A good understanding

of the electrical activity

of the heart is key to the
accurate interpretation
of ECGs

ECG interpretation in sm~all anim~als

1. Understanding the electricity
of the heart MIKE MARTIN

THIS article, the first of three aimed at assisting those in practice in interpreting electrocardiograms
(ECGs), discusses the electrical activity of the heart and how this relates to the complexes seen on an ECG.
It also describes the clinical findings on auscultation and palpation of the pulse. It must be remembered
that an ECG trace should always be interpreted in the light of a thorough clinical examination of the
cardiovascular system, with particular attention being paid to heart rate and rhythm, pulse rate, and
identification of pulse deficits, if present. The second article in the series, to be published in the next
issue, will discuss the abnormalities associated with the conduction system of the heart. The final article,
to be published in the May issue, will outline a practical approach to interpreting ECGs.
Mike Martin
graduated from
Dublin in 1986. In THE ELECTRICITY OF THE HEART
1997, he founded his
own cardiorespiratory
Atrioventricular /Sinoatrial node Atrioventricular
The heart must contract in a coordinated atrioventricular node \ring|
referral practice,
the Veterinary sequence to act efficiently as a 'circulatory pump'. To do
Cardiorespiratory
Centre, in Kenilworth, this, the cardiac muscle cells must receive an electrical
Warwickshire. He stimulus. It is this electrical activity that is detected by \ Right atrium | Left atrium J
holds the certificate
and diploma in an electrocardiograph (see box below). \|
\\
/ ~~~~~Left
{_ _ ~~~bundle
veterinary cardiology The electrical stimulus must first depolarise the two
and is an RCVS Bundle bac
Specialist in
atria and then, with an appropriate time interval, stimu- of His
Cardiology. He is the late the two ventricles. The heart must then repolarise Anterior
current chairman fascicle
of the Veterinary
(while 'refilling') in time for the next electrical stimulus
Cardiorespiratory and contraction and must do so repeatedly, increasing in Right
Society and is a past rate with a rise in demand and, conversely, slowing at bundle - Posterior
recipient of the branch - fascicle
BSAVA's Dunkin and rest.
Melton Awards. Purkinje
- fibres

anI The heart's electrical circuit. Reproduced

with permission from Blackwell Science
Simply put, an electrocardiograph (ECG machine)
is a voltmeter (or galvanometer) that records the
changing electrical activity of the heart between a
positive and negative electrode. Electrocardiogra-
phy is the process of recording these electrical
changes.
Although a positive and negative electrode can
be placed almost anywe on, or 1n, the body to
record electrical changes, the most common and
simplest method is to place these electrodes on the
legs of an animal. This is referred to as body surface
limb ECG recording.
FORMATION OF THE NORMAL
P-QRS-T COMPLEX
Most of the cells within the heart have the ability to
generate their own electrical activity, but the sinoatrial
node is the fastest to do so and is, therefore, the 'rate
controller' or pacemaker of the heart. The rate of the
sinoatrial node is influenced by the balance in autonomic
tone, involving the sympathetic (which increases the rate)
and parasympathetic (which decreases the rate) systems.
The sinoatrial node normally initiates the electrical
discharge for each cardiac cycle. Depolarisation spreads

14 In Practice * MARCH 2002

 Atrioventricular
node I

Sinoatrial_
nodeI

Right

::,.I.
: I.
Complete depolarisation of the
.. p : I."I. atria and formation of the P wave.
e-,\ --.: Reproduced with permission from
1. Blackwell Science

