Weakness-Fainting-Syncope-

Seizures
• A progressive set of symptoms
• Clinically relevant in daily practice
Steve Ettinger, DVM
California Animal Hospital
Los Angeles, Ca. 90025
PetDRx Corporation
Important Definitions
Lassitude
Asthenia
Syncope
Faintness
Seizure
Stupor-Coma
 Lassitude/Fatigue

Defined as a lack of energy:

listlessness, weakness,
languor, without pep and
without interest
Severe Asthenia- unable to rise or
pick up head
 Lassitude or Fatigue
• Psychological
• Over activity; over work; over exercise
• Chronic infection
• Metabolic Disease
• Endocrine disorder
• Anemia
• Nutritional
• Heartworms
• Ascites
• Fever
 ASTHENIA
• A true loss of strength that occurs
continuously or following a
repeated contractions
• It may proceed to paralysis
without a loss of consciousness
 Causes of Asthenia
• Anemia
• Chronic Fever
• Endocrine disorders
• Neoplasia
• Neuromuscular problems
• Electrolyte imbalances
• Chronic Wasting Diseases (GI; Cardiac; Renal
and Cirrhosis as examples)
 Minimum Data Base
• Physical Examination
• Good historical information from client
• Laboratory testing (general chemistry and
CBC; urinalysis)
• Radiography- two views of thorax and
abdomen
• Electrocardiogram or Holter recording for
arrhythmia detection
Hypoaklenia (vomiting induced)
Hypokalemia causing Weakness
Electric Cord Burn
NEUROLOGICAL- MYELOPATHY
THYROID NODULE (T4)
HORNER’S SYNDROME
 Definitions
• Seizure:
– Clinical manifestation of excessive neuronal discharges in the
cerebral cortex
– Neurotransmitters imbalance
• Excitatory: glutamate, Ach, aspartate
• Inhibitory: GABA, glycine
– Excitatory > Inhibitory
– Paroxysmal depolarization shift (PDS)

• Epilepsy:
recurrent seizures activity, w/ or w/out intra-cranial disease
 Seizures Classification
• Generalized
– Loss of consciousness
– Autonomic signs
• Partial (Simple vs Complex)
– Conscious
– Twitching of one part of the body
– Repeated abnormal behavior
Epileptic Seizure- Full
Myoclonus--Distemper Chorea
Focal Seizure in Dog
 Definition
• Syncope: from Greek syncoptein, to cut short
– Short, episodic loss of consciousness
– Result from transient cerebral hypoxia or anoxia
– If hypoxia is prolonged  actual seizures may result
– Most often result from a cardiorespiratory disorder
 Syncope
• Circulatory
– Peripheral
– Cardiac
• Other
– Chemical
– Cerebral
 Syncope Recognition
• Precipitating event: exercise, stress, cough
• No pre or post-ictal period
• Event features:
• flaccid or rigid
• urination, foaming ALSO possible
• Duration: usually short (<1 minute)
• Recovery: usually quick
“The only difference between syncope and
sudden death is you awake from one’’
 Cardiac Syncope
• Heart Rate- rapid or slow
• Rhythm- regular; irregular
• Mechanical- obstruction
• Myocardial function- hypo or
hyper contractility
 Video-Syncope
Video part of the collection from Cornell University and Dr deLahunta

From Dr. Paquette and Dr. deLahunta collection- gratefully acknowledged

 Tachyarrhythmia

• Ventricular: V tachycardia
• Supra-Ventricular: A fibrillation, A tach
 Syncope
cerebral hypoperfusion

systemic hypotension

Decreased CO Loss vascular resistance

– Arrhythmias – Vagally mediated
(brady, tachy) – Drugs therapy
– Flow obstruction – Sepsis, shock
– Loss preload
 Bradyarrhythmia
• Vasovagal reflex (2nd coughing, vomiting, stress,
pain)
• Sick sinus syndrome (SSS)
• AV Blocks
 Syncope
cerebral hypoperfusion

systemic hypotension

Decreased CO Loss vascular resistance

– Arrhythmias – Vagally mediated
(brady, tachy) – Drugs therapy
– Flow obstruction – Sepsis, shock
– Loss preload
 Sub-Aortic Stenosis
Lateral thorax Valve Stenotic and Irregular
Heart Worm in RV
 Syncope
cerebral hypoperfusion

systemic hypotension

Decreased CO Loss vascular resistance

– Arrhythmias – Vagally mediated
(brady, tachy) – Drugs therapy
– Flow obstruction – Sepsis, shock
– Loss preload
 Peripheral Syncope
• Vaso-vagal syncope: associated with an acute
hypotensive episode
• Postural Hypotension
• Tussive (coughing syncope)
• Peripheral Circulatory Failure
 Drugs-Therapy
• Tranquilizers
• Pain Medications
• Anesthesia-sedation
• Diuretics
• Hypotensive agents (B Blockers; ACEI; Alpha
blocking agents
• Drug Reactions- e.g. antibiotics
 Syncope
cerebral hypoperfusion

systemic hypotension

Decreased CO Loss vascular resistance

– Arrhythmias – Vagally mediated
(brady, tachy) – Drugs therapy
– Flow obstruction – Sepsis, shock
– Loss preload
 Weakness-Fainting-Syncope-
Seizures
• A progressive set of symptoms
• Clinically relevant in daily practice
• Requires history, physical examination and
good use of laboratory testing (xray-blood-
urine-ultrasound-ECG)
• Get good history (sometimes video) from
owner when dog/cat has these episodes
• Other causes not discussed (but do occur)