Ventricular Premature Complexes in Dogs
The heart relies on a coordinated electrical conduction system to effectively pump blood throughout the body. This system involves two key nodes: the sinoatrial (SA) node, located in the right atrium, which acts as the heart’s natural pacemaker by generating electrical impulses, and the atrioventricular (AV) node, also situated in the right atrium, which receives impulses from the SA node and directs them to the ventricles after a slight delay. This delay ensures proper timing for blood ejection from the atria into the ventricles before ventricular contraction occurs. Additionally, the AV node can assume the role of pacemaker if the SA node is impaired due to cardiac conditions.
Ventricular premature complexes are a form of irregular heartbeat where an electrical impulse originates within the ventricles rather than from the SA node, leading to premature ventricular contractions. These premature contractions manifest as abnormal QRS complexes on an electrocardiogram (ECG) recording—wider and/or differently shaped than normal—indicating alterations in electrical potential during a single heartbeat. Notably, ventricular premature complexes do not exhibit associated P waves.
Symptoms and Types
- Weakness
- Exercise intolerance
- Fainting
- Often asymptomatic
- Cough if caused by congestive heart failure (CHF)
- Difficulty breathing if caused by CHF
- Sudden death
Causes
- Cardiomyopathy
- Congenital defects, especially subaortic stenosis
- Chronic valve disease (heart disease)
- Gastric dilation and volvulus (stomach turning and flipping on itself)
- Traumatic inflammation of the heart
- Digitalis toxicity (heart medication)
- Cancer of the heart
- Myocarditis
- Pancreatitis
Other factors that may predispose a dog to ventricular premature complexes include:
- Low blood magnesium
- Acid-base disturbances
- Low blood oxygen
Diagnosis
Diagnosing ventricular premature complexes in your dog involves a comprehensive approach by your veterinarian. They will conduct a thorough physical examination, considering the dog’s symptoms and any relevant incidents. A complete blood profile, including a chemical blood profile, complete blood count, urinalysis, and electrolyte panel, will be performed. The electrolyte panel can reveal hypokalemia and hypomagnesemia, while pancreatitis can also be confirmed through bloodwork.
An echocardiogram will be conducted to assess the heart’s structure for any signs of structural heart disease. Additionally, long-term ambulatory (Holter) recording of the electrocardiogram (ECG) may be recommended, especially in cases of unexplained fainting or weakness, to detect transient ventricular arrhythmias.
Treatment
Treatment for ventricular premature complexes in dogs typically involves outpatient care for most patients. However, if there’s an electrolyte imbalance such as hypokalemia or hypomagnesemia, temporary hospitalization may be required for fluid therapy with electrolytes to correct the imbalance. Oxygen therapy will be administered if the dog is hypoxemic. Additionally, depending on the underlying cause of the ventricular premature complexes, your veterinarian may prescribe anti-arrhythmic drugs for your dog.
Living and Management
Managing a dog with ventricular premature complexes involves uncertain prognosis, contingent upon addressing the underlying cause. There’s a risk of worsening arrhythmia, fainting, or sudden death. If structural heart disease is present or clinical signs of arrhythmia persist, activity restriction is necessary. Your veterinarian will provide guidance on an appropriate physical routine and schedule follow-up appointments as needed to manage the underlying condition.