Partial depolarisation of the atria and Formation of the P-R interval

formation of the P wave. The shaded area
represents depolarised myocardial cells and The speed with which the electrical depolarisation wave
the arrows show the direction in which the travels through the atrioventricular node is relatively
depolarisation wave is travelling. Reproduced
with permission from Blackwell Science slow so that the ventricular contraction will be timed to
occur following atrial contraction and maximal ventricu-
lar filling. Once the depolarisation wave passes through
through the atrial muscle cells. The depolarisation wave the atrioventricular node, it travels very rapidly through
then spreads through the atrioventricular node, but it the specialised conduction tissues of the ventricles (ie,
does so more slowly, thereby creating a time delay. the bundle of His, the left and right bundle branches and
Conduction passes through the atrioventricular ring Purkinje fibres).
(from the atria into the ventricles) through a narrow
pathway called the bundle of His. This then divides in Formation of the QRS complex
the ventricular septum into left and right bundle branch- It is often quite useful to think of the QRS complex as a
es (going to the left and right ventricles). The left bundle whole, rather than in terms of its individual components.
branch divides further into anterior and posterior fasci- The depolarisation wave passes through the atrioventric-
cles. The conduction tissue spreads into the myocardium ular node to the rapid conduction tissue of the ventricles.
as very fine branches called Purkinje fibres. When the ventricular myocardium is depolarised, this
creates a depolarisation wave that travels towards the
Formation of the P wave positive electrode; because the ventricular myocardium
From the sinoatrial node, the depolarisation wave is a large mass of muscle tissue, this usually creates a
spreads through the atria (somewhat like the ripples cre- large deflection. Hence, the QRS complex is usually
ated by dropping a stone into water). As the first portion large and positive (in lead II).
of the atria (nearest the sinoatrial node) is depolarised,
this creates an electrical potential difference between
the depolarised atria and the parts not yet depolarised
(ie, those still in a resting state).
When negative and positive electrodes are placed in
alignment with the right atrium and the left ventricle,
respectively, this results in the voltmeter (ie, the ECG
machine) detecting the depolarisation wave travelling
across the atria in the general direction of the positive
electrode. When a depolarisation wave travels towards a
positive electrode, this is reflected as a positive (upward)
depolarisation on the ECG recording. The atrial depolar-
isation wave, therefore, creates an upward excursion of
the stylus on the ECG paper.
When the whole of the atria becomes depolarised,
there is no longer an electrical potential difference and
so the stylus returns to its idle position (ie, the baseline).
The brief upward deflection of the stylus on the ECG
paper creates the P wave, representing atrial electrical Depolarisation of the bulk of

activity. The muscle mass of the atria is fairly small and the ventricular myocardium
and formation of the QRS
so the electrical changes associated with its depolarisa- -------------------complex. Reproduced with
tion are also small. permission from Blackwell Science

InPractice * MARCH 2002 115

 This is because repolarisation of the myocardium in
small animals is a little random compared with humans,
for example, in which repolarisation is very organised
and the T waves always share the same polarity as the
QRS complexes (irrespective of the lead in which the
recording is made). The diagnostic value of abnormali-
ties in the T wave of small animals is therefore very
limited (whereas abnormal T waveforms in humans can
be very useful diagnostic features).

SINUS RHYTHMS
A normally formed complex is termed a sinus complex;
that is, there is a P wave for every QRS complex and
T wave (or vice versa). A sequence of beats originating
from the sinoatrial node forms a rhythm, known as the
sinus rhythm. There are four common sinus rhythms and
these are described below.

Normal sinus rhythm

Complete depolarisation and repolarisation of the atria
and ventricles and completion of the P-QRS-T complex.
Reproduced with permission from Blackwell Science
Formation of the T wave
After complete depolarisation of the ventricles, they then
repolarise in time for the next stimulus. This phase of
repolarisation creates a potential difference across the
ventricular myocardium until it is completely repolar-
ised. This results in a deflection from the baseline (in
lead II) which is termed the T wave.
The T wave in dogs and cats is very variable and can
be negative, positive or even biphasic (ie, a bit of both).
In normnal sinus rhythm, the stimulus originates regularly
at a constant rate from the sinoatrial node (dominant pace-
maker), depolarising the atria and ventricles normnally and
producing a coordinated atrioventricular contraction.
CLINICAL FINDINGS
Regular heart sounds are heard on auscultation (ie, lubb
dupp) with a pulse for each heartbeat and at a rate which
is normal for age, breed and species.
ECG FEATURES
The ECG shows a normal P wave followed by normal
QRS and T waves. The rhythm is regular (constant) and
the rate is normal for age, breed and species. The size
of the ECG complexes are typically small in cats and,

