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Discussion on Help - vet suspects AF - ECG on thursday
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Member:
lindsey
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Posted on Tuesday, Apr 17, 2007 - 5:54 pm:
Help....., where did I go wrong now  . Feeling really bad.
Today I had the vet out to check some futile issue on my gray horse and whilst he was here I thought I should mention that my other horse has had some labored breathing during canter the last 5 days, so could he please listen to his lungs.
Vet also listened to his heart and told me to bring him into the clinic for an ECG as he suspects atrial fibrillation.
He explained that if he does have AF, they can put him on drugs to return heartbeat to normal.
Only 3 to 4 weeks ago this horse was at the clinic for a shoulder injury and at that time the vets had listened to his heart too and all was normal.
Can the onset of AF be so sudden then?
And what would be the cause?
Of course I'll discuss everything at the clinic after the ECG results, but I just keep wondering, how & why so sudden?
This is a 12 yr old DWB, until a week ago in fit condition and used for dressage & trail riding.
Dietary-wise about 2 weeks ago I introduced papaya juice on a daily basis 60cc. Could this be to blame??? I'm feeling really bad now, if this were to be the cause.
I started this papaya because he's been very depressed the last month as he lost his best buddy (colic). Since that day he stopped eating his hay and had little appetite or zest in life. In some desperate effort to get him to eat more roughage I started this papaya juice and it remarkably increased his appetite. Now he's back to eating normal amounts of roughage.
However I noticed papaya has high potassium levels, could this be to blame?
I feel so incredibly guilty now, and I was only trying to help him .
Blood test etc will be done on thursday, so I hope this will give me some indication.
Anybody any ideas?
Thank you!!!
Patsy
PS, The product is called 'stomach soother' and is sold as an equine product.
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Member:
lindsey
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Posted on Tuesday, Apr 17, 2007 - 8:05 pm:
But now I'm even more confused. Apparently it's precisely low potassium levels that could be linked to AF, so adding potassium in the form of papaya shouldn't really affect him.
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Member:
zarr
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Posted on Tuesday, Apr 17, 2007 - 9:22 pm:
Patsy, we always like at ourselves and blame US this would appear not to be your fault.We try to do the "right" thing.I've cursed myself more than once so until you know for sure what is wrong do not look in the mirror!I've had heart filbrillation and mine is not always obvivous either.My old canine companion had it also went to the age of 14! So wait til all is known and go from there! Cindy
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Moderator:
DrO
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Posted on Wednesday, Apr 18, 2007 - 6:40 am:
60 cc of papaya juice is not really going to effect the horse's potassium balance either way Patsy so you did not do anything to hurt your horse.
I suspect the onset of feeling poorly may have been associated with the onset of depression and loss of appetite and as he has compensated for the problem appeared to feel better. Afib can be of rapid onset without a obvious cause but we will have to wait for further diagnostics to know.
DrO
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Member:
lindsey
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Posted on Wednesday, Apr 18, 2007 - 7:14 am:
Thank you Dr O.
What a relief to read this! I was worried sick about this papaya juice.
I will post an update thursday or friday when I have more results.
Thank you again.
Patsy.
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Member:
lindsey
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Posted on Friday, Apr 20, 2007 - 7:31 am:
Just a quick update.
ECG confirmed A Fib. No heart murmures present.
In general the heart was considered large, (didnt' fit monitor), but the vet wasn't concerned because he's a big bodied 18hh+ WB, so she expected it to be of a larger size.
Atrium sizes were measured and appeared normal.
Blood results will be coming back today.
Vet suggests conversion with Quinidine naso gastric tube. But explained to me about the latest transvenous electro cardioversion. But she's didn't know which hospital at present offers this. If it were only to be Cornell then I can't see me taking him for a 4 to 5 hour haul and will probably go with the Quinidine, although I'm a bit at unease about it, wondering if Quinidine would mean only the second best treatment considering there's the other option out there.
My vet would get back to me today with regards to IV Quinidine, especially because I'm very worried about colic complication with the naso gastric application of the drug.
I'll discuss with vet today, horse is back at home and we'll get a plan together for next week.
Fingers crossed things will go well.
The positive I was told, is the fact that this must have come on only recently and no other heart problems suspected (no murmures), hence he might have a good prognosis for conversion.
I hope..........
I'll keep you updated.
Patsy.
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Member:
jockyrdg
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Posted on Friday, Apr 20, 2007 - 8:20 am:
Patsy, did you talk with Dr. Meg Sleeper at New Bolton. She is an equine cardiologist- all she does, besides endurance riding. New Bolton is usually very happy to answer questions. She also works on consults at Mid-Atlantic in Ringoes. Just thinking of options to that 5 hour haul to Cornell.
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Member:
lindsey
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Posted on Friday, Apr 20, 2007 - 9:56 am:
Hi Beverly, thanks for the idea.
