Amanda Shelby talks about what an ECG can and can't tell you

Amanda Shelby interview ECG

 interview, Amanda Shelby, RVT, VTS (Anesthesia; Analgesia), explains that while an ECG is an essential tool for visualizing the heart’s electrical activity, it cannot confirm mechanical function or guarantee that the heart is effectively beating. She reminds practitioners of the importance of evaluating the entire clinical picture rather than relying solely on monitor readings.

Amanda Shelby, RVT, VTS (Anesthesia; Analgesia): 

I'm super excited to be speaking at Fetch. My name is Amanda Shelby. Apologies for my appearance—I just got back from a massage. You know, self care is important. I am a registered veterinary technician in the state of Indiana and a VTS in anesthesia and analgesia, a title I’ve held since 2010. My background in academia, especially in anesthesia and analgesia, has given me years of experience that led to this achievement and beyond.

Today, I’m focusing on topics closely related to anesthesia, sharing clinical pearls that you can incorporate into your everyday practice. I currently serve as a Senior Content Creator and CE Coordinator for VETgirl. In previous roles, I built “Think Anesthesia,” an educational platform, and I’m excited to continue that journey both virtually and in person.

For those joining me live at Fetch, you’ll experience my lecture titled “ABCs for ECGs,” which will also be available on demand. The three primary takeaways include understanding the importance—and the limitations—of ECG monitoring. The key concept is that an ECG is only the electrical reflection of the heart; it does not guarantee mechanical or actual heart beating function. I hope you become more comfortable recognizing both normal and abnormal ECGs in sedated or anesthetized patients, as well as in ER scenarios.

Let me share a personal experience: when I was just six months into being a credentialed technician and still learning my craft in anesthesia at a university, I encountered a patient arrest under anesthesia despite a normal ECG reading. I noticed a drop in carbon dioxide levels—an insight that reinforced the idea that while monitors are invaluable, they only capture part of the patient’s picture. Thankfully, with the guidance of a supervising resident, I was able to manage the situation and learn a valuable lesson that has inspired me to improve my ECG interpretation skills.

Remember, while ECGs are wonderful tools, they have limitations. I hope you never have to learn this lesson the hard way, as I did.

Videos

Amanda Shelby, RVT, VTS (Anesthesia; Analgesia), outlines how an ECG’s electrical data must be interpreted alongside clinical signs, as it does not necessarily reflect the heart’s mechanical performance

What an ECG can—and can’t—tell you

The FDA announced it was conditionally approved sirolimus delayed-release tablets (Felycin-CA1; TriviumVet). The conditionally approved medication is for management of ventricular hypertrophy in feline patients with subclinical hypertrophic cardiomyopathy (HCM), making it the first product to receive approval for use in cats with this condition for any indication.

Feline HCM is a condition that causes the muscular walls of a feline patient’s heart to thicken, which decreases the heart’s efficiency, and can create other symptoms within other parts of the body. Currently, there is no cause of HCM clearly identified, but it is prevalent in certain breeds, including British shorthair, Chartreux, Maine coon, Persian, and Sphynx cats. Mutations of several cardiac heart genes has also been identified in some cats with HCM, suggesting genetics play a role.

Feline patients with HCM may not show any signs of being ill and can live for years in this subclinical phase. Others may present with congestive heart failure, including labored or rapid breathing, open-mouthed breaking, and lethargy. The presenting symptoms occur when fluid accumulates around or in the patient’s lungs. When it comes to HCM, a serious and life-threatening consequences is the formation of blood clots in the heart. The clots could move through the blood stream, causing thromboembolism. Although rare, feline patients with HCM are also at risk of sudden death.

Feline HCM Is extremely common in cats, affecting 1 in 1 of all pet cats, and for cats over 9-years-old, the prevalence is 1 in 3, making it the leading cause of mortality in adult cats.

Sirolimus, the active ingredient in Felycin-CA1, at a higher dose is used as an immunosuppressant in human patients receiving organ transplants. Felycin-CA1 is given to cats at a target dose of 0.3 mg/kg orally once a week and is not expected to be an immunosuppressive in patients.

In order for an animal drug to be eligible for conditional approval, it must address a serious or life-threatening disease or address an unmet need in animal or human health. The drug would also need to demonstrate effectiveness, requiring a complex or particularly difficult study or studies. Felycin-CA1 met this requirement because subclinical HCM progresses to clinical HCM, impacting daily functioning in cats and could be fatal. Felycin-CA1 also addresses an unmet animal need because there were no other drugs approved for use in feline patients with ventricular hypertrophy due to subclinical HCM. 

“Felycin-CA1 is the first and only medication shown to reduce the ventricular hypertrophy that is the principal feature of subclinical HCM. It provides a valuable treatment option for veterinarians and pet owners and will transform the way feline HCM is managed’ said Stuart Fitzgerald, Chief Scientific Officer at TriviumVet, in an organizational release.

