Cool Case: Bruno


A image00070Bruno is a one-year-old, male, intact German Shepherd. He was seen by his primary care veterinarian for hind limb lameness. On physical examination, the veterinarian heard an irregular heartbeat and referred Bruno to NorthStar VETS. He was seen in September and diagnosed with lone atrial fibrillation. Atrial fibrillation typically causes an irregular and rapid heart rhythm due to chaotic electrical signals in the upper chambers of the heart (the atria). In small animal patients, atrial fibrillation usually develops due to significant underlying heart disease. Lone atrial fibrillation, on the other hand, refers to atrial fibrillation with a relatively normal heart rate and no underlying heart disease. Lone atrial fibrillation is most commonly seen in large and giant breed dogs (as well as horses) because a relatively large heart size is required to initiate and sustain this type of heart rhythm.

A image00004Bruno was not symptomatic for atrial fibrillation at the time of presentation. He was active, energetic, and seemed totally normal to his family. However, the long-term consequences of atrial fibrillation remain unknown. Atrial fibrillation, which causes loss of coordinated contraction between the upper (atria) and lower (ventricles) chambers of the heart, leads to sub-optimal cardiac performance and could negatively affect the heart’s structure and function over time.

The team at NorthStar VETS opted for electrical cardioversion of atrial fibrillation. Delivery of an electrical current to the entire heart via patches placed on either side of the chest helps to break the irregular heart rhythm and allows the heart’s own pacemaker (the sinus node) to resume control of the heart rate and rhythm. Dr. Alexandra Crooks of the Cardiology team worked closely with Dr. Urshulaa Dholakia of the Anesthesia service to come up with an anesthetic protocol. Dr. Steven Berkowitz of the Critical Care team gathered all of the supplies and medications they might need in the event of a complication (mostly worsening arrhythmias immediately after the shock). In the end, a single shock of 50 joules was enough to successfully convert him from atrial fibrillation to sinus rhythm. Bruno recovered well from the procedure and went home later the same day.

A image00035Bruno will continue to be monitored to make sure he stays in sinus rhythm for as long as possible. He may be at risk of going back into atrial fibrillation at some point in the future. He is on an anti-arrhythmic medication called amiodarone, which should delay and/or minimize that risk as much as possible. He will be back in two months to reassess his heart rhythm using echocardiogram (ECG).

Learn more about the Cardiology service at NorthStar VETS.

Alexandra Crooks, VMD (Practice Limited to Cardiology)
Dr. Alexandra Crooks was born and raised in Philadelphia, Pennsylvania. She completed her undergraduate studies at the University of Pennsylvania in 2012. She graduated from the University of Pennsylvania School of Veterinary Medicine in 2016. She stayed at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania for a one-year rotating internship in small animal medicine and surgery and a three-year residency in cardiology, which she completed in July 2020. Although she enjoys all aspects of veterinary cardiology, she has a special interest in cardiovascular imaging and pathology, management of heart failure, and diagnosis and treatment of arrhythmias.

Urshulaa Dholakia, DVM, MPH, DACLAM, DACVAA
Urshulaa Dholakia, DVM, MPH, DACLAM (Practice Limited to Anesthesia)Dr. Dholakia attended St. George’s University School of Veterinary Medicine, and following graduation completed a rotating small animal internship. She went on to a residency program in Laboratory Animal Medicine at Columbia University in New York City in 2008, and continued working as a laboratory animal vet for several years. She went on to pursue a further specialization in large and small animal anesthesiology first through an internship at the University of Illinois College of Veterinary Medicine, and subsequent residency at the University of Tennessee College of Veterinary Medicine, in Knoxville, TN.

Steven Berkowitz, DVM, DACVECCSteven Berkowitz, DVM, DACVECC
Dr. Steven Berkowitz attended St. Georges University and did his clinical year at the University of Illinois. Berkowitz joined NorthStar VETS after serving as the Chief of Emergency and Critical Care at another specialty hospital. Prior to that, he completed a three-year residency in Emergency and Critical Care medicine at the Oradell Animal Hospital in Paramus, NJ. His residency was completed at one of only a few recognized veterinary trauma centers in the United States. Prior to his residency, he was a staff Emergency Veterinarian at Animal Specialty Center in Yonkers, NY as well as serving as an emergency doctor at Animal Emergency and Referral Associates in Fairfield, NJ for 3 years. Dr. Berkowitz can be seen on seasons 5 and 6 of “Animal Precinct” on Animal Planet, which was filmed during his internship at The Bergh Memorial Animal Hospital of the ASPCA in New York City.

Dr. Berkowitz has special interest in the management of metabolic and endocrine derangements, trauma, as well as management of the septic patient.

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