Actually my vet did tell me about a great cardiologist at New Bolton, but the name went past me. She was going to put in a call to find out of New Bolton did transvenous electro cardioversion. If so Alpha, NJ, to New Bolton wouldn't be that big of a deal indeed.
If they don't do it at New Bolton, then I figured I might as well have the Quinidine done at my local clinic.
My poor boy has been so stressed out the last month/weeks, hence I can't see a long haul helping him much.
At least he's gotten used to our local clinic and it helps keeping his stress levels down.
But still waiting on feedback from my vet to see what the options will be.
Poor boy, he again didn't finish his breakfast this morning. He probably senses my stress too .
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Member:
lindsey
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Posted on Friday, Apr 20, 2007 - 8:02 pm:
Well, we are now scheduled with the cardiologist at New Bolton for this coming Wednesday. They will re-evaluate him and they also have the possibility for transvenous electro cardioversion at New Bolton. I was told however that they do not recommend converting all cases, it really depends on the horse and what they conclude from the ultrasound etc.
However I'm a little more relaxed about it now, knowing that he'll be in the right hands and that I'm doing the best I can. Hopefully it will all go well. After reading up on the internet/talking to many people, I have also read/heard of quite some success stories. So fingers crossed, he'll be one of them too  .
(The cardiologist I spoke with was ever so nice & yes, his companion is allowed to come along, thank God, this should help keeping his stress levels down)
I'll post an update after NBC.
Patsy.
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Member:
lindsey
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Posted on Thursday, Apr 26, 2007 - 8:06 pm:
I'm decision-less......
We were at NBC yesterday. My boy has been examined by several vets & head cardiologist.
Same conclusion, other then A Fib no heart irregularities found. Left atrium rather larg-ish, but even head cardiologist also mentioned very big horse, so not necessary to worry immediately.
Exercise ECG recorded heartbeat of 180-200 in trot & canter.
We came fully prepared with the idea of leaving him behind there yesterday and attempt conversion treatment today with quinidine and if not successful move onto transvenuous electrocardioversion.
However we were sent home to think. They explained the side effect of treatment (including death), the possible relapse and the fact that they figured that as a dressage horse at heartbeat of 180-200 he could happily continue to perform in A Fib and he doesn't have to be converted to have a good usable life so to speak when left in A Fib.
So I don't know what to do now.
If only they had kept him yesterday as originally booked then I wouldn't have had those doubts in my mind and he would already have started treatment.
Now, I don't whether to take him back or not.
Yesterday was ever so stressful for him, he got all worked up in the stocks etc and is suffering from diarrhea as a result today. So he certainly won't appreciate another visit.
But I want to do what's best for him, but no one seems to know what's best .
They advised sort of against TVEC considering his size and effects of gen anaesthetics.
They said preferred treatment, if treated, is certainly oral quinidine.
I forgot to ask, if they administer every 2 hours, will my poor boy have to stand there with the nasal tube stuck in his throat for hours until he hopefully converts? This could mean a long time without a little munch of hay or so, especially if they were to have to move onto the 6 hour intervals????
Or would they take it out & re-insert allowing him some hay in between. I know, pathetic question, but I'm just thinking of him getting depressed or so...., I really love this boy and don't like to see him suffer.
Ahhhhhhh, I truly don't know what to do anymore, leave him (he's still alive & happy today) or treat him with quinidine & either have a successful conversion or risk possible serious side effects .
L.
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Moderator:
DrO
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Posted on Friday, Apr 27, 2007 - 8:06 am:
Wow Patsy, that was the last thing I would have suspected, the recommendation to leave the afib alone.
One of the symptoms that you have already experienced that is most likely do to the afib is the exercise intolerance you noted in your first post. When present in horses with afib without other significant disease it goes away with conversion. I went looking to see if stroke in horses is reported like in humans (15% of human strokes are associated with afib) and could not find cases. On the other hand the mechanism of action for stroke in humans should be equally if not more applicable to horses do to their larger hearts and slower heart rates. There is risk with this procedure but I think there is also risk not doing the procedure and impaired exercise potential too. I don't know of a statistical way to compare the risk do to the paucity of information available. However here is a review of 77 cases, that while there was a high incidence of adverse reactions, none died during treatment. However they propose that the data suggests untreated cases may worsen over time.
DrO
Cornell Vet. 1982 Oct;72(4):339-49.
Atrial fibrillation in horses: factors associated with response to quinidine sulfate in 77 clinical cases.
Morris DD, Fregin GF.