QRS

ECG from a dog showing P1

normal sinus rhythm at a ~ ~ ~~~K.n ~ ~ \ s
rate of 140/minute. (Lead 11, ' V 'V "V "I 1 1
I cm/mV, 25 mm/second)

ECG from a cat showing QRS

normal sinus rhythm at a
rate of 220/minute. Some AT .
baseline drift associated f
with movement during the
ECG recording can also be
seen. (Lead 11, I cm/mV,
25 mm/second)

ORS

ECG from a dog showing

respiratory sinus
arrhythmia at a rate of
approximately 100/minute.
Note also the slight
variation in P wave
amplitude - this is termed
a wandering pacemaker.
(Lead 11, I cm/mV,
25 mm/second)

116 116 ~~~~~~~~~~~~~~~~~~~In

Practice * MARCH 2002
therefore, obtaining an artefact-free tracing is important
in order to clearly identify the ECG complexes.
Sinus arrhythmia
In the case of sinus arrhythmia, the stimulus originates
from the sinoatrial node, but the rate varies (increases
and decreases) regularly. This is usually associated with
the variation in autonomic tone which is often synchro-
nous with respiration and is therefore sometimes called
respiratory sinus arrhythmia.
CLINICAL FINDINGS
The heart rhythm varies with some regularity, increasing
and decreasing in rate, and there is a pulse for every
heartbeat.
ECG FEATURES
The ECG shows a normal P wave followed by normal
QRS and T waves. The rhythm varies in rate, often associ-
ated with respiration. The rhythm is sometimes described
as being regularly irregular (ie, the variation in rate is fair-
ly regular). The rate is normal for age, breed and species.
Sinus tachycardia
In the case of sinus tachycardia, the sinoatrial node gen-
erates an impulse and depolarisation which occurs faster
than normal.
CLINICAL FINDINGS
The heart rate is faster than normal for age and breed
with a pulse for every heartbeat (although with a very
fast rate, the pulse may become weaker).
ECG FEATURES
The ECG shows a normal sinus rhythm but at a faster
rate than normal.
Sinus bradycardia
In the case of sinus bradycardia, the sinoatrial node gen-
erates an impulse and depolarisation which occurs more
slowly than normal. This can be a normal feature in
some giant-breed dogs and in athletically fit animals.
QRS
ECG from a dog showing sinus tachycardia at a rate of 200/minute. (Lead 11, 1 cm/mV, 25 mm/second)
11 QRS
: * * * f ~~~~~~~~~~~~~4
ECG from a dog showing sinus bradycardia at a rate of 30 to 40/minute. (Leads
In Practice 0 MARCH 2002
CLINICAL FINDINGS
The heart rate is slower than normal for age and breed,
with a pulse for every heartbeat.
ECG FEATURES
The ECG shows a normal sinus rhythm but at a slower
rate than normal.
ABNORMAL ELECTRICAL ACTIVITY
OF THE HEART
Dysrhythmia literally means abnormal rhythm; arrhyth-
mia is a synonymous term. Dysrhythmias include abnor-
malities in rate, conduction or those associated with
ectopia (see box below). Dysrhythmias that are essential-
ly slow are referred to as bradydysrhythmias, and those
that are fast are termed tachydysrhythmias.
While there can be considerable variation in the
'normal' morphology of a QRS complex for a particular
animal, it is nevertheless important to identify from the
ECG recording a normal sinus complex for the animal
being examined. Once a normal complex has been iden-
tified, the shape of the QRS complex and the T wave
should be noted. Depolarisation of the ventricles occurs
by conduction from (or through) the atrioventricular
node to produce this QRS complex and it is therefore of
paramount importance in any tracing to determine which
shape represents the conduction that has arisen via the
