Backwell's 5 Min Veterinary Consult

Cardiology
Topic-Aortic Stenosis
Figure 1. Angiogram of aortic stenosis.
Figure 2. Postmortem of a dog with subaortic stenosis
demonstrating left ventricular (LV) hypertrophy, aortic
post-stenotic dilation (Ao), and a subvalvular fibrous
ridge (instrument pointer).
Figure 3. Two-dimensional echocardiograph, right
parasternal long axis view, demonstrating a subvalvular
ridge typical of subaortic stenosis. Thickening of the
anterior mitral valve leaflet (MV) is also apparent. Aorta
(Ao), left ventricle (LV), and left atrium (LA).
Figure 4. Similar to 1A with color flow Doppler overlay
demonstrating turbulent flow distal to the obstruction.
Topic-Aortic Thromboembolism
Figure 1.
Figure 2. A cat with thrombus of the left forelimb.
Figure 3. A cat with thrombus and cyanotic pads.
Figure 7. Aortic thromboembolism.
Topic-Ascites
Figure 1. Ascites in a doglateral radiography.
Figure 2. A dog with ascites.
Topic-Atrial Fibrillation and Atrial Flutter

Figure 1. Atrial flutter with 2:1 conduction at ventricular
rate of 330/minute in a dog with an atrial septal defect.
This supraventricular tachycardia was associated with
a Wolff-Parkinson-White pattern. (From: Tilley, L.P.
Essentials of canine and feline electrocardiography,
3rd ed. Baltimore: Williams & Wilkins, 1992, with
permission.)
Figure 2. Coarse atrial fibrillation in a dog with
patent ductus arteriosus. The f waves are prominent.
(From: Tilley, L.P. Essentials of canine and feline
electrocardiography, 3rd ed. Baltimore: Williams &
Wilkins, 1992, with permission.)
Figure 4. Postmortem thrombus in a cat.

A John Wiley & Sons, Ltd., Publication
Cardiology
Topic-Atrial Premature Complexes
Figure 1. APC in a dog. P9 represents the premature
complex. The premature QRS resembles the basic
QRS. The upright P9 wave is superimposed on the T
wave of the preceding complex. APC. (From: Tilley,
L.P. Essentials of canine and feline. 3rd ed. Blackwell
Publishing, 1992, with permission.)
Figure 2. APCs in bigeminy in a cat under general
anesthesia. The second complex of each pair is
an APC, where the first is a sinus complex. The
abnormality in rhythm disappeared after the anesthetic
was stopped. (From: Tilley, L.P. Essentials of canine and
feline electrocardiography. 3rd ed. Blackwell Publishing,
1992, with permission.)
Topic-Atrial Septal Defect

Figure 1. Atrial septal defect. Defect involves the
lowermost part of the atrial septum, known as ostium
primum defect. Note the left dominant left-to-right
shunt. RV = right ventricle, LV = left ventricle, RA =
right atrium, Ao = aorta, PT = pulmonary trunk. (From
Roberts W. Adult congenital heart disease. Philadelphia:
FA Davis Co., 1987, with permission.)
Topic-Atrial Standstill
Figure 1. Persistent atrial standstill in English springer
spaniel. No P waves are present on any of the
leads (also including chest leads and intracardiac
electrocardiogram, not shown here). The regular
bradycardia is either junctional in origin, with pathologic
involvement of the left bundle branch block (wide
positive QRS complexes), or ventricular. (From: Tilley,
L.P. Essentials of canine and feline electrocardiography.
permission.)
Topic-Atrial Wall Tear

Figure 1. Gross specimenleft atrial tear
Figure 2. Right parasternal short axis echocardiographic
image at the level of the aorta and left atrium. The arrow
points to an intra-atrial thrombus attached to the atrial
wall at the junction of the body of the left atrium and the
left auricular appendage. Severe left atrial enlargement
and pericardial effusion are present. LAA= Left auricular
appendage; LA=Left atrium; PE=Pericardial effusion.
Cardiology
Figure 3. Right parasternal short axis echocardiographic
image at the level of the left ventricle (LV). Pericardial
effusion is noted and a characteristic linear thrombus is
seen within the pericardial sac adjacent to the LV. LV=
left ventricle; PE=pericardial effusion.
Figure 4. Gross cardiac specimen from a dog with
advanced mitral endocardiosis that died following an
acute left atrial tear. The probe is pointing to a 2 cm
tear in the left atrial wall at the junction of the body of
the left atrium and left auricular appendage. LAA=left
auricular appendage; LA=left atrium. Photo courtesy of
Dr. Richard Jakowski.
Topic-Atrioventricular Block, Complete

(Third Degree)
Figure 1. Complete heart block. The P waves occur at
a rate of 120, independent of the ventricular rate of 50.
The QRS configuration is a right bundle branch block
pattern. The regular rate and stable QRS indicate that
the rescuing focus is probably near the AV junction.
electrocardiography. 3rd ed. Blackwell Publishing, 1992,
with permission.)
Figure 2. Complete heart block in a cat. The P waves

rate is 240/minute, independent of the ventricular
rate of 48/minute. QRS configuration is a left bundle
branch block pattern. (From: Tilley, L.P. Essentials of
canine and feline electrocardiography. 3rd ed. Blackwell
Figure 3. Lateral radiograph of a dog with transvenous
pacemaker.
Topic-Atrioventricular Block, First Degree

Figure 1. Lead II ECG rhythm strip recorded from
a cat with hypertrophic cardiomyopathy. There is
sinus bradycardia (120 beats/minute) and first degree
atrioventricular conduction block. The PR interval is
0.12 second. (paper speed = 50 mm/s)
Figure 2. Lead II ECG rhythm strip recorded from a dog
showing sinus tachycardia (175 beats/minute) and first
degree atrioventricular conduction block. Because the
heart rate is rapid, P waves are superimposed on the
downslope of the preceding T waves. The PR interval
exceeds 0.16 second. (paper speed = 50 mm/s)
Cardiology
Topic-Atrioventricular Block, Second
Degree - Mobitz Type I
Figure 1. Lead II ECG strip recorded from a dog
with Mobitz type I, second degree AV block. The PR
intervals become progressively longer with the longest
PR intervals preceding nonconducted P waves (typical
Wenkebach phenomenon). (paper speed = 50 mm/s)
Topic-Atrioventricular Block, Second

