8/25/09 - LSU Cardiology patient is a television star!
Beamer, a 13 year old Scottish Terrier was presented to the LSU Cardiology Service earlier in August of 2009 for evaluation of an arrhythmia (3rd Degree AV block) noted on an ECG performed by Dr. Brent White in Monroe, LA. Mr. Larry and Mrs. Theresa Foreman had taken Beamer for a routine dental procedure when Dr. White astutely noted a bradyarrhythmia. ECG findings demonstrated 3rd Degree AV block where basically the sinus node (pacemaker of the heart) fires but the impulse becomes blocked at the AV node leaving the ventricle of the heart to fire on its own at a much slower heart rate than normal. Untreated 3rd Degree AV block can result in congestive heart failure and death if left untreated.
Beamer was evaluated by the LSU Cardiology Service and 3rd Degree AV block was confirmed with a junctional escape rhythm on ECG evaluation. Echocardiogram also revealed moderate degenerative valve disease with moderate mitral valve regurgitation and left-sided heart enlargement. This finding is common in older, small breed dogs and did not exclude Beamer from therapy with pacemaker implantation. Additionally, Beamer had incidental urinary calculi and was scheduled for pacemaker implantation.
Beamer underwent surgery for pacemaker implantation on August 12, 2009 and recovered from the procedure uneventfully. As seen from the news story, Beamer is full of energy and doing well at home. He will return to LSU one month after pacemaker implantation for interrogation to ensure proper function and positioning of the pacemaker.
7/18/08 - LSU Cardiology Service places an implantable defibrillator in a dog: The second time only in the US !
General is a 6-month-old male German Shepherd dog. His owners live in Jackson, Missouri. Although apparently healthy, he was diagnosed with irregular heartbeats. He was further assessed by a board-certified veterinary cardiologist, Dr. Cecilia Marshall (Board certified specialists train 3 years after completion of an internship) , who performed an echocardiogram, blood work and a Holter monitoring (The dog wears a small recorder called a Holter monitor as it goes about normal daily life for 24 hours. The machine makes a graphic record of the heart’s electrical currents). The result of those tests was that General was most likely affected with an inherited cardiac disease specific to his breed and had a very high risk of sudden death.
This disease of German Shepherds was identified in 1994 by Dr. Sydney Moise, a Professor of Veterinary Cardiology at Cornell University. Affected dogs show frequent ventricular arrhythmias and a risk of sudden death at a young age. Sudden death results from ventricular fibrillation, a very fast, irregular heart rhythm in the lower chambers of the heart. During ventricular fibrillation the heart quivers, and provides little or no blood flow to the body. Death follows within minutes unless medical help is provided immediately. Most dogs die during their sleep or at rest after exercise. Dogs that don’t die outgrow the disease at about 1.5 years of age and subsequently have a normal life. Those dogs don’t display signs that can be identified by the owners. This is frequent with cardiac diseases, that usually progress undetected until the damage to the heart is too advanced to be treated. It is therefore critical to fully investigate any cardiac abnormalities, such as an irregular heart rate or abnormal heart sounds that can usually be identified by the local veterinarian during the annual health check. Only a board-certified cardiologist and advanced testing can provide a definitive diagnosis.
General was started on anti-arrhythmic medications, but it is known that drugs mildly decrease the risk of sudden death at best. The treatment of choice was to implant an internal cardioverter defibrillator, or ICD.
Implantable defibrillators are a life-saving therapy for many people with heart disease who are at risk for dangerously fast and potential lethal heart rates. The first one was implanted in 1980. ICDs drew heavy attention in June 2001 when Vice President Dick Cheney received one. An implantable defibrillator continuously monitors the heart and if a dangerous or potentially lethal heart rate is detected, an electrical shock is sent to correct it. When it delivers a shock, the device operates on the same principle as external defibrillators, that are commonly pictured in TV medical dramas. Because the ICD is inside the body, it delivers a much smaller amount of electricity. The implantable defibrillator is made of two parts: A heart device, which contains a battery and electronics to automatically monitor the heart rhythm, placed under the skin on the chest; a lead or wire is threaded through a vein into the heart and connected to the heart device.
Because of the difficulties associated with the implantation of a highly complex device designed for humans and the cost involved with such a procedure, there is only one pet with cardiac disease that has to this day received an internal defibrillator. With the support of an ICD manufacturer (Medtronic, Inc, Minneapolis), General’s owners were able to obtain an internal defibrillator. They contacted the cardiology service at Louisiana State University who accepted the challenge of performing this rare procedure. Because ICD implantation is rarely performed in dogs, and because of the severity of General’s condition, it was unknown if the surgery would be successful. Dr. Romain Pariaut, an Assistant Professor of Cardiology, who trained at Cornell University and was familiar with General’s inherited disease, coordinated the procedure.
General’s owners drove from Missouri to Baton Rouge on July 14th. Additional tests were done and General was monitored in the intensive care unit. The team led by Dr. Pariaut prepared the surgery. It involved Dr. Keith Strickland, an Associate professor of Cardiology, Dr. Carley Saelinger, an Intern in Cardiology, Rachel Tankersley, the cardiology assistant, Dr. Patricia Queiroz, an Assistant Professor of Anesthesiology, technicians from the Diagnostic Imaging service and veterinary students. On Wednesday July 16th, the procedure was done with the support of the local ICD manufacturer’s field engineer. Unfortunately, this first surgery was unsuccessful because of the many differences between the dog and the human anatomy. New plans were made for a second attempt using all the information that had been collected during the first surgery. On July 21rst, General was again anesthetized. The heart device and the leads were placed differently. After another 5-hour procedure, it was a success! The ICD was able to detect the episodes of rapid heart rate and treat them appropriately.
General has been monitored for the past week in the intensive care unit. Gregg Griffenhagen, a fourth year veterinary student, has been the student in charge of the care of General during his stay. The ICU technical staff has also been largely involved in 24-hour monitoring of General’s heart rhythm. All the medical team has become really attached to this puppy, who now feels home in the intensive care unit and loves playing with his LSU Tigers plush football dog toy. Because a new generation ICD was implanted, it is possible for the doctors to monitor the ICD wirelessly from a specifically designed computer, also called programmer. Also, it allows them to change multiple parameters as needed.
The entire team involved with the care of General is happy about the outcome of the surgery. However, there are many short term and long term complications, such as infection, that may happen after placement of an ICD. Also, there is a risk that, when General retrieves a normal activity, the ICD triggers inappropriate therapy. Dr. Pariaut will continue to monitor his progress, thanks to the collaboration of an engineer from the ICD Company in Missouri and Dr. Marshall, the cardiologist in Saint Louis.
On a daily basis, veterinary cardiologists at LSU School of veterinary medicine use state of the art technologies to diagnose and treat pets with cardiac disease. Since the arrival of Dr. Pariaut, the school has been developing the area of interventional cardiology, a branch of the medical specialty of cardiology that deals specifically with the catheter based treatment of heart disease. Within the next few months, a fully equipped cardiology catheterization suite, or cardiology catheter lab, will be opened. Dr Pariaut is convinced that interventional and minimally invasive surgical techniques have a tremendous potential for treatment of cardiac disease in pets, which are currently managed with palliative medical therapy. However many of these procedures are expensive and are still largely experimental in animals, and significant progress will only be obtained with philanthropic support of the program, that would allow the cardiologists to perform innovative procedures at an affordable cost to pet owners. Through support of this program, LSU Cardiology could become a center of excellence in interventional cardiology and rhythm management.