atrioventricular node, especially if there are a variety of
shapes of QRS complexes.
Ectopia
Ectopia literally means 'in an abnormal place'. In
connection with the heart, this refers to outside the
sinoatrial node, the dominant pacemaker. Ectopic
beats arise as a result of various mechanisms due to
a number of causes (eg, cardiac pathology, hypoxia,
electrolyte imbalances).
11 and 111, cm/mV, 25 mm/second)
117
 _-s,
MORPHOLOGY OF AN ECTOPIC
Terminology VENTRICULAR DEPOLARISATION
Providing a normal QRS-T wave has been correctly
With an understanding of the terminology used, the interpretation of dysrhyth-
mias due to ectopia becomes relatively easy. The term 'beat' implies that there
tound and identified, any QRS-T complex which is not
has been an actual contraction. In 'ECG speak', it is better to use the term associated with a preceding P wave, and is a different
shape to this normal QRS-T wave, represents an abnor-
complex or depolarisation to describe waveforms on the ECG. Ectopic complexes
mal complex. When the QRS-T complex is different
may be classified by the following:
* SITE OF ORIGIN. Complexes may be either ventricular or supraventricular in
from the normal sinus complex, the only possible site of
origin is a ventricular ectopic focus as there is no other
nature
site which can stimulate the ventricles. In addition, these
* TIMING. Ectopic complexes that occur before the next normal complex would
ventricular ectopic complexes are not associated with a
have been due are termed premature; those that occur following a pause, such
preceding P wave (unless by coincidence).
as a period of sinus arrest or in the case of complete heart block, are termed
The direction of the ventricular depolarisation in an
escape complexes
ectopic case is different from that which would have
* MORPHOLOGY. If all the ectopics in a tracing have a similar morphology to each
occurred from depolarisation arising from the atrioventric-
other, they are referred to as uniform; ectopics with different shapes are known
ular node. In the example shown in the diagram on the
as multiform
right, the ventricular ectopic depolarisation wave is travel-
* NUMBER OF ECTOPICS. Premature ectopic complexes may occur singly, in pairs or
ling away from the positive electrode and is therefore
in runs of three or more; the last is referred to as tachycardia. Tachycardia may
displayed on the ECG paper below the baseline (ie, the
be continuous, in which case it is known as persistent or sustained, or may be
QRS complex is negative). Also, because conduction has
intermittent, which is termed paroxysmal
not travelled through the normal (fast) electrical conduc-
* FREQUENCY. The number of premature ectopic complexes in a tracing may vary
tion tissue (ie, it has depolarised the ventricular muscle
from occasional to very frequent. When there is a set ratio, such as one sinus
mass from 'cell to cell'), the time it takes to depolarise the
complex to one ectopic complex, this is known as bigeminy; when there is one
ventricles is prolonged. Therefore, not only is the QRS
ectopic to two sinus complexes, this is termed trigeminy
complex of the ventricular ectopic ditferent in shape, but
vPC
T

, ^ ~~~~~QRS A
1~~
*-ft -.W e 0% v1
/ 'v

ECG (lead 11) from a 10-year-old dog showing an underlying sinus

rhythm interrupted by one ventricular premature complex (VPC)

VPC vPc
Ti

QRS QRS
ECG (lead 11) from a cat showing an underlying sinus rhythm
interrupted by an occasional ventricular premature complex