Degree - Mobitz Type II
Figure 1. Lead II ECG rhythm strip recorded from a dog
with both first- and second-degree atrioventricular block.
The second-degree AV block is high grade with both 2:1
and 3:1 block resulting in variation in the RR intervals.
The PR interval for the conducted beats is prolonged
but constant (0.28second) (paper speed = 25 mm/s).
Topic-Atrioventricular Valve Dysplasia

Figure 1. Lateral radiographs of mitral valve dysplasia.
Topic-Atrioventricular Valve Endocardiosis

Figure 1. Postmortem of valvular endocardiosis.
Figure 2. Lateral radiograph of mitral valve
endocardiosis.
Topic-Atrioventricular Valvular Stenosis

Figure 1. This image of the liver in a dog with tricuspid
stenosis and right heart failure shows markedly
distended hepatic veins.
Figure 2. This continuous wave Doppler recording
across the tricuspid valve in a dog with tricuspid
stenosis illustrates the prolonged pressure half time
(evidenced by the slope of the line between E and F
points) and the prominent atrial contribution (A) to filling.
This animal also had tricuspid regurgitation.
Topic-Cardiomyopathy, Dilated - Cats

Figure 1. Postmortem of dilated cardiomyopathy (cat).
Figure 2. Echocardiogram of dilated cardiomyopathy
(cat).
Topic-Cardiomyopathy, Dilated - Dogs

Figure 1. Gross postmortem of dilated cardiomyopathy
(dog).
Figure 2. Electrocardiographic findings.
Topic-Cardiomyopathy, Hypertrophic - Cats

Figure 1. Dyspnea in a cat.
Cardiology
Figure 2. Chest radiograph (lateral) of hypertyrophic
cardiomyopathy (cat).
Figure 3. Jugular distension in a cat with right-sided

congestive heart failure.
Figure 3. Chest radiography (dorsoventral) of

hypertrophic cardiomyopathy (cat).
Figure 4. Abdominal venous distension in a dog with

right-sided heart failure.
Figure 4. Echocardiogram of hypertrophic

Figure 5. Gross postmortem of hypertrophic
Figure 6. Angiocardiogram of hypertrophic
Topic-Cardiomyopathy, Restrictive - Cats

Figure 1. Cardiomyopathy, restrictivecats.
Topic-Congestive Heart Failure, Left-Sided

Figure 2. Cachexia in a dog.
Topic-Congestive Heart Failure, RightSided

Topic-Digoxin Toxicity
Figure 1. Sagging type of S-T segment depression in a
dog with digitalis toxicity.
Topic-Endocarditis, Infective
Figure 1. Gross postmortem of bacterial endocarditis
Figure 2. Echocardiogram of bacterial endocarditis.
Topic-Heartworm Disease - Cats

Figure 1. Gross postmortem of heartworm disease in
cat.
Topic-Heartworm Disease - Dogs

Figure 1a. Microfilaria of dirofilaria and
acanthocheilonema (Justin A. Thomason).
Figure 1b. Microfilaria of dirofilaria and
acanthocheilonema (Justin A. Thomason).
Cardiology
Figure 2. Dorsoventral radiograph of heartworm disease
in a dog.
Figure 3. Echocardiogram of heartworm disease.
Figure 4. Gross postmortem of heartworm disease in a
dog.
Topic-Idioventricular Rhythm
Figure 1. Ventricular escape complexes (arrows) during
various phases in the dominant sinus rhythm in a dog
during anesthesia. The sinus rate increased (not shown)
after anesthesia was stopped; 1/2 cm1 mv. (From: Tilley,
3rd ed. Blackwell Publishing, 1992, with permission.)
Figure 2. Complete heart block. The P waves occur at
a rate of 120, independent of the ventricular rate of 50.
The QRS configuration is a right bundle branch block
pattern. The regular rate and stable QRS indicate that
the rescuing focus is probably near the AV junction.
with permission.)
Topic-Left Anterior Fascicular Block

Figure 1. Left anterior fascicular block in a cat with
hypertrophic cardiomyopathy. Severe left axis deviation
(2608) with a qR pattern in leads I and aVL and an rS
pattern in leads II, III, and aVF. The QRS complexes
are of normal duration. (From: Tilley, L.P. Essentials of
Figure 2. Left anterior fascicular block in a dog with
hyperkalemia (serum potassium, 5.3 mEq/L). There is
abnormal left axis deviation (260_) with a qR pattern
in leads I and aVL and an rS pattern in leads II, III,
and aVF. The large T waves are compatible with
hyperkalemia. (From: Tilley, L.P. Essentials of canine
and feline electrocardiography. 3rd ed. Blackwell
Cardiology
Topic-Left Bundle Branch Block
Figure 1. Left bundle branch block in a cat with
hypertrophic cardiomyopathy. The QRS complex is
of 0.07-second duration and is positive in leads I, II,
III, aVF. Neither a Q wave nor an S wave occurs in
these leads. The QRS complex is inverted in leads
aVR. (From: Tilley, L.P. Essentials of canine and feline
with permission.)
Figure 2. Intermittent left bundle branch block in a
Chihuahua. QRS complexes are wider (0.070.08
second) in the second, third, and fourth complexes and
in the last three complexes. Consistent P-R interval
confirms a sinus origin for the abnormal-appearing
QRS complexes (lead II, 50 mm/second, 1 cm 5 1
mV). (From: Tilley, L.P. Essentials of canine and feline
with permission.)
Topic-Murmurs, Heart
Figure 1. Differential diagnosis of cardiac disease
based on the timing and location of murmurs. (Adapted
from Allen, D.G. Murmurs and abnormal heart sounds.
By permission of Mosby-Year Book, Inc. In: Allen,
D.G., Kruth, S.A., eds. Small animal cardiopulmonary
medicine. Philadelphia: BC Decker, 1988:13.)
Topic-Myocardial Infarction
Figure 1. Transmural infarction of the left ventricle in a
dog with arteriosclerosis and hypothyroidism. The first
three rapid successive complexes represent ventricular
tachycardia. The sinus rhythm that follows illustrates
small complexes, marked elevation of the S-T segment,
and first degree AV block (prolonged P-R interval).
with permission.)
Topic-Patent Ductus Arteriosus

