular tachycardia

Sinus tachycardia with intermittent bundle branch block

Paroxysmal atrial tachycardia

Quiz: Mixed Arrhythmia Cases

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Quiz: Mixed Arrhythmia Cases

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