11
VPC
T
QRS A
.,

I'
I I~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
,'I

.
I
~~~~~~~~~~~~~ I

I"'.
. ( .

I
, I it

i1
il Ij
:,
QRS
ECG (leads I and 11) from a dog showing alternating sinus complexes
with ventricular premature complexes (so-called ventricular bigeminy)

1 18 In Practice MARCH 2002


T complex.
t
QRS
An ectopic focus with the spreading out
>
I,
of the depolarisation wave (right) and
the formation of a QRS-T complex (left)
associated with the ventricular ectopic.
Note that because the depolarisation
wave is travelling away from the positive
electrode, the QRS is displayed as a negative
complex on the ECG. Reproduced with
permission from Blackwell Science
it is also prolonged. A useful tip is that, quite often, the
T wave following a QRS complex of a ventricular ectopic
is opposite in polarity to the QRS wave and large.
Ventricular ectopic complexes can arise from any part
of the ventricles. The direction in which they depolarise
the ventricles is therefore variable, which means that the
electrical potential difference recorded by the ECG will
also be variable. In other words, as the direction in which
the depolarisation wave travels in relation to the positive
electrode is variable, the shape and magnitude of the QRS
complex of a ventricular complex will also be variable. It
is important to note that the QRS wave of a ventricular
ectopic complex is different to the one that has arisen
from the atrioventricular node and travelled normally
down the electrical conducting tissue to the ventricles.
II
Illl
! #~~~I
InPractice 0 MARCH 2002
A ventrricular ectopic complex can occur quickly (or
early), in vwhich case it is termed a ventricular premature
complex. IIf a ventricular ectopic occurs after a pause (or
with delay ) then it is referred to as a ventricular escape
Ventricul lar premature complexes
Ventricula r premature complexes are a common finding
in dogs an d cats and arise from an ectopic focus or foci
within the ventricular myocardium. Depolarisation
therefore occurs in an abnormal direction through the
myocardiuim and the impulse is conducted from cell to
cell (not wiithin the conduction tissue).
CLINICAL FFINDINGS
OccasionalLI premature beats will sound like a 'tripping in
the rhythnrn'. Depending on how early the beat occurs,
the 'extra' 'premature beat may be heard or it might be
'silent', p roducing a brief pause in the rhythm. There
will be liti tle or no pulse associated with the premature
b
beat (ie, a pulse deficit). If the premature beats are more
frequent, tl:he tripping in the rhythm will start to make the
heart rhytl hm sound more irregular. With very frequent
premature beats, the heart rhythm can sound quite chaot-
ic and, witth a pulse deficit for each premature beat, the
pulse rate will be much slower than the heart rate.
During a s,ustained ventricular tachycardia, however, the
heart rhythim will sound fairly regular- pulses will prob-
ably be palpable, but reduced in strength, becoming
weaker wilLth faster heart rates.
ECG FEATIURES
The QRS ecomplex morphology is abnormal (ie, unlike a
QRS wave that would have arisen from the atrioventric-
ular node). The complex is usually:
* Abnormnal (bizarre) in shape;
* Slightly widened (prolonged);
* The T wave of a ventricular premature complex is
often large and opposite in direction to the QRS wave.
When aa ventricular premature complex is so prema-
ture that it is superimposed on the T wave of the preced-
vPCs
+ t
i
XA.%1 K 'rZ$'; v\ > '~"JlVP0'N ECG (leads 1, 11 and 111) from a dog showing a
short burst of ventricular premature complexes
which are of different shapes. This is known as
multiform paroxysmal ventricular tachycardia
119
 QRS

QRS

ECG from a dog showing the

phenomenon of R-on-T. This is where
a ventricular premature complex occurs
I' 'lil;
f i
so early that it is superimposed on the
T wave of the preceding ventricular T
premature complex T

