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EPISODIC SYNCOPE CAUSED by VENTRICULAR FLUTTER in a TIGER (PANTHERA TIGRIS) Author(S): Daniel M

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EPISODIC SYNCOPE CAUSED by VENTRICULAR FLUTTER in a TIGER (PANTHERA TIGRIS) Author(S): Daniel M EPISODIC SYNCOPE CAUSED BY VENTRICULAR FLUTTER IN A TIGER (PANTHERA TIGRIS) Author(s): Daniel M. DeLillo , M.S., D.V.M., Sophy A. Jesty , D.V.M., Dipl. A.C.V.I.M. and Marcy J. Souza , D.V.M., M.P.H., Dipl. A.B.V.P. (Avian), Dipl. A.C.V.P.M. Source: Journal of Zoo and Wildlife Medicine, 44(2):500-504. 2013. Published By: American Association of Zoo Veterinarians DOI: http://dx.doi.org/10.1638/2012-0203.1 URL: http://www.bioone.org/doi/full/10.1638/2012-0203.1 BioOne (www.bioone.org) is a nonprofit, online aggregation of core research in the biological, ecological, and environmental sciences. BioOne provides a sustainable online platform for over 170 journals and books published by nonprofit societies, associations, museums, institutions, and presses. Your use of this PDF, the BioOne Web site, and all posted and associated content indicates your acceptance of BioOne’s Terms of Use, available at www.bioone.org/page/ terms_of_use. Usage of BioOne content is strictly limited to personal, educational, and non-commercial use. Commercial inquiries or rights and permissions requests should be directed to the individual publisher as copyright holder. BioOne sees sustainable scholarly publishing as an inherently collaborative enterprise connecting authors, nonprofit publishers, academic institutions, research libraries, and research funders in the common goal of maximizing access to critical research. Journal of Zoo and Wildlife Medicine 44(2): 500–504, 2013 Copyright 2013 by American Association of Zoo Veterinarians EPISODIC SYNCOPE CAUSED BY VENTRICULAR FLUTTER IN A TIGER (PANTHERA TIGRIS) Daniel M. DeLillo, M.S., D.V.M., Sophy A. Jesty, D.V.M., Dipl. A.C.V.I.M., and Marcy J. Souza, D.V.M., M.P.H., Dipl. A.B.V.P. (Avian), Dipl. A.C.V.P.M. Abstract: Acaptive, 9-yr-old castrated male tiger (Panthera tigris) from an exotic cat sanctuary and rescue facility was observed to have three collapsing episodes within a 2-wk interval prior to being examined by veterinarians. No improvement in clinical signs was noted after empiric treatment with phenobarbital. During a more complete workup for epilepsy, ventricular flutter was observed on electrocardiogram (ECG). The arrhythmia resolved with a single intravenous bolus of lidocaine. Cardiac structure and function were unremarkable on echocardiogram and cardiac troponin I levels were within normal limits for domestic felids. No significant abnormalities were noted on abdominal ultrasound. Complete blood count and biochemistry panel were unremarkable, and heartworm antigen and Blastomyces urine antigen enzyme-linked immunosorbent assays were negative. Antiarrhythmic treatment with sotalol was initiated. On follow-up ECG performed 1 mo later, no significant arrhythmias were noted, and clinical signs have completely resolved. Key words: Arrhythmia, collapse, Panthera tigris, syncope, tiger, ventricular flutter. BRIEF COMMUNICATION and intermittent nature of the events. Also, seizures and syncope may coexist in the same The term ‘‘collapse’’ refers to a loss of postural patient, adding to the diagnostic complexity.1 tone with or without progression to recumbency During a cardiovascular-mediated syncopal and with or without loss of consciousness.7 event, an animal will usually collapse into lateral Causes for collapse can be broadly categorized recumbency and may display multifocal myoclo- as either syncopal or nonsyncopal. Syncope is defined as a sudden transient loss of conscious- nus, opisthotonos, vocalization, and urination. ness and postural tone with spontaneous recovery However, it is uncommon to see persistent facial that occurs as a result of hypoperfusion and lack spasms, persistent tonic/clonic motion, defeca- 6 of sufficient nutrient delivery (i.e., glucose) to the tion, postictal dementia, or neurologic deficits. reticular activating system and cerebral hemi- ‘‘Convulsive syncopal episodes’’ resulting from spheres of the brain for at least 6–8 sec.1,2,9,12 severe hypotension or asystole are typically Causes for syncope include decreased cardiac preceded by loss of muscle tone, whereas seizure output from loss of preload, mechanical outflow activity is usually preceded by atypical limb or obstruction, and arrhythmias, loss of vascular facial movement or staring spells prior to the loss resistance, often by neurocardiogenic reflex mech- of body tone.6 anisms, and focal or generalized decrease in The most common causes for syncope in cerebral perfusion caused by cerebrovascular veterinary patients are cardiogenic in nature. disease.12 Nonsyncopal causes for collapse occur Rhythm disturbances secondary to inherent car- without alteration to cerebral blood flow and diac