Cardio - Pericardial Diseases

Question 1

What are some congenital pericardial diseases?

Answer 1

Absence of pericardium, PPDH

Question 2

What are some acquired pericardial diseases?

Answer 2

Pericardial eff and cardiac tamponade, constrictive pericarditis

Question 3

What are the 2 layers of the pericardium?

Answer 3

Fibrous and serous (parietal and visceral)

Question 4

What are the 3 types of effusions and which is most common?

Answer 4

Hemorrhagic (most common), transudate, exudate

Question 5

What are some DDx for hemorrhagic pericardial eff?

Answer 5

Neoplasia (HSA, chemodectoma, mesothelioma, ectopic thyroid CA, LSA), idiopathic

Question 6

What are some DDx for transudate pericardial eff?

Answer 6

R-CHF, hypoAlb, chemodectoma, infections/toxemia, pericardial cysts, PPDH

Question 7

What are some DDx for exudative pericardial eff?

Answer 7

Infectious (FB/hardware diz in cattle, fungal, bacterial, viral), sterile

Question 8

What are the most common spp to have pericardial effusion?

Answer 8

Dogs and cattle

Question 9

Pericardial effusion is a _____ dysfunction disease.

Answer 9

diastolic

Question 10

What is cardiac tamponade?

Answer 10

Clinical syndrome that occurs when increased intrapericardial pressure interferes with normal cardiac filling

Question 11

What is the pathophysiology of cardiac tamponade?

Answer 11

1. Underlying disease causes pericardial effusion
2. Increased pressure in pericardial space compresses the heart chambers (R > L)
3. Reduced cardiac filling –> low CO and low BP
4. Compensation over time –> sudden death

OR just #3 –> sudden death

Question 12

When does sudden death due to cardiac tamponade occur?

Answer 12

If the CO is severely and/or acutely compromised

Question 13

How does compensation work in cardiac tamponade?

Answer 13

Over time activation of RAAS results in fluid retention and vasoconstriction, stabilizing the BP

Question 14

What is the appearance of the heart on rads when there is pericadial effusion?

Answer 14

Globoid

Question 15

Cardiac tamponade can occur with low volume effusions if they occur _____.

Answer 15

rapidly

Question 16

Why does slowly developing pericardial effusion have less consequences over time?

Answer 16

The pericardium has time to stretch and the heart can compensate

Question 17

What are some CS of cardiac tamponade?

Answer 17

Collapse, weakness, decreased appetite, vomiting, lethargy, decreased milk production (cattle), polyurea, polydypsia

Question 18

PE findings in cardiac tamponade are directly linked to the _____.

Answer 18

pathophysiology

Question 19

What are PE findings with cardiac tamponade?

Answer 19

Muffled heart sounds, weak pulses (pulsus paradoxus), jugular distention, signs of R-HF

Question 20

What is pulsus paradoxus?

Answer 20

Pericardial effusion –> RV free wall can’t stretch –> IVS must stretch further –> decreased LV size –> less LV filling during inspiration –> less blood pumped out to body –> weak femoral pulses during inspiration

Question 21

What are the 3 hallmark findings of pericardial effusion on rads?

Answer 21

1. Enlarged, rounded cardiac silhouette
2. Dilated CdVC
3. Small pulmonary arteries and veins

Question 22

What are “other” findings that can show with pericardial effusion?

Answer 22

Sharp, well-demarcated edges of cardiac silhouette (less motion artifact), no distinct chamber enlargement, mass effect or lung metastasis, pleural effusion (R-HF), metallic FB (cattle)

Question 23

What ECG abnormalities may be observed in pericardial effusion?

Answer 23

Decreased QRS amplitude (< 1 mV), electrical alternans (heart “swings” in the fluid)

Question 24

What is electrical alternans?

Answer 24

ECG finding where the R waves are of variable heights due to large effusions where the heart “swings” in the fluid

Question 25

What does pericardial effusion look like on echo?

Answer 25

Anechoic (black) fluid between pericardium and heart (mixed echogenicity if exufate or new blood)

Question 26

What finding can cardiac tamponade cause on echo?

Answer 26

Compression/collapse of RA +/- RV

Question 27

What is the treatment for pericardial effusion if the patient is unstable / low BP?

Answer 27

IVF while preparing for a pericardiocentesis (shock bolus of crystalloids), reassess BP, repeat until ready

Question 28

What are potential complications of a pericardiocentesis?

Answer 28

Infection, arrhythmias, hemorrhage, pneumothorax, cardiocentesis

Question 29

How can infection be avoided in a pericardiocentesis?

Answer 29

sterile technique

Question 30

How can arrhythmias be noted during a pericardiocentesis?

Answer 30

monitor ECG

Question 31

How can hemorrhage be avoided in a pericardiocentesis?

Answer 31

tap the R side

Question 32

How can a pneumothorax be avoided in a pericardiocentesis?

Answer 32

tap on R side

Question 33

How can you tell you have pericardial fluid and that you didn’t accidentally do a cardiocentesis?

Answer 33

Pericardial effusion does not clot (heart blood does)

Question 34

What phrase is helpful to remember the technique for a pericardiocentesis?

Answer 34

Go RIGHT, AHEAD, and TAP

R side of chest, cranial to the rib, perform tap

Question 35

What can constrictive pericarditis be likened to?

Answer 35

Shrink wrapping the heart

Question 36

What is the pathophysiology of constrictive pericarditis?

Answer 36

Inflammatory or infectious process –> thickened, noncompliant pericardium +/- adhesion to epicardium prevents relaxation of the heart –> reduced filling –> low CO and low BP –> same CS, etc. as effusion except heart can be normal size

Question 37

T/F: Absence of the pericardium is not clinically significant

Answer 37

True

Question 38

What is PPDH?

Answer 38

Pericardioperitoneal diaphragmatic hernia:

abnormal connection from the abdomen to the pericardium

Question 39

What is the signalment for PPDH?

Answer 39

Cats > dogs (weimeraners)

Question 40

What CS are associated with PPDH?

Answer 40

Vary depending on organs affected; tachypnea, dyspnea, vomiting, anorexia, weight loss

Question 41

When should a PPDH be repaired?

Answer 41

If it causes symptoms or has bowel entrapment