T
QRS t

T
ECG from a dog showing only one
normal sinus complex; the rest are -
I\ r-* V* W i

all ventricular premature complexes

(occurring at a rate of 200/minute).
This is known as ventricular -
tachycardia Q~RS

inT comi1plex (sinus or ectopic), such that the ventricles is usually norm-i'al - thalt is, the samile the QRS complex
as

are depolairised before they haxve comipletely repolarised for a siinus coImlplex (the exception being when there is
from the preceding contraction, this is term-ied R-on-T. (aberrancy). This can make identificcation of a supraventric-
A runi of three or more ventriCular premlature complexes ulalr- ectopic difficLult. In the v ast majority of cases, how-
is knows as ventricular tachycar-dia. ecer, it OCCurIs a premature belt, which means that it is
as

primnartily recognised by its prematue timi-ng. The QRS of

MORPHOLOGY OF AN ECTOPIC a supraxventricular ectopic complex is the sarme shape as a

SUPRAVENTRICULAR DEPOLARISATION QRS of normal sinus com1lplex and is recognised by its

a

Any ectopic stimulus arisinig above the ventricles is premature timinlg and, usually, also by the absenice o' a

reterred to as Supraventricular and can be divided into: normal P \waxe.

* Those which occur in the atrial muscle mass (atrial While the timillg (in relation to its QRS complex) anld
ectopics); and the morphology of the P axve (whichi iS usually differenit
w

* Those which arise firoIml within the atriovenitricular
node or bunldle ot His (junctional or nodal ectopics).
In-espective of where supraventricular ectopics arIise,
they musit traxvel down the bundle ot His and so depolarise
the ventricles as normal. Therefore, the morphology of the
QRS complex associated with a supraventricular ectopic
from a norm-lal P waxve) can aLid in identifying whether
the ectopic alrose from the atrial (atrial preImatule coIml-
plex) or the atrioxentricular node (junctional or nodal
premlaL.ture complex). it is initially of little practical
importcance in smlall anim-Ials. In addition, it does not
affect the managecrlemnt or treatmiienit in the vast major-ity
of cases in smlall animials. Therefore, the distinctioln
between atriatl anid junctionial prematul-e coImIplexes
will not be discussed in this article aind both will be
referr-ed to by the broader term. supravxentricular premna-
tli-e comiiplexes.

Supraventricular premature complexes

Suprax entricular premntature complexes arise romio 1
an

ectopic tOCuS aboxve the xventricles - that is. either

or foci
in the atria, the atrioxventriculaIr node or the bundle of'
His. The xventricles are thein depolarised normally, hence
producing a normnal shaped QRS complcx with a normal
The site of origin of durationi.
supraventricular and ventricular \
ectopic complexes. APC, atrial CLINICAxI FINDINCiS
premature complex;
JPC, junctional premature Clinically, it is not possible to distinguish supraventricu
complex; VPC, ventricular lar premiatLtre beats fromi xventricular premnatul-e beats.
premature complex. Reproduced
with permission from Blackwell Science Occasional premn-ature beats will sounld like aI 'trippinl in

120 In Practice MARCH 2002

 I ~~~~~~QRS QRS
QR

- -
N
77J

ECG from a dog showing a single supraventricular premature complex, recognised by its normal QRS morphology but

premature timing and no identifiable preceding P wave

I -I~
I IQRS tQRS QRS

ECG from a dog showing a single supraventricular premature complex. On this occasion, there is a recognisable preceding
P wave, which has an abnormal morphology compared to the other P waves - suggesting that this is an atrial premature
complex

QRS QRS QRS54

T T~~~~R

T~~~~~
ECG from a dog showing a short burst of supraventricular premature complexes this is termed paroxysmal
supraventricular tachycardia

QRS

ECG from a dog showing

a sustained run of

supraventricular premature
\J\complexes (at a rate of
in te ) th is is te d