For Felycin-CA1, demonstrating effectiveness required a complex or particularly difficult study or studies because the detection of subclinical HCM requires advanced diagnostic tests, which makes it difficult to enroll enough eligible cats.

Felycin-CA1 is only available by prescription from a licensed veterinarian, and cats should be screened for pre-existing live disease before starting the medication. This medication should also not be used in feline patients with diabetes mellitus or a pre-existing liver condition.

Felycin-CA is available in 0.4 mg, 1.2 mg, and 2.4 mg tablet sizes.

FDA Conditionally Approves Drug for Management of Ventricular Hypertrophy in Cats. News release. US Food and Drug Administration. March 14, 2025. Accessed March 14, 2025. https://www.fda.gov/animal-veterinary/cvm-updates/fda-conditionally-approves-drug-management-ventricular-hypertrophy-cats?utm_medium=email&utm_source=govdelivery

Cornell University. Hypertrophic Cardiomyopathy. Cornell University College of Veterinary Medicine. Accessed March 14, 2025. https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/hypertrophic-cardiomyopathy

Kaplan JL, Rivas VN, Walker AL, et al. Delayed-release rapamycin halts progression of left ventricular hypertrophy in subclinical feline hypertrophic cardiomyopathy: results of the RAPACAT trial. 

. 2023;261(11):1628-1637. Published 2023 Jul 26. doi:10.2460/javma.23.04.0187

TriviumVet Secures FDA Conditional Approval for Feline Cardiology Disease. News release. TriviumVet. March 14, 2025. Accessed March 14, 2025. https://www.triviumvet.com/blog/triviumvet-secures-fda-conditional-approval-for-feline-cardiology-disease

Articles

Felycin-CA1 manages ventricular hypertrophy in feline patients with subclinical hypertrophic cardiomyopathy 

FDA conditionally approves first drug for feline subclinical hypertrophic cardiomyopathy 

Erica Brandt, CVT, VTS (ECC), discusses what Fetch dvm360 Conference attendees can take away from her CE session on "Surviving Triage."

Confronting triage challenges

The ability to accurately and rapidly assessing an patient in an emergency situation makes the difference between a good veterinary technician and an excellent one, according to Erica Brandt, CVT, VTS (ECC), hospital director at WestVet in Meridian, Idaho. 

, her educational session being presented Saturday, March 15, at the 2025 Fetch dvm360 Conference in Charlotte, North Carolina. The session highlights the importance of recognizing a true emergency and immediate interventions.

The following is a transcript of the video:

, what I really want technicians to take away is [that] we've gone through a really rough time with communicating with clients, through the pandemic and those types of things. And I just want to reiterate we are all going through the same types of concerns, and troubleshooting that [what] we're trying to do to reestablish our relationship with clients and get back into those rooms. And then, it's not easy. It's not easy to look at a patient and decide, is this patient truly having an emergency, and what next steps do we need to take? So, I want a big collaborative room, a safe space to say this is a very difficult thing that we do, and here are some tips that I use to make it a little bit easier.

Erica Brandt, CVT, VTS (ECC), discusses her educational session being presented at the 2025 Fetch dvm360 Conference in Charlotte, North Carolina.

As veterinary medicine advances, the demand for compassionate, holistic care for pets at every stage of life grows. For general practitioners, urgent care, and emergency veterinarians, becoming a Certified Hospice and Palliative Care Veterinarian (CHPV) offers numerous benefits, enhancing both career satisfaction and quality of patient care. Here’s why CHPV certification is a smart move for veterinarians in these fields.

Clients increasingly seek specialized care options, especially for aging or terminally ill pets. They want to ensure their pets have comfort and dignity in their final stages of life, along with support in making difficult decisions. When veterinarians have the CHPV certification, it allows them to provide the compassionate end-of-life care clients are seeking, turning potentially challenging conversations into reassuring, educational moments.

CHPV certification empowers veterinarians to broaden their services to include hospice and palliative care, meeting the growing demand from pet families prioritizing their pets’ quality of life. Integrating these services into practices not only provides a unique offering but also strengthens client relationships as well as opens new revenue opportunities.

Additionally, it’s crucial to meet the expectations of your clients. You can enhance client loyalty and retention by delivering comprehensive care, including compassionate end-of-life services. Various studies show a 14-25% client attrition rate following pet loss- often due to owners feeling dissatisfied with the support they received during their pet's end-of-life care. Offering dignified and respectful end-of-life care addresses the evolving needs of all your clientele, ensuring your practice remains their trusted choice.

 These insights highlight the need for veterinary practices to provide adequate training to their staff in handling pet loss to maintain client trust and satisfaction.

