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Discussion Starter · #1 ·
Sorry this post is a bit long.....;)

A quick recap on Juno, she had her first abnormal holter in Nov 2010, and in Nov 2011, the results got worse (Juno's Previous Holter Topic). We took her to the Cardiologist for her echo, which was normal (it was normal both times). My son is pretty freaked out about all of this, so he decided to do holters every 3 months. So, here's the weird thing, this holter was completely normal, say what??? Don't get me wrong, we're doing a happy dance around here, but how is that possible? I keep wondering if somehow the tapes got mixed up and we got the wrong results.

Now, I will say that after her Cardiologist appointment in Nov 2011, my son put Juno on supplements, so she gets fish oil with CoQ10, and a few frozen blueberries (we get big bags at Costco) every day, and then she also gets a small amount of sardines, krill oil, and Ubiquinol (enhanced bioactivity CoQ10) 3 times a week. We still feed Acana.

So, below are the 3 holter results with the results highlighted in a different color for each test, green is 2010, blue Nov 2011, and red is March 2012. The last two holters were both read by Dr. Kathryn Meurs. Also, for the March 2012 holter, we took Juno to the park to have her chase the ball, at the park we throw the ball WAY further than here at home, so they run much longer without a break.

Has anyone had experience with this? Could it be that I didn't do the holter right? Is it normal for the holter to go back and forth between normal and not normal?

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Hours of analysis completed: 23:59 23:59 23:59
Quality of recording Very Good (Good) (Good)
Total Beats recorded 86,482 (77,745) (103,676)
Heart rate
Minimum: 31 (29) (34)
Average: 60 (54) (72)
Maximum: 178 (185) (243)
Predominant rhythm Sinus Sinus Sinus
Pauses 6 (blank) (blank)
Comment: longest 4.1 sec (sinus arrhythmia) Ventricular escapes beats also noted) (blank) (blank)
Supraventricular Arrhythmia 12 (0)(0)
Ventricular Premature Complexes (VPC)
Singles 9 (980) (1)
Bigeminy, Trigeminy blank (0.4) (0)
Couplets, Triplets 1 (39) (0)
RonT, Vtach blank (No)(No)
Grade of Arrhythmia* 3 (3) (1)
Grading scheme:
1=single uniform VPCs, 2= bigeminy, trigeminy, 3= couplets, triplets, 4= RonT, or ventricular tachycardia (4 or more consecutive VPCs).

Recommendations (March 2012):Although the previous Holter reading done in November was very abnormal, this reading is consistent with that of a normal dog and does not indicate obvious cardiac disease. As we noted previously, it should be remembered that sometimes other diseases including viral or bacterial infections of the heart can cause the abnormal heart beats seen previously and the abnormal Holter reading does not mean that this dog definitively had dilated cardiomyopathy. This normal Holter would support that the abnormal reading was NOT caused by cardiomyopathy but we can not say for sure at this point. Therefore we recommend one more reading in 6-12 months, if this is normal we would recommend reevaluation annually. Additionally, we would recommend discussing this with your regular cardiologist to determine if they would suggest other testing as well.

Recommendations (Nov 2011):
This reading is consistent with an abnormal number of ventricular premature complexes (VPCs, abnormal heart beats) for a dog. Since Tazzman Winter’s Tale is a 5 year old Doberman pinscher this finding could be consistent with a diagnosis of Doberman pinscher cardiomyopathy and we would recommend consulting your veterinarian and a veterinary cardiologist for a cardiac echocardiogram and further evaluation. Importantly it should be remembered that sometimes other diseases including viral or bacterial infections of the heart can cause these abnormal heart beats as well and this Holter reading does not mean that this dog definitively has dilated cardiomyopathy. We recommend that dogs that have abnormal Holter readings have a second reading in 6 – 12 months and be reevaluated annually. In some cases, the repeat Holter is within the normal range. In the meantime, we recommend withholding (not completely removing), the animal from the breeding program until further evaluation can help determine if this is an inheritable heart disease.

Although the importance of treatment at this time is not known, we would generally not recommend treatment yet because the complexity of the arrhythmia (39 couplets, 0 triplets, no vtach) is low and the increase in number of abnormal beats is only moderate. Additionally, treatment with antiarrhythmics is not without risk, so risks and benefits should be carefully weighed. Careful discussion of this subject should be performed with your
regular veterinarian. Additionally, if clinical signs including syncope (fainting) or exercise intolerance develop, treatment should be strongly considered.

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Also, the cardiologist that did Juno's echo in November 2011, sent us the information below (the first cardiologist didn't provide this information, so I can't compare numbers). Juno was 5 Years old at this time.