~~~~~~~~~~~~~~~~~~~~~~~~~Supraventricular tachycardia

the rhythm', with little or no pulse associated with the P waves may or may not be identified;

premature beat. If the premature beats are more frequent, If P waves are seen, they are usually of an abnormal

the tripping in the rhythm will start to make the heart morphology (ie, non-sinus) and the P-R interval may

rhythm sound more irregular. With very frequent pre- differ from that seen in a normal sinus complex.
mature beats, the heart rhythm can sound quite chaotic A run of three or more supraventricular premature
and, with a pulse deficit for each premature beat, the complexes is termed a supraventricular tachycardia,
pulse rate will be much slower than the heart rate. which is usually at a rate in excess of 160/minute (but

During a sustained supraventricular tachycardia, how- can be as high as 400/minute) and regular. Supra-
ever, the heart rhythm will sound fairly regular- pulses ventricular tachycardias need to be distinguished from

will probably be palpable, but reduced in strength, sinus tachycardia.

becoming weaker with faster heart rates.

Atrioventricular dissociation

ECG FEATURES The term atrioventricular dissociation describes the situ-

QRS-T complexes, which have a normal morphology, ation when the atria and ventricles are depolarised hy
are seen to occur prematurely. The ECG features are: separate, independent foci. This may occur due to an

Normal QRS morphology (except with bundle branch accelerated junctional or ventricular rhythm, disturbed

block); atrioventricular conduction or depressed sinoatrial nodal

The QRS complex is seen to occur prematurely; function.

InPractice MARCH 200212 121

ECG from a dog showing
atrioventricular dissociation.
Note how the P waves
(arrowed) appear to drift in
and out of the QRS complexes

CLINICAL FINDINGS originates above the ventricles, it can also be classified

The heart rhythm will sound fairly normal and the pulse
should match the heart rate.
ECG FEATURES
The ECG shows a ventricular rate that is usually very
slightly faster than the atrial rate. The P waves may
occur before, during or after the QRS complex. The
P waves and QRS complexes are independent of each
other, with the QRS complexes appearing to 'catch up'
on the P waves. Atrioventricular dissociation should be
differentiated from complete heart block. In the case of
heart block, the ventricular rate is slow and much lower
than the atrial rate; in atrioventricular dissociation, the
atrial and ventricular rates are not dissimilar (and usually
at a normal or faster rate).
Atrial fibrillation
Fibrillation means rapid irregular small movements of
fibres. In atrial fibrillation, one of the most common
arrhythmias seen in small animals, depolarisation waves
occur randomly throughout the atria. As atrial fibrillation
as a supraventricular arrhythmia.
CLINICAL FINDINGS
The heart rhythm sounds chaotic and the pulse rate is
often half the heart rate, especially with fast atrial fibril-
lation. This is a very common arrhythmia in dogs and
can be strongly suspected on auscultation by its chaotic
rhythm and 50 per cent pulse deficit. Very frequent
premature beats (ventricular or supraventricular) can
mimic it.
ECG FEATURES
The QRS complexes have a normal morphology (simi-
lar to that of supraventricular premature complexes,
described above) and occur at a norm-al to fast rate. The
ECG features are:
* Normal QRS morphology (except when there is
bundle branch block);
* The R-R interval is irregular and chaotic (note this is
easier to hear on auscultation!);
* The QRS complexes often vary in amplitude;

QRS QRS

T
T~~~~~~~~~~~(

ECG from a dog showing atrial fibrillation with a ventricular response rate of 160/minute. Note the normal

(or supraventricular) morphology of the QRS complexes, the chaotic R-R intervals (this is actually easier to

hear on auscultation) and the absence of P waves

Q?RS

,~~~~

III

~~~~Vwv A\~~~~~~~~~~~
ECG from a dog showing
atrial fibrillation with a
ventricular response rate
of nearly 300/minute

122 122 Practice * MARCH 2002