disease account for almost two-thirds of the include metabolic disturbances like hypoglycemia cases of syncope seen in dogs and cats.6 The or electrolyte disorders, neurologic abnormalities following brief communication is, to the authors’ like seizures or neuromuscular disease, and hyp- knowledge, the first case of arrhythmic syncope oxia.7,8,12 documented in a tiger. It is important to attempt to differentiate A captive, 9-yr-old castrated male tiger (Pan- syncopal from nonsyncopal causes of collapse; thera tigris) from an exotic cat sanctuary and differentiation is often difficult due to the many rescue facility was observed to have three col- possible etiologies, similar clinical presentations, lapsing episodes within a 2-wk interval prior to being examined by veterinarians. The events were suspected to be seizures based on the staff ’s From the Departments of Small Animal Clinical description of the episodes (collapse with exten- Services (DeLillo, Jesty) and Biomedical and Diagnostic Sciences (Souza), University of Tennessee Veterinary sor rigidity lasting approximately 7 to 8 sec with Medical Center, 2407 River Drive, Knoxville, Tennessee immediate recovery). After a second episode was 37996, USA. Correspondence should be directed to Dr. observed, the tiger was empirically treated with Jesty ([email protected]). phenobarbital (0.74 mg/kg p.o. b.i.d.; Qualitest 500 DELILLO ET AL.—VENTRICULAR FLUTTER IN A TIGER 501 Pharmaceuticals, Huntsville, Alabama 35811, laria immitis was negative but was weakly positive USA). When a third episode occurred after on antibody ELISA. antiepileptic treatment had been initiated, mag- Complete blood count and serum biochemistry netic resonance imaging (MRI) was advised to panels were unremarkable except for a mild look for a possible structural brain lesion. Prior to azotemia (blood urea nitrogen: 38 mg/dL; creat- these incidents, the tiger had no previously inine: 1.8 mg/dL). Urinalysis showed mild to reported medical issues and was in ideal body moderate proteinuria with adequate concentra- condition at the time of this brief communication tion (urine specific gravity: 1.052). No evidence of (174 kg). There was no known toxin exposure; Blastomyces was detected on urine antigen enzyme however, Blastomyces dermatitidis had been previ- immunoassay. Abdominal radiographs showed ously reported on the premises. mildly irregular kidney margins suggestive of The tiger was premedicated (5 mg midazolam chronic renal disease but were otherwise unre- i.m.; Hospira Inc., Lake Forest, Illinois 60045, markable. An abdominal ultrasound confirmed USA) and then immobilized (300 mg ketamine; that the kidneys were irregularly marginated and Bioniche Teoranta, Inveria County, Galloway, hyperechoic with mild loss of corticomedullary Ireland, 1.5 mg dexmedetomidine; Pfizer Animal distinction. The contents of the urinary bladder Health, New York, New York 10017, USA, and 5 were markedly echogenic, consistent with pro- mg midazolam i.m.). Adequate sedation for teinuria. The only other abnormality noted on intubation was not seen within 20 min, so abdominal ultrasound was mild thickening of the additional medication was administered (100 mg gall bladder wall. ketamine and 0.5 mg dexmedetomidine i.m.). The While positioning the animal for radiographs, a tiger was then maintained on 3% inhaled isoflur- small, 1-cm mass was discovered on the caudo- ane(Abbott,Chicago,Illinois60064,USA). medial aspect of the left forelimb. Aspirates of the During anesthetic preparation for MRI, parox- mass were submitted for cytology. The samples ysms of a sinusoidal arrhythmia were noted on the were of low cellularity and contained predomi- electrocardiogram (ECG) monitor. During these nantly individual spindle-shaped cells with mini- paroxysms, the heart was difficult to auscultate, mal anisocytosis and anisokaryosis, low numbers and femoral pulses were weak to absent. After of erythrocytes, and rare, poorly preserved mast verifying that all leads and equipment were cells. The findings were more suggestive of a properly attached and working so as to rule out benign, non-neoplastic, inflammatory lesion with artifact, a diagnostic six-lead ECG was obtained fibroblasts; however, the low numbers of mast to better characterize the rhythm. The ECG cells in the presence of spindle cells raised the showed a predominant sinus rhythm at a rate of index of suspicion for a mast cell tumor. It was approximately 80 bpm with frequent paroxysms decided that if the tiger needed to be anesthetized of ventricular flutter at a rate of approximately in the future, the mass would be removed and 250 bpm (Fig. 1A). A single bolus of lidocaine was submitted for histopathology; the period of anes- given (1.15 mg/kg i.v.; Hospira Inc.) and within 4 thesia that day had already been protracted and min, complete resolution of the arrhythmia was results from the fine-needle aspirate
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