Figure 1. Angiocardiogram of patent ductus arteriosus.
Figure 2. Patent ductus arteriosus.
Cardiology
Topic-Pericarditis
Figure 1. The photograph demonstrates catheter
positioning and orientation for pericardiocentesis
from the right ventral approach. While stabilizing the
catheter near the entry point with one hand, the catheter
is advanced in a cranial and dorsal direction with
the other, i.e. towards the opposite scapula. A small
degree of suction is maintained with the syringe so that
pericardial fluid is aspirated at the moment of pericardial
penetration. Subsequently the syringe and stylet are
held stationary while the flexible catheter is advanced
well into the pericardium. The sharp metal stylet is
withdrawn after the catheter is fully positioned.
Figure 2. Echocardiograph acquired with transducer
at the same location and orientation (direction) as the
catheter shown above. Dotted line indicates structures
encountered by the central ultrasound beam, i.e. in
the path of the catheter. While this patient had a
relatively small amount of pericardial effusion (PE),
proper catheter positioning, orientation, and linear
advancement minimizes risk. Oblique orientation of the
catheter, relative to the cardiac surface, increases the
effective distance between the pericardium and heart.
Figure 3. Instrumentation used for pericardiocentesis.

A 14g 5catheter and stylus are shown with a small
syringe attached, i.e. configured to advance into the
pericardial space. The sharp metal stylus is removed
after the catheter is fully positioned, as demonstrated
for the 16g 5catheter, and an extension tube attached
to the catheter for aspiration using a larger syringe and
3-way stopcock. An 18g 2 catheter is used for cats and
similarly sized dogs. A #11 blade is ideal for creating a
small stab incision at the site of entry. The author uses
a #10 blade to cut side holes in the distal end of the
larger catheters (optional).
Topic-Pleural Effusion
Figure 2. Radiograph of pleural effusionlateral (dog).
Topic-Pulmonic Stenosis
Figure 1. Ventrodorsal radiograph of a dog with
pulmonic stenosis. There is a marked right ventricular
enlargement, with the apex shifted to the left. A
prominent pulmonary artery bulge is visible (arrow)
(Virginia Luis Fuentres).
Cardiology
Figure 2. Two-dimensional echocardiographic right
parasternal long axis view of a dog with severe
pulmonic stenosis. The right ventricular free wall and
interventricular septum are very hypertrophied, with mild
right atrial enlargement (Virginia Luis Fuentres).
Figure 3. Continuous wave spectral Doppler recording
of pulmonary artery flow from a left cranial view in a
dog with severe pulmonic stenosis. Pulmonary artery
velocities are greatly increased (approximately 5 m/s).
Topic-Right Bundle Branch Block

Figure 1. Right bundle branch block in a dog. The
electrocardiographic features include QRS duration
of 0.08 second; positive QRS complex in aVR, aVL,
and CV5RL (M-shaped); and large wide S waves in
leads I, II, III, and aVF. There is a right axis deviation
(approximately 110) (50 mm/second, 1 cm 5 1
mV). (From: Tilley, L.P. Essentials of canine and feline
with permission.)
Figure 2. Right bundle branch block in a cat with the

dilated form of cardiomyopathy. The QRS duration is
0.08 second (4 boxes). Large and wide S waves are
present in leads I, II, III, aVF, and CV6LU. The QRS
in CV5RL has a wide R wave (M-shaped). There
is a marked axis deviation (approximately 90 ).
with permission.)
Topic-Sick Sinus Syndrome

Figure 1. A continuous lead II ECG rhythm strip
recorded from a dog with sick sinus syndrome. The
dogs rhythm is initially an ectopic atrial rhythm
(negative P waves; heart rate 187 beats/minute)
followed by asystole of more than 10 seconds duration
which is terminated by a junctional escape complex.
Four sinus complexes precede a brief sinus pause that
is again terminated by a junctional escape complex. The
ectopic atrial rhythm then resumes. (paper speed = 50
mm/s)
Cardiology
Topic-Sinus Arrest and Sinoatrial Block
Figure 1. Intermittent sinus arrest in a brachycephalic
breed with an upper respiratory disorder and episodes
of fainting. The pauses (1 and 1.44 seconds) are greater
than twice the normal R-R interval (0.46). (From: Tilley,
permission.)
Topic-Sinus Arrhythmia
Figure 1. Respiratory sinus arrhythmia with an average
rate of 120/minute (paper speed, 25 mm/second; 6
complexes between 1 set of time lines m 20). The rate
increases during inspiration (INSP) and decreases
during expiration (EXP). The fluctuation of the baseline
correlates with the movement of the electrodes by the
thoracic cavity. (From: Tilley, L.P. Essentials of canine
and feline electrocardiography. 3rd ed. Baltimore:
Williams & Wilkins, 1992, with permission.)
Topic-Sinus Bradycardia
Figure 1. Sinus bradycardia at a rate of 75 beats/
minute in a cat during anesthetic complications during
surgery. (From: Tilley, L.P. Essentials of canine and
feline electrocardiography. 3rd. ed. Baltimore: Williams
& Wilkins, 1992, with permission.
Topic-Sinus Tachycardia
Figure 1. Sinus tachycardia at a rate of 272/minute in a
dog in shock. The rhythm is sinus because the P waves
are normal, the P-R relationship is normal, and the
rhythm is regular. (From: Tilley, L.P. Essentials of canine
and feline electrocardiography. 3rd ed. Baltimore:
Topic-Supraventricular Tachycardia
Figure 1. Sinus with an atrial premature complex
and paroxysmal supraventricular tachycardia. Abrupt
initiation and termination of the tachycardia help
distinguish it from sinus tachycardia (lead II, 50 mm/
second, 1 cm = 1 mV). (From: Tilley, L.P. Essentials
of canine and feline electrocardiography. 3rd ed.
Baltimore: Williams & Wilkins, 1992, with permission.)
Cardiology
Topic-Syncope
Figure 1
Topic-Tetralogy of Fallot
Figure 1. Classic Tetralogy of Fallot.
Topic-Ventricular Arrhythmias and Sudden

