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Year 4 Small Animal Studies > Cardiology: Pericardial Diseases > Flashcards

Cardiology: Pericardial Diseases Flashcards

1
Q

Describe the anatomy of the pericardium

A

Outer- fibrous pericardium:
* tough sac that continues with the adventia of the great vessels dorsally, with the sternopericardial ligament ventrally

Inner- serous pericardium:
* contains two laters with pericardial fluid between them- a thin layer of mesothelial cells is present
* Parietal layer- inner surface of fibrous pericardium
* Visceral layer: froms the epicardium

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2
Q

What innervates the pericardium?

A
  • Vagus nerve
  • Laryngeal recurrent nerve
  • Sympathetic nerve fibres
  • Phrenic nerves
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3
Q

What supplies blood to the pericardium?

A
  • Aorta
  • Internal thoracic artery
  • Musculophrenic arteries

Cardiac, mediastinal and pre-sternal LNs recieve lymphatic draining

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4
Q

What are the functions of the pericardium?

A
  • Contains fluid for lubrication
  • Prevention of overdilation
  • Systolic function
  • Protection from infection
  • Maintain heart in fixed position
  • Co-ordinates function between LV and RV
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5
Q

How are pericardial diseases classified?

A

Congenital or Acquired

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6
Q
  1. What are the three congenital pericardial diseases?
  2. What are aquired diseases?
A
  1. Pericardioperitoneal diaphragmatic hernia, Intrapericardial cyst
    pericardial defect
  2. Pericardial effusion or constrictive pericarditis
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7
Q

What are the three types of pericardial effusions and what diseases can cause each?

A

Haemorrhagic:
* Idiopathic
* Neoplasia
* Coagulopathy
* Rupture of LA
* Trauma

Transudate:
* CHF
* Hypoproteinaemia
* Neoplasia
* PPDH
* Renal failure

Exudate:
* FIP
* Infection
* Foreign body

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8
Q

What is the most common pericardial disorder?

A

Pericardial effusion
Most common- idiopathic or neoplasia

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9
Q
  1. What types of dogs more commonly develop pericardial effusion?
  2. When is it frequently found in cats?
  3. What other casues are there?
A
  1. Older, large breed dogs
  2. Cats with CHF, FIP
  3. Lymphoma, rhabdomyosarcoma, bacterial pericarditis, coccidiomycocis, aspergillus, coagulation disorder, uraemia
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10
Q
  1. How is idiopathic PE diagnosed?
  2. What breeds are more affected?
  3. How can it be treated?
A
  1. Exclusion diagnosis
  2. Older, larger breeds- GR, Saint B, Lab, New FL
  3. May require pericardiectomy if recurrencte (3rd)
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11
Q

What neoplasias can cause pericardial effusions?

A
  • Haemangiosarcoma
  • Chemodectoma
  • Mesothelioma
  • Lymphoma
  • Ectopic thyroid carcinoma
  • Rhadomyosarcoma
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12
Q
  1. What breed is predisposed to haemangiosarcoma PE?
  2. Where is the mass usually associated?
  3. What should be checked?
  4. How can it be treated?
A
  1. Older dogs, especially GSD and golden retriever
  2. RA or right auricular appendage
  3. effusion PCV- actively bleeding
  4. Grave prognosis- pericardiocentesis/ectomy/ balloon pericardiotomy palliative, chemo (MST 6months)
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13
Q
  1. What breeds are predisposed to chemodectoma?
  2. What type of neoplasm is it?
A
  1. Older especially brachs dogs
  2. Benign- locally invasive, low metastasis

Palliation with pericardiectomy prolonged survival with good quality of life

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14
Q
  1. How can mesothelioma PE be diagnosed?
  2. How can it be treated?
A
  1. difficult- usually requires pericardial biopsy
  2. Difficult- intracavitary cisplatin, IV doxorubicin- poor prognosis
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15
Q

Explain the following signs of chronic effusion
* Cardiac tamponade
* Right congestive heat failure signs
* Left ventricle compression
* Pulsus paradoxus

A
  • Effusion decreases stroke volume
  • Activates RAAS and sympathetic
  • Peripheral vasoconstriction, increased HR and fluid retention
  • Compression on right side causes right atrial cardiac tamponade (collapse)
  • Venous return compromised- systemic venous pressures- RCHF
  • Greater filling of the right ventricle during inspiration- deviation of the IVS toward LV- compresses LV
  • Pulsus paradoxus- no/reduced pulse during inspiration
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16
Q

What are the effects of acute effusion?

A
  • Even small effusion causes large haemodynamic compromise
  • Haemorrhage usually
  • Combination of forward failure and haemorrhagic shock
17
Q

What does constrictive pericarditis cause?

A
  • Pericardium- thickened, fibrotic and non-distended
  • Small effusion causes elevated pressures- cardiac tamponade
18
Q

What are the clinical signs of pericardial effusions?

A
  • Non-specific
  • Organomegaly
  • Abdominal enlargment
  • Decreased excercise intolerance
  • Syncope/collapse
  • Respiratory distress
19
Q

What is likely to be found on physical examination of pericardial effusion cases?

A
  • R-CHF with muffled heart sounds, weak femoral pulses
  • Ascites
  • Jugular distension
  • Positive hepatojugular reflex
  • Hepatomegaly
  • Muffled heart sounds
  • Weak femoral pulses
  • Tachycardia
20
Q

What is commonly found on routine haematology?