~~~~~~~~~~~~~~~~~~~In
 Escape rhythms
When the dominant pacemaker tissue (usually the
sinoatrial node) fails to discharge for a long period,
the pacemaker tissue with a slower intrinsic rate (junc-
tional or ventricular) may then discharge and 'escape'
control of the sinoatrial node. This is commonly seen
in association with bradydysrhythmias (eg, sinus
bradycardia, sinus arrest, atrioventricular block).
If escape rhythms did not develop, no electrical
activity of any kind would occur; this is termed
asystole. It is a terminal event unless electrical activity
returns (hence, escape complexes are sometimes
referred to as rescue beats). Ventricular standstill
occurs if no escape rhythms develop during complete
heart block (ie, there are P waves but no QRS com-
plexes). Again, if ventricular electrical activity does
not return, death is imminent.
Junctional escapes are fairly normal in shape
(ie, junctional ectopic), whereas ventricular escapes
are abnormal and bizarre (ie, ventricular ectopic).
A continuous junctional escape rhythm occurs at a
rate of 60 to 70/minute and a continuous ventricular
escape rhythm occurs at a rate of less than
50/minute. Both types of escape rhythm may be seen
in complete atrioventricular block.
As escape rhythms are rescue beats, they should
not be suppressed by any form of treatment.
Treatment should be directed towards the under-
lying bradydysrhythmia.

A /~ ~ ~ , ,

ECG showing ventricular

fibrillation. Note the random
unorganised deflections

* There are no recognisable P waves preceding the
QRS complex;
* Sometimes, fine irregular movements of the baseline
- known as 'f waves' - are seen as a result of the atrial
fibrillation waves. However, frequently these f waves are
indistinguishable from baseline artefact (eg, muscle
tremor) in small animals.
MARTIN, M. & CORCORAN, B. (1997) Cardiorespiratory Disease
of the Dog and Cat. Oxford, Blackwell Science
SMITH, F. W. R. & TILLEY, L. P. (1992) Rapid Interpretation of Heart
Sounds, Murmurs, and Arrhythmias. Philadelphia, Lea & Febiger
TILLEY, L. P. (1992) Essentials of Canine and Feline
Electrocardiography: Interpretation and Treatment, 3rd edn.
Philadelphia, Lea & Febiger
TILLEY, L. P. (1992) Self Assessment: Small Animal Arrhythmias.
Philadelphia, Lea & Febiger

Ventricular fibrillation
Ventricular fibrillation is nearly always a terminal event
associated with cardiac arrest. The depolarisation waves
occur randomly throughout the ventricles. There is there-
fore no significant coordinated contraction to produce
any cardiac output. If the heart is visualised or palpated,
fine irregular movements of the ventricles are evident
and likened to a 'can of worms'. Ventricular fibrillation
In Practice
can follow ventricular tachycardia.

CLINICAL FINDINGS
Binders
No heart sounds are heard. No pulse is palpable.
Binders for In Practice are available from:
ECG FEATURES
The ECG shows coarse (larger) or fine (smaller) rapid, McMillan-Scott Subscriber Services,
irregular and bizarre movement with no normal waves or 6 Bourne Enterprise Centre, Wrotham Road,
complexes.
Borough Green, Kent TN15 8DG
Acknowledgement Telephone 01732 884023, Fax 01732 884034
This article is based on material published in the author's book
entitled 'Small Animal ECGs: An Introductory Guide' (2000),
Oxford, Blackwell Science, and is reproduced with permission
of the publisher. BVA members' price £7.50 (inc postage)
Further reading
DARKE, P., BONAGURA, J. D. & KELLY, D. F. (1996) Color Atlas The red-coloured binders each hold a year's
of Veterinary Cardiology. London, Mosby-Wolfe
FOX, P. R., SISSON, D. & MOISE, N. S. (1999) Textbook of Canine supply of issues
and Feline Cardiology. Philadelphia, W. B. Saunders
KITTLESON, M. D. & KIENLE, R. D. (1998) Small Animal
Cardiovascular Medicine. St Louis, Mosby
LUIS FUENTES, V. & SWIFT, S. (1998) Manual of Small Animal
Payment with order please
Cardiorespiratory Medicine and Surgery. Cheltenham, BSAVA
MARTIN, M. (2000) Small Animal ECGs: An Introductory Guide.
Oxford, Blackwell Science

In Practice * MARCH 2002 123