Death in German Shepherds
Figure 1. Example of ventricular arrhythmia seen in
severely affected German shepherds with inherited
arrhythmias and propensity for sudden death. Courtesy
of Sydney Moise.
arrhythmias and propensity for sudden death.Courtesy
of Sydney Moise.
of Sydney Moise.

of Sydney Moise.
of Sydney Moise.
Topic-Ventricular Fibrillation
Figure 1. Coarse ventricular fibrillation. (From: Tilley,
permission.)
Figure 2. Ventricular flutter-fibrillation in a cat with
severe myocardial damage from an 11-story fall. The
complexes are very wide, bizarre, tall, and rapid.
electrocardiography. 3rd ed. Baltimore: Williams &
Cardiology
Topic-Ventricular Premature Complexes
Topic-Ventricular Septal Defect
Figure 1. VPC and a fusion complex (fifth complex)

in a dog with myocarditis from a pancreatitis. A
fusion complex is the simultaneous activation of the
ventricle by impulses coming from the SA node and
the ventricular ectopic foci. The QRS complex is
intermediate in form. (From: Tilley, L.P. Essentials
Figure 1 Ventricular septal defect. The defect is

an unobstructed communication. Right ventricular
hypertrophy and pulmonary hypertension are
associated. Left-to-right shunting is shown. RA =
right atrium, LA = left atrium, RV = right ventricle,
LV= left ventricle, AO = aorta, PT = pulmonary trunk.
(From: Roberts, W. Adult Congenital Heart Disease.
Philadelphia: F.A. Davis, 1987, with permission.)
Figure 2. Ventricular bigeminy. Every other complex is a

VPC from the same focus. Each is coupled (interval the
same between it and the adjacent sinus complex) to the
preceding normal complex. (From: Tilley, L.P. Essentials
Figure 2. Angiocardiogram of ventricular septal defect.

Figure 3. Necropsy specimen of ventricular septal
defect.
Topic-Ventricular Standstill (Asystole)

Figure 1. Ventricular asystole in a dog with severe
complete AV block. Only P wages (atrial activity) are
present; there is no ventricular activity. (Lead II, 50 mm/
second, 1 cm = 1 mV) (From: Tilley, L.P. Essentials of
Cardiology
Figure 2. Ventricular asystole in a cat with severe
hyperkalemia (11 mEq/L) from urethral obstruction. No
P waves or QRS complexes are seen after four wide
and nozaree QRS complexes (atrial standstill with
delayed ventricular conduction). (lead II, 50 mm/sec, 1
cm = 1 mV) (From: Tilley LP: Essentials of canine and
feline electrocardiography. 3rd ed. Blackwell Publishing,
1992, with permission.)
Topic-Ventricular Tachycardia
Figure 1. Ventricular tachycardia. The wide and bizarre
QRS complexes occur at a rate of 160 beats/minute,
with no relationship to the P waves. There are more
QRS complexes than P waves. Ventricular tachycardia
should be treated as soon as possible. Acid-base and
electrolyte abnormalities should always be corrected.
electrocardiography. 3rd ed. Baltimore: Williams &
Topic-Wolff-Parkinson-White Syndrome
Figure 1. Wolff-Parkinson-White syndrome (canine).
Ventricular pre-excitation represented by the short
P-R interval, wide QRS complex, and delta wave
(arrow) in CV6LU. Paroxysms of supraventricular
tachycardia are represented in the long lead II rhythm
strip. (From: Tilley, L.P. Essentials of canine and feline
with permission.)
Figure 2. Ventricular pre-excitation in a cat with
episodes of fainting. The P waves are normal, the P-R
interval is short, and the QRS complex is wide; delta
waves (arrow) are present. (From: Tilley, L.P. Essentials
Blackwell Publishing, 1992, with permission.)
Cardiology
Figure 1. Angiogram of aortic stenosis.
Cardiology
Figure 2. Postmortem of a dog with subaortic stenosis demonstrating

left ventricular (LV) hypertrophy, aortic post-stenotic dilation (Ao), and a
subvalvular fibrous ridge (instrument pointer).
Cardiology
Figure 3. Two-dimensional echocardiograph, right parasternal long axis

view, demonstrating a subvalvular ridge typical of subaortic stenosis.
Thickening of the anterior mitral valve leaflet (MV) is also apparent. Aorta
(Ao), left ventricle (LV), and left atrium (LA).
Cardiology
Figure 4. Similar to 1A with color flow Doppler overlay demonstrating

turbulent flow distal to the obstruction.
Cardiology
Figure 1.
Cardiology
Figure 2. A cat with thrombus of the left forelimb.
Cardiology
Figure 3. A cat with thrombus and cyanotic pads.
Cardiology
Figure 4. Postmortem thrombus in a cat.
Cardiology
Cardiology
Cardiology
Cardiology
Topic-Ascites
Cardiology
Topic-Ascites
Cardiology
Figure 1. Atrial flutter with 2:1 conduction at ventricular rate of 330/minute

in a dog with an atrial septal defect. This supraventricular tachycardia
was associated with a Wolff-Parkinson-White pattern. (From: Tilley, L.P.
Essentials of canine and feline electrocardiography, 3rd ed. Baltimore:
Cardiology
Figure 2. Coarse atrial fibrillation in a dog with patent ductus arteriosus.

