Bobby is a 3 year 10-month old, male-neutered, domestic shorthair cat who started to have unusual ‘episodes’ at home. The episodes were becoming increasingly frequent, with 10-20 reported in a day at home. The events varied significantly in character but usually involved Bobby ‘staring into space’ or occasionally collapsing on to his back from a standing position.
Bobby was referred to the SCVS neurology department for further investigations into suspected ‘seizure-like’ episodes. Neurological examination was unremarkable, however, auscultation of the heart during physical examination identified a murmur prompting detailed cardiac assessment.
An echocardiogram (heart scan) did not reveal any structural or functional cardiac abnormalities. Paper-trace ECG showed no evidence of cardiac arrhythmias during a 5-minute recording, but transient arrhythmias could not be excluded. Consequently, Bobby was fitted with an ambulatory Holter ECG monitor and sent home the same day.
Bobby had an episode on the day of discharge whilst the Holter monitor was in position (see figure 4). The trace shows a bradyarrhythmia (slow-heart rhythm) called third-degree atrioventricular block, in which the atria and ventricles are unable to communicate effectively due to the presence of a diseased AV node. Unfortunately, oral medications are rarely successful in treating these sorts of arrhythmias. Pacemaker implantation is considered the treatment of choice for the management of symptomatic bradyarrhythmias in cats and this procedure has been scheduled for Bobby in the near future.
This case illustrates that reliance on history and description of episodes to differentiate seizures (sudden uncontrolled electrical disturbances in the brain) from syncope (transient reduction in blood supply to the brain associated with loss of consciousness) can be problematic. Syncopal episodes can be associated with slow or fast heart rhythms (brady- or tachyarrhythmias) and the use of Holter monitors in cats can help us to establish a definitive diagnosis and ensure appropriate treatment. We are now routinely performing Holter ECG recordings in cats using state-of-the art equipment available within the SCVS Cardiology Service.
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