Build skills in compassionate communication

A CHPV-trained veterinarian learns how to navigate sensitive discussions around pet illness, end-of-life decisions, and euthanasia. This skill is particularly valuable in general practice, where routine visits often turn to difficult conversations as pets age, and in emergency care, where emotional support is essential. CHPV certification provides tools and techniques for effectively communicating with pet owners, helping veterinarians support clients through emotionally charged situations.

One of the primary focuses of hospice and palliative care is to maximize comfort, even in the absence of a cure. Veterinarians trained in hospice and palliative care can offer pain management, anxiety relief, and supportive therapies that improve quality of life. CHPV certification empowers veterinarians with the knowledge to assess and treat complex cases, improving patient outcomes and satisfaction.

Dealing with end-of-life care can be emotionally challenging, but CHPV certification helps veterinarians approach it with confidence, empathy, and skill. Many veterinarians find that by offering hospice and palliative services, they experience greater career satisfaction and a renewed sense of purpose.

 Supporting pets and families during the end-of-life journey can be one of the most fulfilling aspects of veterinary practice.

While many veterinarians pursue hospice and palliative care for its profound emotional rewards, it’s also important to recognize its potential to generate additional revenue streams. With growing demand for options that prioritize pets’ comfort and quality of life, clients are increasingly willing to invest in services that align with their values. By incorporating hospice and palliative care, veterinarians can offer a vital service that supports both their patients and their practice’s sustainability.

These services also help bridge a critical gap in emergency cases, where families are often presented with only a few options: high-cost interventions, limited middle-ground treatments, or euthanasia. Providing hospice and palliative care offers families another path that prioritizes their pet's comfort and dignity when other treatments are not viable. This alternative helps alleviate the distress and negativity that can arise when choices feel limited, empowering families to make decisions with greater compassion and clarity.

For veterinarians in all types of practices, CHPV certification represents a chance to enhance their approach to care, expand services, and experience greater fulfillment in their careers. The skills and perspectives gained from CHPV training foster empathy, professionalism, and a commitment to the well-being of every pet, making it a valuable addition for any veterinarian looking to provide comprehensive, compassionate care.

Fernandez-Mehler, P, Gloor, P, Sager, E, Lewis, FI, & Glaus, TM. Veterinarians' role for pet owners facing pet loss. 

Compassion Understood. (n.d.). The impact of pet loss on veterinary Compassion Understood. Vets. Compassion Understood. Accessed March 14, 2025. https://www.compassionunderstood.com/vets

Cooney K, Lewis J. Consider end-of-life care as a career. Veterinary Practice News. Published January 26, 2023. Accessed March 14, 2025. https://www.veterinarypracticenews.com/myvpnplus/consider-end-of-life-care-as-a-career

The Certified Hospice and Palliative Care Veterinarian certification enables veterinarians to be not only healers but also compassionate guides through the final chapters of a patient’s life.

How pursuing a CHPV certification can benefit veterinary teams

Image Credit: © Kriang - stock.adobe.com

Editors note: Quotes have been lightly edited for brevity and clarity.

At Fetch Charlotte 2025, Joya Griffin, DVM, DACVD, kicked off her dermatology series of lectures with 

Treating the itch that won't quit: Diagnostic approach to the pruritic pet. 

One aspect she keyed in on was the fundamental importance of a meticulous history and basic diagnostics in the evaluation of pruritic pets.

“For me, it really is just getting back to basics,” Griffin said, “I'm trying to figure out how do I get the case from looking like a disaster to looking good again and feeling good?” She explained to attendees that focusing on these foundational principles is 1 of the most important pieces of the puzzle for effectively managing complex dermatologic cases.

“All of pruritus is not created equally”, Griffin said. “The history of pruritus sometimes can confuse us. Sometimes that confusion comes from a pet parent, because they can actually know when the disease how it started, but they don't know how it started.”

With the mindset of getting back to the basics, Griffin said that when assessing a dermatologic condition, these are the questions she’s asking and the information she is looking for:

 Determining the age of onset, whether symptoms are intermittent or continuous, and how they have evolved over time.

 Ascertaining if signs were initially seasonal and if pruritus preceded lesions or vice versa.

 Inquiring about the pet's travel history, indoor/outdoor status, and the health status of other pets or human family members.

 A thorough review of past and current medications, including their efficacy, dosage, duration, and consistency of administration.

Asking whether the pet’s bowel movements were solid or diarrhea, and whether there was any vomiting.

: Assessing the type of flea control being used and the consistency and correctness of its administration—especially in atopic dogs, which may exhibit heightened sensitivity to flea bites.