The f waves are prominent. (From: Tilley, L.P. Essentials of canine and
feline electrocardiography, 3rd ed. Baltimore: Williams & Wilkins, 1992, with
permission.)
Cardiology
Figure 1. APC in a dog. P9 represents the premature complex. The

premature QRS resembles the basic QRS. The upright P9 wave is
superimposed on the T wave of the preceding complex. APC. (From: Tilley,
L.P. Essentials of canine and feline. 3rd ed. Blackwell Publishing, 1992,
with permission.)
Cardiology
Figure 2. APCs in bigeminy in a cat under general anesthesia. The second

complex of each pair is an APC, where the first is a sinus complex. The
abnormality in rhythm disappeared after the anesthetic was stopped.
(From: Tilley, L.P. Essentials of canine and feline electrocardiography. 3rd
ed. Blackwell Publishing, 1992, with permission.)
Cardiology
Topic-Atrial Septal Defect
Figure 1. Atrial septal defect. Defect involves the lowermost part of the
atrial septum, known as ostium primum defect. Note the left dominant leftto-right shunt. RV = right ventricle, LV = left ventricle, RA = right atrium,
Ao= aorta, PT = pulmonary trunk. (From Roberts W. Adult congenital heart
disease. Philadelphia: FA Davis Co., 1987, with permission.)
Cardiology
Topic-Atrial Standstill
Figure 1. Persistent atrial standstill in English springer spaniel. No P

waves are present on any of the leads (also including chest leads and
intracardiac electrocardiogram, not shown here). The regular bradycardia
is either junctional in origin, with pathologic involvement of the left bundle
branch block (wide positive QRS complexes), or ventricular. (From: Tilley,
L.P. Essentials of canine and feline electrocardiography. 3rd ed. Baltimore:
Cardiology
Figure 1. Gross specimenleft atrial tear
Cardiology
Figure 2. Right parasternal short axis echocardiographic image at the level

of the aorta and left atrium. The arrow points to an intra-atrial thrombus
attached to the atrial wall at the junction of the body of the left atrium and
the left auricular appendage. Severe left atrial enlargement and pericardial
effusion are present. LAA= Left auricular appendage; LA=Left atrium;
PE=Pericardial effusion.
Cardiology
Figure 3. Right parasternal short axis echocardiographic image at the level

of the left ventricle (LV). Pericardial effusion is noted and a characteristic
linear thrombus is seen within the pericardial sac adjacent to the LV. LV=
left ventricle; PE=pericardial effusion.
Cardiology
Figure 4. Gross cardiac specimen from a dog with advanced mitral

endocardiosis that died following an acute left atrial tear. The probe is
pointing to a 2 cm tear in the left atrial wall at the junction of the body of
the left atrium and left auricular appendage. LAA=left auricular appendage;
LA=left atrium. Photo courtesy of Dr. Richard Jakowski.
Cardiology
Topic-Atrioventricular Block, Complete (Third Degree)
Figure 1. Complete heart block. The P waves occur at a rate of 120,

independent of the ventricular rate of 50. The QRS configuration is a right
bundle branch block pattern. The regular rate and stable QRS indicate
that the rescuing focus is probably near the AV junction. (From: Tilley, L.P.
Essentials of canine and feline electrocardiography. 3rd ed. Blackwell
Cardiology
Figure 2. Complete heart block in a cat. The P waves rate is 240/minute,

independent of the ventricular rate of 48/minute. QRS configuration is a
left bundle branch block pattern. (From: Tilley, L.P. Essentials of canine
and feline electrocardiography. 3rd ed. Blackwell Publishing, 1992, with
permission.)
Cardiology

Figure 3. Lateral radiograph of a dog with transvenous pacemaker.
Cardiology
Figure 1. Lead II ECG rhythm strip recorded from a cat with hypertrophic
cardiomyopathy. There is sinus bradycardia (120 beats/minute) and first
degree atrioventricular conduction block. The PR interval is 0.12 second.
(paper speed = 50 mm/s)
Cardiology
Figure 2. Lead II ECG rhythm strip recorded from a dog showing sinus
tachycardia (175 beats/minute) and first degree atrioventricular conduction
block. Because the heart rate is rapid, P waves are superimposed on
the downslope of the preceding T waves. The PR interval exceeds 0.16
second. (paper speed = 50 mm/s)
Cardiology
Topic-Atrioventricular Block, Second Degree - Mobitz

Type I
Figure 1. Lead II ECG strip recorded from a dog with Mobitz type I, second
degree AV block. The PR intervals become progressively longer with the
longest PR intervals preceding nonconducted P waves (typical Wenkebach
phenomenon). (paper speed = 50 mm/s)
Cardiology
Topic-Atrioventricular Block, Second Degree - Mobitz

Type II
Figure 1. Lead II ECG rhythm strip recorded from a dog with both firstand second-degree atrioventricular block. The second-degree AV block
is high grade with both 2:1 and 3:1 block resulting in variation in the RR
intervals. The PR interval for the conducted beats is prolonged but constant
(0.28second) (paper speed = 25 mm/s).
Cardiology
Topic-Atrioventricular Valve Dysplasia
Figure 1. Lateral radiographs of mitral valve dysplasia.
Cardiology
Figure 1. Postmortem of valvular endocardiosis.
Cardiology
Figure 2. Lateral radiograph of mitral valve endocardiosis.
Cardiology
Figure 1. This image of the liver in a dog with tricuspid stenosis and right
heart failure shows markedly distended hepatic veins.
Cardiology
Figure 2. This continuous wave Doppler recording across the tricuspid

valve in a dog with tricuspid stenosis illustrates the prolonged pressure half
time (evidenced by the slope of the line between E and F points) and the
prominent atrial contribution (A) to filling. This animal also had tricuspid
regurgitation.
Cardiology
Figure 1. Postmortem of dilated cardiomyopathy (cat).
Cardiology
Figure 2. Echocardiogram of dilated cardiomyopathy (cat).
Cardiology
Figure 1. Gross postmortem of dilated cardiomyopathy (dog).
Cardiology
Figure 2. Electrocardiographic findings.
Cardiology
Cardiology
Figure 2. Chest radiograph (lateral) of hypertyrophic cardiomyopathy (cat).
Cardiology
Figure 3. Chest radiography (dorsoventral) of hypertrophic cardiomyopathy

