Featured at June 4 Animal Survivor Event – 2015 ACVIM Forum, Indianapolis Convention Center
(Indianapolis, Ind.) From death’s doorstep to a normal life span, Gus, a boxer, is alive today thanks to incredible professional collaboration and owner commitment stretching from Philadelphia to Cincinnati in June 2014.
Owned by Lissa and Gary Brown, of Flourtown, Pa., Gus began showing signs of nausea and subsequent vomiting and was diagnosed with a slight heart murmur at four months of age.
After a check-up from Gus’s primary veterinarian, Dr. Andrea Orscher, in Fort Washington, Pa., the dog was referred to Dr. Beth Bossbaly, in Levittown, Pa., an ACVIM Board-certified cardiologist.
Chest radiographs revealed an enlarged heart but no signs of congestive heart failure. Because of his history, Bossbaly placed a 24-hour Holter monitor on Gus and gave the Browns a diary in which to record his specific activities and corresponding time of day during the monitoring any events or periods when they saw Gus’ heart pounding at home. The recording monitor revealed rapid heart rates with arrhythmia that landed Gus in the ICU immediately.
In the process Gus lost considerable weight. “Looking back,” says Lissa, “it seems the genetically destined arrhythmia was progressive, finally at five months, showed signs (murmur), symptomatic with changes in heart structure (valvular leakage and myopathy), steadily worsening over the next month.”
Brown, an ophthalmologist and a former nurse with experience in cardiac surgery, says,” I understood generally the arrhythmia issue, and my background allowed me to read medical and veterinary literature to fully understand Gus’ condition and the treatment options available.”
Next, Gus was referred to the University of Pennsylvania School of Veterinary Medicine, where he was seen by Dr. Mark Oyama, another Board-certified cardiologist.
Oyama diagnosed Gus’ condition as a unique form supraventricular tachycardia (SVT), a congenital electrical defect that permits electrical impulses to travel between the top and bottom portions of the heart outside of the normal single pathway. This allows the electrical impulse to continuously circulate around the heart, Oyama explains, and results in the accelerated heart rate with which Gus presented.
On four occasions last June, Gus was admitted and discharged from the hospital for recurrent episodes of SVT, and treated with various combinations and doses of oral drugs with limited success.
In his final three-day hospitalization, Gus experienced problems tolerating IV drugs needed to control his SVT. At one point he collapsed due to a critically low heart rate, requiring staffers to revive him.
Because medical management at Penn Vet’s Ryan Hospital was not enough to control the condition, his best hope was an immediate cardiac ablation procedure performed by Dr. Kathy Wright, a Cincinnati ACVIM specialist in cardiology and internal medicine. The hospital (MedVet Medical and Cancer Center for Pets) is recognized as the premier site for clinical ablations in the U.S. and Canada; more than 70 have been conducted.
This meant Lissa needed to drive the ailing dog from Philadelphia to Cincinnati—11 hours and 625 miles—for the surgery.
“Gus preferred to curl up in the passenger seat and put his head next to the gear shift and rest it on my knee or the arm rest and sleep. I had a harness on him but didn’t actually need it. Because I had no way to control his heart rate I stopped checking when we set out on the trip. I knew my job was to drive safely, not get lost and get to the veterinary hospital on time.”
So what does ablation operation involve? Wright replies, “An electrophysiologic study is performed, in which special electrode catheters are introduced through veins in the leg and the neck and positioned at key areas within the heart. We do extensive testing in which we pace various parts of the heart through these catheters. Based on electrical responses, we are able to tell where the extra electrical connection, known as the accessory pathway, is generally located within the heart.
“We then have to do fine mapping, in which we determine within a millimeter or so where this accessory pathway lies. Radio frequency energy is then delivered through a special catheter whose tip is positioned on the accessory pathway.
“If conduction through the pathway is not interrupted within seven seconds we perform additional fine mapping for better positioning. If conduction through the pathway is interrupted within the seven-second period we continue to deliver energy for a full minute. This is followed by an hour-long study to make certain that conduction through the accessory pathway does not return.”
The entire procedure in Gus took four hours 15 minutes. Recovery was quick, allowing the Browns to take him home the following day.
Without the surgery and with the severity of Gus’ rhythms, Wright speculates he would most likely not have survived more than a year or two. And during that span he would have required several hospitalizations to control the rapid heart rhythm.
Twenty one dog breeds have been documented with accessory pathways, according to Wright. It has been most commonly seen in the Labrador retriever (40 percent of the cases).
The veterinary treatment team will be introduced at the 2015 ACVIM Forum in Indianapolis 10 a.m. Thursday, June 4. This special Animal Survivor event will be held in the Indiana Convention Center exhibit hall and the emcee will be Tim Doty, morning/noon news anchor for WTTV Indianapolis. Members of the media are invited to attend.
Media Note: Accredited members of the media may attend the 2015 ACVIM Forum at no charge. However, you are required to register with the ACVIM. For media registration, please fill out a registration form or contact Laurie Nelson at [email protected] or 303.231.9933 Ext. 101.
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About the American College of Veterinary Internal Medicine (ACVIM)
The American College of Veterinary Internal Medicine (ACVIM) is a nonprofit organization dedicated to improving the lives of animals and people through education, training and certification of specialists in veterinary internal medicine, discovery and dissemination of new medical knowledge, and increasing public awareness of advances in veterinary medical care.
The ACVIM is the certifying organization for veterinary specialists in cardiology, large animal internal medicine, neurology, oncology and small animal internal medicine.
To find an ACVIM specialist in your area, please visit www.ACVIM.org.