Seventy-seven horses with atrial fibrillation (AF) were treated orally with quinidine sulfate (QS) at the University of Pennsylvania, School of Veterinary Medicine, Thirty-seven horses (48%) had adverse reactions to QS, the most common of which were nasal mucosal edema, anorexia, colic, and diarrhea. The mean highest daily QS dose was slightly greater in horses showing toxicity (P less than 0.1) and their conversion rate was less (P less than 0.05). A schedule of gradually increasing QS dose was time consuming, costly and not associated with fewer adverse reactions. Horses were compared by their response to QS: conversion for at least 12 months (Group I; 25 horses); reversion with 12 months (Group II; 8); nonconversion (Group III; 14). All horses with congestive heart failure (CHF) failed to convert. The mean age (P less than 0.05), total QS dose and highest daily QS dose (P less than 0.05) were significantly greater in Group III horses. The mean duration of signs before treatment and occurrence of adverse reactions to QS were greater in horses in Group II and III than Group I. (P less than 0.05). All horses in Groups I and II returned to performance, and many (81%) were successful. Most Group III horses (13/14) are known to have died. It was concluded that most horses with AF uncomplicated by CHF have a good prognosis when treated early with QS. Delayed QS therapy may reduce chances for conversion of AF or increase the probability of reversion.
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Member:
lindsey
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Posted on Friday, Apr 27, 2007 - 5:09 pm:
Yes, Dr O, I agree, I was rather stunned when we were sent back home.
I will indeed take some time to think about it. But it now really makes it a difficult decision to take.
I am not keen on the possible risks of the quinidine, but leaving the A Fib as is,... I just can't think this to be of any good for my horse in the long run.
Agreed, right now, he could possibly survive a 4 minute dressage test. But I would have thought that staying in A Fib, perhaps next year or in a couple of years he will just show more & more weakness as a result and his heart will be more likely to increase in size.
And I did explain to them that earlier this week I pushed him to see how far he could go (sorry, I had not posted this on here yet), but didn't do anymore then his previous workload before A Fib and he went through his hind end as a result of severe fatigue and we were both sort of on the floor (albeit I let myself slide off in a panic). He was very incoordinated after the event, which they explained to me was a severe weakness most likely induced by the A Fib, as they could not find any other explanations or clinical findings to explain the 'going down'.
But if I slowly built his fitness levels up, he might be able to cope better I was told.
Nevertheless I worry about another episode of going down. It wasn't exactly a collapse, but it felt close enough to me.
I did some lunging with him today, and just watched him very closely, any nostril flaring or spontaneous downstepping from canter to trot or trot to walk & I had him stop for a sec to re-cuperate. He made about 40 minutes on the lunge, of which about 20-25mins were in walk or handwalking next to me.
Thank you for the review, it's reassuring to read there were no death resulting from the quinidine.
I spoke to NBC again today and they said that 'if' I decide to treat they would only start treatment on a monday and the earliest they could do him would be monday after next (in 10 days so to speak), because they need to arrange for intensive monitoring etc, basically he can't be left alone at any time & heartrate must be monitored round the clock etc, which is understandable, so I guess it takes some logistics to get it all set-up properly and of course the fact that he has to have his companion within eye-sight doesn't really help either.
So this leaves me a few days to ponder whether or not to book treatment for that monday or not.
They explained that if he is co-operative they remove the tube after each application and re-insert, in order to allow him some hay in between. If he's difficult, then it might be left in to allow 2-3 treatments. He'd be in a bare matted treatment stall in the cardiology wing, but going to a normal stall at night, unless complications arise.
So I got my answers ;), I am of course thinking of his mental state (I hate hospital rooms myself)
Well, I guess I'll have some sleepless nights to follow, until I've made up my mind.
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Member:
leslie1
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Posted on Saturday, Apr 28, 2007 - 12:21 am:
My thoughts are with you. Please keep us posted on how he is doing.
Leslie Christian
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Member:
lindsey
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Posted on Wednesday, May 9, 2007 - 9:40 pm:
Update : back in sinus rythm !!!!!
We DrOpped him off at New Bolton sunday night.
They treated him with quinidine on monday and late monday night he converted. He was irregular for a couple of hours but thereafter been stable.
He had none of the expected side effects during treatment other then some noticeable depression, but no diahrrea, colic or other sideeffects!
We brought him back home today and I was told to slowly bring him back into work and have my regular vet check in a couple of weeks time.
I was also told to watch his summer pasture RAO as this could potentially pre-dispose him for relapse.
But other then that, they thought it went very well and fingers crossed he'll stay fine..........!!
Regards, Patsy.
PS, I'm so relieved. I think I'll get a good nights sleep
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Member:
leslie1
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Posted on Wednesday, May 9, 2007 - 10:34 pm:
That is great news!!! Im so happy for you I was wondering how he was doing. Wow! just great!
nighty - nite
leslie
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Member:
mrose
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Posted on Wednesday, May 9, 2007 - 11:13 pm:
Great news is right! I'm so glad.
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Member:
paul303
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Posted on Thursday, May 10, 2007 - 1:11 am:
How great!!
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Moderator:
DrO
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Posted on Thursday, May 10, 2007 - 7:01 am:
Very good Patsy. Get yourself a inexpensive stethascope and learn the characteristics of the very regular heart rate of horses, you will quickly recognize the wandering irregular heart beat associated with afib.
DrO
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