(cat).
Cardiology
Figure 4. Echocardiogram of hypertrophic cardiomyopathy (cat).
Cardiology
Figure 5. Gross postmortem of hypertrophic cardiomyopathy (cat).
Cardiology
Figure 6. Angiocardiogram of hypertrophic cardiomyopathy (cat).
Cardiology
Topic-Cardiomyopathy, Restrictive - Cats
Figure 1. Cardiomyopathy, restrictivecats.
Cardiology

Cardiology

Figure 2. Cachexia in a dog.
Cardiology
Topic-Congestive Heart Failure, Right-Sided
Cardiology
Cardiology
Figure 3. Jugular distension in a cat with right-sided congestive heart

failure.
Cardiology
Figure 4. Abdominal venous distension in a dog with right-sided heart

failure.
Cardiology
Topic-Digoxin Toxicity
Figure 1. Sagging type of S-T segment depression in a dog with digitalis

toxicity.
Cardiology
Figure 1. Gross postmortem of bacterial endocarditis
Cardiology
Cardiology
Cardiology
Topic-Heartworm Disease - Cats
Figure 1. Gross postmortem of heartworm disease in cat.
Cardiology
Figure 1a. Microfilaria of dirofilaria and acanthocheilonema (Justin A.

Thomason).
Cardiology
Figure 1b. Microfilaria of dirofilaria and acanthocheilonema (Justin A.

Thomason).
Cardiology
Figure 2. Dorsoventral radiograph of heartworm disease in a dog.
Cardiology
Figure 3. Echocardiogram of heartworm disease.
Cardiology
Figure 4. Gross postmortem of heartworm disease in a dog.
Cardiology
Figure 1. Ventricular escape complexes (arrows) during various phases

in the dominant sinus rhythm in a dog during anesthesia. The sinus rate
increased (not shown) after anesthesia was stopped; 1/2 cm1 mv. (From:
Tilley, L.P. Essentials of canine and feline electrocardiography. 3rd ed.
Blackwell Publishing, 1992, with permission.)
Cardiology
Figure 2. Complete heart block. The P waves occur at a rate of 120,

independent of the ventricular rate of 50. The QRS configuration is a right
bundle branch block pattern. The regular rate and stable QRS indicate
that the rescuing focus is probably near the AV junction. (From: Tilley, L.P.
Cardiology
Figure 1. Left anterior fascicular block in a cat with hypertrophic

cardiomyopathy. Severe left axis deviation (2608) with a qR pattern in
leads I and aVL and an rS pattern in leads II, III, and aVF. The QRS
complexes are of normal duration. (From: Tilley, L.P. Essentials of canine
permission.)
Cardiology
Figure 2. Left anterior fascicular block in a dog with hyperkalemia (serum

potassium, 5.3 mEq/L). There is abnormal left axis deviation (260_) with
a qR pattern in leads I and aVL and an rS pattern in leads II, III, and aVF.
The large T waves are compatible with hyperkalemia. (From: Tilley, L.P.
Cardiology
Figure 1. Left bundle branch block in a cat with hypertrophic

cardiomyopathy. The QRS complex is of 0.07-second duration and is
positive in leads I, II, III, aVF. Neither a Q wave nor an S wave occurs in
these leads. The QRS complex is inverted in leads aVR. (From: Tilley,
L.P. Essentials of canine and feline electrocardiography. 3rd ed. Blackwell
Cardiology
Figure 2. Intermittent left bundle branch block in a Chihuahua. QRS

complexes are wider (0.070.08 second) in the second, third, and fourth
complexes and in the last three complexes. Consistent P-R interval
confirms a sinus origin for the abnormal-appearing QRS complexes (lead
II, 50 mm/second, 1 cm 5 1 mV). (From: Tilley, L.P. Essentials of canine
permission.)
Cardiology
Topic-Murmurs, Heart
Figure 1. Differential diagnosis of cardiac disease based on the timing and

location of murmurs. (Adapted from Allen, D.G. Murmurs and abnormal
heart sounds. By permission of Mosby-Year Book, Inc. In: Allen, D.G.,
Kruth, S.A., eds. Small animal cardiopulmonary medicine. Philadelphia: BC
Decker, 1988:13.)
Cardiology
Topic-Myocardial Infarction
Figure 1. Transmural infarction of the left ventricle in a dog with

arteriosclerosis and hypothyroidism. The first three rapid successive
complexes represent ventricular tachycardia. The sinus rhythm that follows
illustrates small complexes, marked elevation of the S-T segment, and first
degree AV block (prolonged P-R interval). (From: Tilley, L.P. Essentials of
canine and feline electrocardiography. 3rd ed. Blackwell Publishing, 1992,
with permission.)
Cardiology
Figure 1. Angiocardiogram of patent ductus arteriosus.
Cardiology

Figure 2. Patent ductus arteriosus.
Cardiology
Topic-Pericarditis
Figure 1. The photograph demonstrates catheter positioning and

orientation for pericardiocentesis from the right ventral approach. While
stabilizing the catheter near the entry point with one hand, the catheter
is advanced in a cranial and dorsal direction with the other, i.e. towards
the opposite scapula. A small degree of suction is maintained with the
syringe so that pericardial fluid is aspirated at the moment of pericardial
penetration. Subsequently the syringe and stylet are held stationary while
the flexible catheter is advanced well into the pericardium. The sharp
metal stylet is withdrawn after the catheter is fully positioned.
Cardiology
Topic-Pericarditis
Figure 2. Echocardiograph acquired with transducer at the same location

and orientation (direction) as the catheter shown above. Dotted line
indicates structures encountered by the central ultrasound beam, i.e. in
the path of the catheter. While this patient had a relatively small amount
of pericardial effusion (PE), proper catheter positioning, orientation, and
linear advancement minimizes risk. Oblique orientation of the catheter,
relative to the cardiac surface, increases the effective distance between the
pericardium and heart.
Cardiology
Topic-Pericarditis
Figure 3. Instrumentation used for pericardiocentesis. A 14g 5catheter