Griffin stressed the importance of cytology, stating, "I do have cytology on the majority of my dermatologic cases because looks can be deceiving." She reminded attendees that you can't truly know if a lesion is bacterial, yeast, or sterile without it. She advocates for its use not only as a diagnostic tool, but also as a means of monitoring response to treatment and to guide decisions on whether to pursue culture and susceptibility testing.

For those who find cytology intimidating, Griffin suggests utilizing available tools such as AI analyzers and online image libraries to improve confidence in sample interpretation. She also shared a tip for improving client compliance. "I like to show pictures when I'm talking about cytology, because it really is just pattern recognition." She added, "If I have a skeptical client, I can bring them back, show them, and say, 'This is what I'm looking for. This is why,' and I can help them understand the importance of the cytology and the importance of the recheck exam."

Griffin also reminded attendees that skin scrapes are essential for detecting superficial and deep ectoparasites. She also shared a tip for improving client compliance, “Another reason to have a camera on your scope is you can bring the pet parents back, and they can show them the mites, and then they will believe that you're not just trying to sell them.”

Griffin said that these in-house diagnostics are not only quick and cost-effective but also integral in prioritizing treatments and determining the necessity of further diagnostics.

Griffin explained that a back-to-basics approach helps prevent overlooking simple diagnoses. A thorough history and basic diagnostics provide a solid foundation for subsequent diagnostic and therapeutic decisions, ultimately leading to more effective management of pruritic pets.

Griffin J. Treating the itch that won't quit: Diagnostic approach to the pruritic pet. Presented at: Fetch Charlotte 2025; Charlotte, North Carolina. March 14-16, 2025.

Joya Griffin, DVM, DACVD, reminds Fetch Charlotte 2025 attendees to maintain a strong foundation when it comes to diagnosing itchy pets

Quick diagnostic tips for evaluating pruritic pets

Dechra shared earlier this week that it has officially launched its terbinafine and betamethasone acetate otic gel (DuOtic; Dechra) for canine patients. The product received FDA approval in March 2024 and is a first-to-market treatment for canine otitis externa associated with 

 Because DuOtic is an antibioitic-free solution, it gives professionals a new tool to combat canine otitis externa with antimicrobial stewardship in mind.

“We are proud to equip veterinarians with a dedicated solution for yeast-driven otitis externa that is aligned with our antimicrobial stewardship goals," said Laura Olsen, president, North America at Dechra, in an organizational release.

 "DuOtic is a game-changer for ear infection care that builds on Dechra’s extensive otic portfolio, giving veterinarians the confidence and ability to treat ear infections with the right treatment at the right time.”

The medication is a fixed combination of terbinafine, an antifungal commonly used to treat athletes’ foot in humans, and betamethasone acetate, a gluccorticosteriod with anti-inflammatory activity.

 The product works by the otic gel dissolving into the earwax and is then slowly eliminated from the pet’s year to fight yeast infections for up to 45 days. DuOtic is only available by prescription from a veterinarian and administered by a veterinary professional.

To administer DuOtic, veterinary professionals should clean and dry the patient’s external ear canal prior to administering the initial dose. One dose is 1 tube per affected ear and administration should be repeated for 7 days, and the pets ear canal is not cleaned for 45 days after the initial administration, allowing contact of the gel with the ear canal.

“It’s exciting to have an antibiotic-free otitis externa product specifically designed for Malassezia infections,” expressed Rusty Muse, DVM, DACVD.

 “As a profession, we have had to use antibiotics in ears that don’t need them for too long. Now, with DuOtic, we don’t have to.”

Duotic comes with premeasured dosing, gentle, alcohol-free gel formulation, and a flexible tip applicated to make the process more comfortable to these patients. They product was also made with compliance in mind because a veterinarian or veterinary technician administered regimen could improve compliance, and help the pet get the full course of treatment as well as follow-up care.

The FDA did state that DuOtic could cause eye injury or irritation in people or dogs and encourages them wear eye protection and the pet be restrained to minimize post-application head shaking.

 This product should also not be used on feline patients or dogs with known tympanic perforation.

The product will be available through veterinary distributors in 2-count and 20-count packages.

Dechra Launches DuOtic®: The First Antibiotic-Free Otitis Externa Treatment for Dogs. News release. Dechra. March 12, 2025. Accessed March 14, 2025.

dvm360 staff. FDA approves drug for treating canine yeast ear infections. March 15, 2024. Accessed March 14, 2025. https://www.dvm360.com/view/fda-approves-drug-for-treating-canine-yeast-ear-infections

FDA Approves Treatment for Yeast Ear Infections in Dogs. News release. US Food and Drug Administration. March 15, 2024. Accessed March 14, 2025. 

https://www.fda.gov/animal-veterinary/cvm-updates/fda-approves-treatment-yeast-ear-infections-dogs?utm_medium=email&utm_source=govdelivery

DuOtic received FDA approval March 2024 to treat canine patients