A
  • Pre-renal azotaemia
  • Increased liver enzymes- liver congestion
  • Anaemia
  • Coagulation panel indicated if petechial haem found
  • Cats- hyperhammaglobinaemia in FIP, azotaemia in uremic pericarditis
  • Myocardial infiltrations- cardiac troponin I
21
Q

What may routine blood pressure and an ECG show with a pericardial effusion?

A

BP
* Can be hypotensive to severe forward failure, haemorrhagic shock
* Can be normal

ECG
* Sinus tachycardia
* Small complexes
* Electrical alternans: rhythmic variation of the QRS amplitude due to changes in the position of the heart swinging in the fluid

22
Q

How does pericardial effusion present on radiography?

A
  • Globoid and enlarged cardiac silhouette
  • Very destinct silhouette- minimal moving
  • Dorsal deviation of the trachea
  • Loss of divergent angle between trachea and spine
  • Dilated caudal vena cava
  • Abdominal effusion
  • Small pulmonary vessels- despite cardiomegaly
  • Clear lung fluids

Needs to be differentiated from cardiomegaly

23
Q

What are the features of echocardiography on pericardial effusion?

Why is the abdomen also ultrasounded?

A
  • Presence of hyperechoic fluid around the heart
  • Hyperechoic pericardial line surrounding the fluid
  • Collapse of the right atrium
  • Swining of the heart within th efluid
  • Pleural effusion may also be present

Abdominal ultrasound:
Assess for primary or metastatic neoplasia
Assess for any other concurrent disease

24
Q

What can pericardial fluid show?

A

Usually serosangineous- port looking
* Always send for cytology ± culture
* Common to find reactive meothelial cells- difficult to differentiate between reactive and neoplastic
* Neoplasias might not shed cells

25
Q

Why should diurectice not be used in managment of pericardial effusion in dogs?

A

Further decrease the cardiac preload and worsen tamponade

26
Q
  1. What needs to be performed if tamponade?
  2. How can cardiac preload be increased ?
A
  1. Pericardiocentesis
  2. High-rate fluids IV
27
Q

Describe the process of pericardiocentesis

A
  1. Check PCV
  2. Mild sedation- opioid or low dose ACP
  3. Left lateral or sternal recumbancy
  4. ECG monitoring- ventricular arrythmia if too close to the heart
  5. Prepare 3-8th IC space
  6. Check with ultrasound where to go
  7. Local anaesthetic infiltration 5-6th intercostal space- lidocaine
  8. Stab incision in skin 1/3 of chest diameter up from sternum
  9. 14G neegle catheter or pericardiocentesis catheter and attached 10-20ml syringe
  10. Advance catheter and syringe- aim for opposite shoulder- maintain gentle syringe suction
  11. Advance catheter with draw needle/three way tap
  12. Take sample of fluid
  13. Check PCV
  14. Meaure fluid
  15. Monitor for arrythmias
  16. Diuresis should follow
28
Q

What complications can follow pericardiocentesis?

A
  • Arrhythmias- usually self limiting
    Atrial fibrillation
    Ventricular arrhythmias
  • Pulmonary oedema due to rapid increase in left heart filling
  • Coronary lacterations
  • Intracardiac puncture
  • Pneumothorax- rare

If improvement not as marked and quick recurrence- neoplasia likely

29
Q

When is a pericardectomy recomended?

A
  • If 3 or more pericardiocenteses
  • Constrictive pericarditis might develop
30
Q

What can cause constrictive pericarditis?

A
  • Idiopathic
  • Recurrent PE
  • Neoplasia
  • Foreign body
  • Infectious pericarditis
31
Q
  1. What clinical signs can occur with constrictive pericarditis?
  2. How is it treated?
A
  1. Signs of R-CHF and cardiac tamponade- despite small amounts of pericardial fluid
  2. Pericardectomy and surgical stripping of the fibrotic pericardium

Guarded prognosis

32
Q
  1. What is peritonealpericardial diaphragmatic hernia?
  2. How is it often discovered?
  3. What breeds are predisposed?
  4. Why do clinical signs vary?
  5. How is it diagnosed?
  6. How is it treated?
A
  1. Defect in ventral diaphragm and pericardium
  2. Often incidental
  3. Weimaraners and persian cats
  4. Depends on herniated organs
  5. Apex beat apsent- radiography/echo
  6. Corrected surgically- not indicated in old asymptomatic
33
Q
  1. What is a benign intrapericardial cyst?
  2. What is it associated with?
  3. How is it diagnosed?
A
  1. Encapsulted adipose tissue- organising cystic haematoma
  2. Associated with PPDH
  3. Echocardiography

Surgical removal- can be difficult

34
Q

When uncommonly can left atrial ruptures/tears occur?
How is it treated?

A
  • With advances mitral valve disease and severe LA enlargment
  • Pericardiocentesis, blood transfucion, thoracotomy to remove clots and repair

Grave prognosis

35
Q

What can cause infectious/inflammatory pericardititis?

A
  • Foreign body
  • Penetrating wound
  • Infectious agent haematogenous spread
  • FIP in cats

Treated with aggressive antibiosis

Year 4 Small Animal Studies (97 decks)

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