and stylus are shown with a small syringe attached, i.e. configured to
advance into the pericardial space. The sharp metal stylus is removed
after the catheter is fully positioned, as demonstrated for the 16g
5catheter, and an extension tube attached to the catheter for aspiration
using a larger syringe and 3-way stopcock. An 18g 2 catheter is used for
cats and similarly sized dogs. A #11 blade is ideal for creating a small stab
incision at the site of entry. The author uses a #10 blade to cut side holes
in the distal end of the larger catheters (optional).
Cardiology
Cardiology
Figure 2. Radiograph of pleural effusionlateral (dog).
Cardiology
Figure 1. Ventrodorsal radiograph of a dog with pulmonic stenosis. There is

a marked right ventricular enlargement, with the apex shifted to the left. A
prominent pulmonary artery bulge is visible (arrow) (Virginia Luis Fuentres).
Cardiology
Figure 2. Two-dimensional echocardiographic right parasternal long axis

view of a dog with severe pulmonic stenosis. The right ventricular free wall
and interventricular septum are very hypertrophied, with mild right atrial
enlargement (Virginia Luis Fuentres).
Cardiology
Figure 3. Continuous wave spectral Doppler recording of pulmonary

artery flow from a left cranial view in a dog with severe pulmonic stenosis.
Pulmonary artery velocities are greatly increased (approximately 5 m/s).
Cardiology
Figure 1. Right bundle branch block in a dog. The electrocardiographic

features include QRS duration of 0.08 second; positive QRS complex in
aVR, aVL, and CV5RL (M-shaped); and large wide S waves in leads I, II,
III, and aVF. There is a right axis deviation (approximately 110) (50 mm/
second, 1 cm 5 1 mV). (From: Tilley, L.P. Essentials of canine and feline
electrocardiography. 3rd ed. Blackwell Publishing, 1992, with permission.)
Cardiology
Figure 2. Right bundle branch block in a cat with the dilated form of
cardiomyopathy. The QRS duration is 0.08 second (4 boxes). Large and
wide S waves are present in leads I, II, III, aVF, and CV6LU. The QRS in
CV5RL has a wide R wave (M-shaped). There is a marked axis deviation
(approximately 90 ). (From: Tilley, L.P. Essentials of canine and feline
electrocardiography. 3rd ed. Blackwell Publishing, 1992, with permission.)
Cardiology
Topic-Sick Sinus Syndrome
Figure 1. A continuous lead II ECG rhythm strip recorded from a dog with
sick sinus syndrome. The dogs rhythm is initially an ectopic atrial rhythm
(negative P waves; heart rate 187 beats/minute) followed by asystole of
more than 10 seconds duration which is terminated by a junctional escape
complex. Four sinus complexes precede a brief sinus pause that is again
terminated by a junctional escape complex. The ectopic atrial rhythm then
resumes. (paper speed = 50 mm/s)
Cardiology
Topic-Sinus Arrest and Sinoatrial Block
Figure 1. Intermittent sinus arrest in a brachycephalic breed with an upper

respiratory disorder and episodes of fainting. The pauses (1 and 1.44
seconds) are greater than twice the normal R-R interval (0.46). (From:
Cardiology
Topic-Sinus Arrhythmia
Figure 1. Respiratory sinus arrhythmia with an average rate of 120/

minute (paper speed, 25 mm/second; 6 complexes between 1 set of time
lines m 20). The rate increases during inspiration (INSP) and decreases
during expiration (EXP). The fluctuation of the baseline correlates with
the movement of the electrodes by the thoracic cavity. (From: Tilley, L.P.
Essentials of canine and feline electrocardiography. 3rd ed. Baltimore:
Cardiology
Topic-Sinus Bradycardia
Figure 1. Sinus bradycardia at a rate of 75 beats/minute in a cat during

anesthetic complications during surgery. (From: Tilley, L.P. Essentials
of canine and feline electrocardiography. 3rd. ed. Baltimore: Williams &
Wilkins, 1992, with permission.
Cardiology
Topic-Sinus Tachycardia
Figure 1. Sinus tachycardia at a rate of 272/minute in a dog in shock. The

rhythm is sinus because the P waves are normal, the P-R relationship is
normal, and the rhythm is regular. (From: Tilley, L.P. Essentials of canine
and feline electrocardiography. 3rd ed. Baltimore: Williams & Wilkins, 1992,
with permission.)
Cardiology
Topic-Supraventricular Tachycardia
Figure 1. Sinus with an atrial premature complex and paroxysmal

supraventricular tachycardia. Abrupt initiation and termination of the
tachycardia help distinguish it from sinus tachycardia (lead II, 50 mm/
second, 1 cm = 1 mV). (From: Tilley, L.P. Essentials of canine and feline
electrocardiography. 3rd ed. Baltimore: Williams & Wilkins, 1992, with
permission.)
Cardiology
Topic-Syncope
Figure 1
Cardiology
Topic-Tetralogy of Fallot
Figure 1. Classic Tetralogy of Fallot.
Cardiology
Topic-Ventricular Arrhythmias and Sudden Death in

German Shepherds
Figure 1. Example of ventricular arrhythmia seen in severely affected

German shepherds with inherited arrhythmias and propensity for sudden
death. Courtesy of Sydney Moise.
Cardiology

