Ventricular bigeminy associated with myocardial ischemia in a dog with a colonic torsion: a case report

Abstract Background Ventricular bigeminy due to myocardial ischemia has been reported in humans as well as in canine patients with obstructive gastrointestinal diseases. This is the first case report of ventricular bigeminy in a dog with a colonic torsion that resolved with fluid resuscitation and restoration of myocardial perfusion. Case Presentation An 11-year-old, male neutered mixed breed dog presented with a one day history of vomiting, tenesmus, and lethargy. Physical examination identified an arrhythmia, namely ventricular premature complexes (VPCs), on a 3-lead ECG and intermittent pulse deficits. Abdominal radiographs confirmed a colonic torsion. Prior to anesthetic induction, ventricular bigeminy was noted that was non responsive to fentanyl or lidocaine. The patient was anesthetized and intravascular volume deficit was identified by dampened plethysmographic wave amplitude (plethysomographic variability), audible softening of the Doppler sound, and more pronounced pulse deficits. Fluid resuscitation was achieved with a combination of intravenous crystalloid and colloid fluid therapy comprising 7.2% hypertonic saline and 6% hetastarch. The patient’s cardiac rhythm converted to normal sinus after fluid resuscitation and the colonic torsion was surgically corrected. The patient recovered well from anesthesia and was ultimately discharged from the hospital. Conclusions The present case report highlights that myocardial ischemia can lead to ventricular arrythmias, such as ventricular bigeminy. This is the first documented case of ventricular bigeminy in the canine patient with a colonic torsion. Assessment of patient volume status and appropriate fluid resuscitation along with continuous electrocardiogram (ECG) monitoring are vital to patient stability under general anesthesia.