Cardiovascular Exam
HR: 120, Rhythm: Regular, No Murmur
CRT: <2 seconds, pink mm
Pulses: strong and synchronous
Respirations: Eupneic, clear lungs

Cardiac Ultrasound Report:
2/D M-Mode (cm):
IVS(D): 1.03 LVID(D): 4.44 LVPW(D): 0.95 LVID(S): 3.19
LA/AO: 1.27
SF%: 28.2%
Comments: The left ventricle is normal in size and the left atrium is normal. The systolic myocardial function is adequate. All values are grossly normal. The right heart appears structurally normal. Trivial mitral and tricuspid regurgitation are noted. No cardiac masses or effusions are identified.

Dopper:
AO: 156 cm/sec
PA: 96 cm/sec
MV: Trivial MR
TV: Trivial TR, pressure gradient ~ 34 mmHg

Assessment:
Ventricular arrhythmias on Holter - r/o occult DCM
Normal cardiac dimensions and systolic myocardial function based on normal values for a female Doberman Pinscher.
 

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Can't help with any information but hoping someone with more experience chimes in.
Two things:

Many times the first indication of DCM is an abnormal holter, not an abnormal U/S. It takes a while for the heart to become significantly enlarged however what we look for even with normal U/S is a trend...in other words readings that may remain in the normal range but significant changes from the last U/S.

Second, it is not unusual to have a variance of readings on a holter. It's a 24 hour snapshot, not a day to day monitor. This is why it is important to do one at least every year and more often if one has an indication to do so. You happen to have gotten a reading that shows significant heart issues and then you got lucky and hit a spot where the heart was doing well. The suppements may have helped as well but they didn't eliminate the problem. I would redo this dog again in at least 6 months and monitor carefully. Over time you may get different results, so be prepared but stay on top of it. The first holter indicated very few pvc's but a triplet and that is as significant as a whole lot of singles.

Regards,
 

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Discussion Starter · #4 ·
Thanks Elaine! This DCM is so darn tricky! I figure the supplements aren't hurting her (and it's true that the cardiologist said there aren't studies saying that supplements can help), so we'll keep her on the same program.

My son wants to do another holter in 3 months, and then she will go for another echo (her 6 month echo). We're keeping our fingers crossed for sure...we love, love, love Juno (JuJu as we like to call her.....:)), we hope she stays around for a very, very long time.
 

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I've had a couple of situations where a dog was throwing more VPCs than I'd like, but nothing came of it.

Case in point, here are Rory's results through the years:

DNA test for the PDK4 mutation – Negative

Normal – June 2001 (Dr. O’Grady / OVC)

0 VPCs per hour – September 2001 (Holter monitor results)

10.17 VPCs average per hour – August 2002 (Holter monitor results)

Normal – February 2003 (Dr. O’Grady / OVC)

0 VPCs per hour – August 2003 (Holter monitor results)

Normal – February 2004 (Dr. O’Grady / OVC)

Normal – November 2004 (Dr. O’Grady / OVC)

29 VPCs average per hour – August 2005 (Holter monitor results)

Normal – January 2006 (Dr. O’Grady / OVC)

.08 VPCs average per hour – August 2006 (Holter monitor results)

Normal – January 2007 (Dr. O’Grady / OVC)

0 VPCs per hour – August 2007 (Holter monitor results)

Normal – April 2008 (Dr. O’Grady / OVC)

0 VPCs per hour – February 2009 (Holter monitor results)

Normal – August 2009 (Dr. O’Grady / OVC)

Normal – September 2010 (Dr. O’Grady / OVC)

Normal - August 2011 (Dr. O'Sullivan / OVC)

As you can see, there were years that Rory was having VPCs followed by years where she had none. Granted, I'm behind in Holtering at this time. Rory hasn't been Holtered since 2009. She's going to be, knock on wood, 13 in six weeks.
 

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I've had a couple of situations where a dog was throwing more VPCs than I'd like, but nothing came of it.

Case in point, here are Rory's results through the years:

DNA test for the PDK4 mutation – Negative

Normal – June 2001 (Dr. O’Grady / OVC)

0 VPCs per hour – September 2001 (Holter monitor results)

10.17 VPCs average per hour – August 2002 (Holter monitor results)

Normal – February 2003 (Dr. O’Grady / OVC)

0 VPCs per hour – August 2003 (Holter monitor results)

Normal – February 2004 (Dr. O’Grady / OVC)

Normal – November 2004 (Dr. O’Grady / OVC)

29 VPCs average per hour – August 2005 (Holter monitor results)

Normal – January 2006 (Dr. O’Grady / OVC)

.08 VPCs average per hour – August 2006 (Holter monitor results)

Normal – January 2007 (Dr. O’Grady / OVC)

0 VPCs per hour – August 2007 (Holter monitor results)

Normal – April 2008 (Dr. O’Grady / OVC)

0 VPCs per hour – February 2009 (Holter monitor results)

Normal – August 2009 (Dr. O’Grady / OVC)

Normal – September 2010 (Dr. O’Grady / OVC)

Normal - August 2011 (Dr. O'Sullivan / OVC)

As you can see, there were years that Rory was having VPCs followed by years where she had none. Granted, I'm behind in Holtering at this time. Rory hasn't been Holtered since 2009. She's going to be, knock on wood, 13 in six weeks.
PVC's occur in the normal heart. That is why the number, the frequency and whether there are doubles or triples are significant.