German Shepherds

death.Courtesy of Sydney Moise.
Cardiology

German Shepherds

Cardiology

German Shepherds

Cardiology

German Shepherds

Cardiology
Figure 1. Coarse ventricular fibrillation. (From: Tilley, L.P. Essentials

of canine and feline electrocardiography. 3rd ed. Baltimore: Williams &
Cardiology
Figure 2. Ventricular flutter-fibrillation in a cat with severe myocardial

damage from an 11-story fall. The complexes are very wide, bizarre,
tall, and rapid. (From: Tilley, L.P. Essentials of canine and feline
electrocardiography. 3rd ed. Baltimore: Williams & Wilkins, 1992, with
permission.)
Cardiology
Figure 1. VPC and a fusion complex (fifth complex) in a dog with

myocarditis from a pancreatitis. A fusion complex is the simultaneous
activation of the ventricle by impulses coming from the SA node and the
ventricular ectopic foci. The QRS complex is intermediate in form. (From:
Cardiology
Figure 2. Ventricular bigeminy. Every other complex is a VPC from the

same focus. Each is coupled (interval the same between it and the
adjacent sinus complex) to the preceding normal complex. (From: Tilley,
L.P. Essentials of canine and feline electrocardiography. 3rd ed. Baltimore:
Cardiology
Figure 1 Ventricular septal defect. The defect is an unobstructed

communication. Right ventricular hypertrophy and pulmonary hypertension
are associated. Left-to-right shunting is shown. RA = right atrium, LA = left
atrium, RV = right ventricle, LV = left ventricle, AO = aorta, PT = pulmonary
trunk. (From: Roberts, W. Adult Congenital Heart Disease. Philadelphia:
F.A. Davis, 1987, with permission.)
Cardiology
Figure 2. Angiocardiogram of ventricular septal defect.
Cardiology
Figure 3. Necropsy specimen of ventricular septal defect.
Cardiology
Figure 1. Ventricular asystole in a dog with severe complete AV block. Only

P wages (atrial activity) are present; there is no ventricular activity. (Lead
II, 50 mm/second, 1 cm = 1 mV) (From: Tilley, L.P. Essentials of canine
permission.)
Cardiology
Figure 2. Ventricular asystole in a cat with severe hyperkalemia (11 mEq/L)

from urethral obstruction. No P waves or QRS complexes are seen after
four wide and nozaree QRS complexes (atrial standstill with delayed
ventricular conduction). (lead II, 50 mm/sec, 1 cm = 1 mV) (From: Tilley
LP: Essentials of canine and feline electrocardiography. 3rd ed. Blackwell
Cardiology
Topic-Ventricular Tachycardia
Figure 1. Ventricular tachycardia. The wide and bizarre QRS complexes

occur at a rate of 160 beats/minute, with no relationship to the P waves.
There are more QRS complexes than P waves. Ventricular tachycardia
should be treated as soon as possible. Acid-base and electrolyte
abnormalities should always be corrected. (From: Tilley, L.P. Essentials
of canine and feline electrocardiography. 3rd ed. Baltimore: Williams &
Cardiology
Figure 1. Wolff-Parkinson-White syndrome (canine). Ventricular preexcitation represented by the short P-R interval, wide QRS complex, and
delta wave (arrow) in CV6LU. Paroxysms of supraventricular tachycardia
are represented in the long lead II rhythm strip. (From: Tilley, L.P.
Cardiology
Figure 2. Ventricular pre-excitation in a cat with episodes of fainting. The P

waves are normal, the P-R interval is short, and the QRS complex is wide;
delta waves (arrow) are present. (From: Tilley, L.P. Essentials of canine
permission.)

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Cardiology

Figure 7. Aortic thromboembolism.

Topic-Atrial Fibrillation and Atrial Flutter

Figure 4. Postmortem thrombus in a cat.

A John Wiley & Sons, Ltd., Publication

Topic-Atrial Septal Defect

Topic-Atrial Wall Tear

A John Wiley & Sons, Ltd., Publication

Topic-Atrioventricular Block, Complete

Figure 2. Complete heart block in a cat. The P waves

Topic-Atrioventricular Block, First Degree

A John Wiley & Sons, Ltd., Publication

Topic-Atrioventricular Block, Second

Topic-Atrioventricular Valve Dysplasia

Topic-Atrioventricular Valve Endocardiosis

Topic-Atrioventricular Valvular Stenosis

Topic-Cardiomyopathy, Dilated - Cats

Topic-Cardiomyopathy, Dilated - Dogs

Topic-Cardiomyopathy, Hypertrophic - Cats

A John Wiley & Sons, Ltd., Publication

Figure 3. Jugular distension in a cat with right-sided

Figure 3. Chest radiography (dorsoventral) of

Figure 4. Abdominal venous distension in a dog with

Figure 4. Echocardiogram of hypertrophic

Topic-Cardiomyopathy, Restrictive - Cats

Topic-Congestive Heart Failure, Left-Sided

Topic-Congestive Heart Failure, RightSided

Topic-Heartworm Disease - Cats

Topic-Heartworm Disease - Dogs

A John Wiley & Sons, Ltd., Publication

Topic-Left Anterior Fascicular Block

A John Wiley & Sons, Ltd., Publication

Topic-Patent Ductus Arteriosus

A John Wiley & Sons, Ltd., Publication

Figure 3. Instrumentation used for pericardiocentesis.

A John Wiley & Sons, Ltd., Publication

Topic-Right Bundle Branch Block

Figure 2. Right bundle branch block in a cat with the

Topic-Sick Sinus Syndrome

A John Wiley & Sons, Ltd., Publication

A John Wiley & Sons, Ltd., Publication

Topic-Ventricular Arrhythmias and Sudden

Figure 4. Example of ventricular arrhythmia seen in

A John Wiley & Sons, Ltd., Publication

Topic-Ventricular Septal Defect

Figure 1. VPC and a fusion complex (fifth complex)

Figure 1 Ventricular septal defect. The defect is

Figure 2. Ventricular bigeminy. Every other complex is a

Figure 2. Angiocardiogram of ventricular septal defect.

Topic-Ventricular Standstill (Asystole)

A John Wiley & Sons, Ltd., Publication

A John Wiley & Sons, Ltd., Publication

Figure 1. Angiogram of aortic stenosis.

A John Wiley & Sons, Ltd., Publication

Figure 2. Postmortem of a dog with subaortic stenosis demonstrating

A John Wiley & Sons, Ltd., Publication

Figure 3. Two-dimensional echocardiograph, right parasternal long axis

A John Wiley & Sons, Ltd., Publication

Figure 4. Similar to 1A with color flow Doppler overlay demonstrating

A John Wiley & Sons, Ltd., Publication

A John Wiley & Sons, Ltd., Publication

Figure 2. A cat with thrombus of the left forelimb.

A John Wiley & Sons, Ltd., Publication

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