Chapter 185 - Pericardiocentesis

Question 1

Causes for pericardial effusion?

Answer 1

• cardiac neoplasia:
• hemangiosarcoma,
• chemodectoma,
• lymphoma,
• ectopic thyroid carcinoma,
• mesothelioma
• non-neoplastic disorders:
• idiopathic pericarditis
• constrictive pericardial disease,
• congestive heart failure
• left atrial tear
• hypoproteinemia
• infection

Question 2

Mechanism of cardiac tamponnade?

Answer 2

Intrapericardial pressure exceeds the pressure within the right atrium and/or right ventricle during diastole

Question 3

Clinical signs consistent with tamponade ?

Answer 3

Hypotension, jugular venous distension, tachycardia,tachypnea, and cardiogenic shock
- Pulsus paradoxus,
- Tachycardia
- Muffled heart sounds,
- Jugular venous distension
- Mucous membrane pallor
- Right-sided congestive heart failure: ascites
maybe identified and may indicate chronic cardiac tamponade.

Question 4

What does the degree of hemodynamic compromise depends upon?

Answer 4

• Both the volume of effusion and the rate of fluid accumulation

Question 5

Contraindications for pericardiocentesis ?

Answer 5

• Animals with active hemorrhage into thepericardial sac :
• Cardiac tamponade secondary to left atrial splitting/left atrial rupture (except if animal is in cardiogenic shock and at risk for cardiopulmonary arrest)
• Coagulopathy

Question 6

What can be mixed with lidocaine for local block?

Answer 6

Sodium bicarbonate (1 part sodium bicarbonate to 9 parts lidocaine), to neutralizethe acidic pH and reduce discomfort

Question 7

Localization for pericardiocentesis?

Answer 7

• Right sided approach (left hemithorax: coronary arteries)

- Between the third and fifth intercostal spaces (typically at the left fifth intercostalspace)

Question 8

Complications - rate and type ?

Answer 8

• Ventricular arrhythmias,
• sudden death,
• laceration or perforation of the myocardium or great vessels,
• hemorrhage into the pleural space or recurrent pericardial effusion,
• pneumothorax,
• introduction of infection into the pericardial space.
• Over 85 dogs: 10.7% within 1 hour of pericardiocentesis and 15.2% within 48 hours (arrhythmia requiring drug therapy, cardiopulmonary arrest (4/85), continued bleeding into pericardium => euthanasia (3/17)