I would say 900+ pvcs in a 24 hr period are significant but it is not beyond the realm of possibility that there was something else other than DCM causing the issue. Again, always good to keep up the monitoring that way you will have a much larger snapshot of what is actually going on.
 

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Discussion Starter · #8 ·
This is all great information!! I'm going to get the results to the cardiologist and see what she thinks. I know it's probably too much to hope that maybe she did have some weird infection that caused the abnormal holters, but hope I will....:)
 

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They also occur for other reasons, one that I recall mentioned in an article was disease of the spleen? Ok, yes, looked up the article ...

From the Doberman Digest, Oct 99 - Doberman Dilated Cardiomyopathy What Can Be Done Now by C. David McLaughlin, DVM
"A WORD OF CAUTION. Some well-intentioned but incompletely informed people have started unequivocally that even one PVC is an indication that a Doberman has dcm. This is a strong statement that must be addressed. While it appears likely at this time that a high percentage of Dobermans exhibiting PVCs will develop the symptomatic (overt) disease, there are other causes of PVCs. Ettinger and Feldman's Textbook of Veterinary Internal Medicine, and Tilley's Essentials of Canine and Feline Electrocardiography lists over 11 primary heart conditions represented by disorders of rhythm. An additional 10 are caused by reduced oxygen, 9 are of nervous origin, 14 due to metabolic and endocrine disease, 5 due to electrolyte imbalances, and an unknown number related to drugs and toxins. PVCs in the Doberman should be considered strongly suggestive of dcm, but in themselves should not be taken as a definitive diagnosis. Anytime PVCs are present, a thorough investigation as to their origin should be instituted. Regardless of their source, they often represent serious disease in any dog. As a practical example, one common cause of PVCs is disease of the spleen. And these PVCs are indistinguishable from those of DCM. ..."
 

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Another personal example was my male, Wonder:

VPCs, normal size and strength – September 1999 (Dr. O’Grady/OVC)
20.9 VPCs average per hour – September 1999 (Holter monitor results)
No VPCs, no enlargement – April 2000 (Dr. O’Grady/OVC)
0 VPCs average per hour – May 2000 (Holter monitor results) *
Normal - June 2001 (Dr. O’Grady/OVC)
.08 VPCs average per hour - June 2001 (Holter monitor results)
0 VPCs average per hour - July 2002 (Holter monitor results)
Normal - February 2003 (Dr. O’Grady/OVC)
0 VPCs per hour - August 2003 (Holter monitor)
Normal - January 2004 (Dr. O’Grady/OVC)
Normal - January 2005 (Dr. O’Grady/OVC)
.05 VPCs per hour - July 2005 (Holter monitor)
Normal - January 2006 (Dr. O’Grady/OVC)
.71 VPCs per hour - July 2006 (Holter monitor)

He was having 21 per hour in 1999, and really had not too many to speak of on subsequent Holters. I lost him in August 2006 to lymphoma.
 

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I am very thrilled to hear about her good holter results! Good luck.
 
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This is great information. The more information on DCM for me, the better. Hoping for more good results for Juno. FYI, all Baron's echos have been normal. His holters were: 989 w/1 couplet Feb. 2011; 928 w/no couplets April 2011 (48 hour holter after being on 40 mg Sotolol twice a day and 2000 mg fish oil for a month and a half); 17 w/2couplets Aug. 2011 (after being on 80 mg Sotolol twice a day and 2000 mg fish oil for 4 months); waiting for most recent holter results from last Friday.
 

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Discussion Starter · #13 ·
I hope Baron's holter comes back good, I know how devestating it is to get those 'bad' results...the good news is that Baron's echos have been good. I'll be looking for your updates Friday :)

I'm curious, why are you doing a 48 hour holter? Is it just that more time is more likely to be more accurate?
 

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I hope Baron's holter comes back good, I know how devestating it is to get those 'bad' results...the good news is that Baron's echos have been good. I'll be looking for your updates Friday :)

I'm curious, why are you doing a 48 hour holter? Is it just that more time is more likely to be more accurate?
We only did one 48 holter. That was after our intial visit with our cardiologist, Dr. Goodwin. Dr. G. wanted to get a wider range on him the first time. We now only do 24 ones.
 
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