Exam 4 - Pericardial Disease

Question 1

what are the main etiologies of pericardial disease in dogs?

Answer 1

acquired - effusion

Question 2

what are the main etiologies of pericardial disease in cats?

Answer 2

acquired, effusion - congestive heart failure

Question 3

what are the most common causes of pericardial effusion in the dog?

Answer 3

neoplastic - hemangiosarcoma & chemodectoma

idiopathic

Question 4

what are some rare causes of pericardial effusion in the dogs?

Answer 4

infectious - fungal, bacterial, & viral

metabolic - uremia, vasculitis, hypoalbuminemia

traumatic

hemorrhagic - coagulopathy

congestive heart failure

Question 5

what is the pathophysiology of pericardial effusion?

Answer 5

impaired filling of the right heart causing poor cardiac output (exercise intolerance, weakness, collapse), & right-sided heart failure (ascites, hepatomegaly, +/- pleural effusion)

Question 6

what 3 components make up beck/s triad in pericardial disease?

Answer 6

1. distant heart sounds
2. decreased blood pressure +/- pulsus paradoxus (decreased pulse with inspiration)
3. distended jugular veins

Question 7

what are some radiographic findings consistent with pericardial effusion?

Answer 7

large globoid silhouette, under-circulated lungs, & diminutive vasculature

Question 8

what are some echocardiographic features of pleural effusion?

Answer 8

1. hypoechoic region around the heart
2. mass may be seen - failure to identify a mass doesn’t rule out neoplasia
3. presence & location of a mass determines probable tumor type
4. left ventricular +/- left atrial chamber sizes may be reduced
5. other structural heart abnormalities consistent with CHF

Question 9

what may be seen on ecg in a patient with pericardial effusion?

Answer 9

sinus tachycardia, ventricular arrhythmias, small QRS complexes, & electrical alternans

Question 10

what may be seen on bloodwork in a patient with pericardial effusion?

Answer 10

anemia, increased lactate, low venous oxygen, & azotemia

Question 11

what are some other differentials for pericardial effusion?

Answer 11

anything that causes right-sided heart failure/ascites - pulmonary hypertension, HW disease, DCM, tricuspid dysplasia

Question 12

when performing a pericardiocentesis, what does the patient need as far as prep & monitoring?

Answer 12

sedation, iv fluids, continuous ecg, patient in left lateral or sternal

tap on right hemithorax!! may need an ultrasound to identify ideal location - sterile prep & local block (skin, intercostals, & pleura)

Question 13

what are the potential complications of pericardiocentesis?

Answer 13

arrhythmias, cardiac perforation, coronary artery laceration, & lung laceration

Question 14

what is the typical fluid analysis of pericardial fluid?

Answer 14

typically hemorrhagic - cytology is low yield but still recommended & culture/sensitivity may be indicated in some cases

Question 15

what is the most common pericardial disease in the dog?

Answer 15

pericardial effusion

Question 16

what is the most common etiology of pericardial effusion in the dog & cat?

Answer 16

dog - neoplasia
cat - CHF

Question 17

in dogs with signs of right-sided heart failure, what differential must be considered?

Answer 17

pericardial effusion

Question 18

T/F: the history & clinical signs of pericardial effusion can be non-specific & variable & maybe absent all together

Answer 18

true

Question 19

when is an emergency pericardiocentesis indicated in an animal with pericardial effusion?

Answer 19

clinical & echocardiographic signs of cardiac tamponade secondary to pericardial effusion

Question 20

what causes cardiac tamponade?

Answer 20

when the volume of pericardial effusion causes an increase in pressure in the pericardial space which impairs preload reducing cardiac output

Question 21

what is the most common cause of congenital feline pericardial disease?

Answer 21

PPDH for congenital

Question 22

what is the hepatojugular reflux test? what does a positive test mean?

Answer 22

identifying jugular venous distention while applying steady, firm pressure to the abdomen - suggestive of right ventricular systolic or diastolic dysfunction, tricuspid valve disease, or pericardial disease