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RUSVM SAM 1 > Pericaradial Disorders > Flashcards

Pericaradial Disorders Flashcards

1
Q

What are the layers of the pericardium?

A

Outer fibrous = parietal pericardium

Inner serous= visceral pericardium

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2
Q

T/F: there is normally some fluid in the pericardial space

A

True

about 0.25ml/kg

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3
Q

What are acquired causes of pericardial effusion?

A 
Neoplastic 
Idiopathic pericarditis 
Infectious
Cardiovascular 
Metabolic 
Toxic/coagulopathy 
Trauma
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4
Q

What are the congenital pericardial diseases?

A

Peritoneopericardial diaphragmatic hernia (PPDH)

Pericardial cyst

Pericardial defects

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5
Q

What is the most common pericardial disorder in dogs and cats?

A

Pericardial effusion

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6
Q

What type of fluid is usually present in a pericardial effusion of a dog?

A

Sanguineous (hemorrhagic)

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7
Q

As long as intrapericardial pressure is _________ than intracardiac pressure, diastolic filling is maintained

A

Lower

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8
Q

When intrapericardial pressure equals or exceeds intracardiac pressure, diastolic filling decreases resulting in _____________

A

Decreased stroke volume and cardiac output

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9
Q

What is a cardiac tamponade?

A

Pressure put on the heart by fluid in the pericardium

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10
Q

As CO falls due to cardiac tamponade, what occurs systemically?

A

Systemic venous pressure rises —> congestion and effusion

Can result in hepatomegaly, ascities, and pleural effusion

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11
Q

What is the signalment of animals with pericardial effusion?

A

Dogs > cat

Middle age to older
Large and medium breeds >small breeds
-golden retriever, GSD, lab, brachycephalic

Males>females

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12
Q

What is the main presenting complaint in dogs with pericardial effusion?

A

Collapse/weakness

-can have vomiting within the last 24/48hrs

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13
Q

What are clinical signs associated with chronic pericardial effusion?

A

Lethargy
Exercise intolerance
Decreased appetite
Abdominal distention (peritoneal effusion due to systemic congestion secondary to pleural effusion)

Respiratory signs also possible (large heart or pleural effusion)

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14
Q

How does the heart sound on auscultation if a pericardial effusion is present?

A

Muffled - significantly decreased intensity

Lung sounds may also be decreased in plural effusion is present

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15
Q

What is the heart rate, and how do the femoral pulses feel win animals with pericardial effusion?

A

High-normal heart rate

Weak femoral pulses

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16
Q

Jugular venous distention and hepatomegaly result from pericardial effusion as a consequence of?

A

Increased systemic venous pressure and congestion

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17
Q

If a tamponade is profound, arterial hypotension and hypoperfusion will be severe. What clinical signs would you observe?

A

Weakness
Depressed or dull mentation
Comatose
Cardiopulmonary arrest

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18
Q

What can confirm a suspect pericardial effusion diagnosis?

A

Thoracic FAST

  • evaluate right atrial wall for collapse=cardiac tamponade
  • evaluate for pleural and peritoneal effusion
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19
Q

If a cardiac tamponade is present, what treatment does this animal need ASAP?

A

Pericardiocentesis

—>patients with cardiac tamponade can “look good” but it is ALWAYS a life threatening condition and is an emergency

20
Q

What would you see on radiographs in a animal with pericardial effusion?

A

Markedly enlarged and globoid cardiac silhouette

- if PE is small volume, may be normal or only mildly increased

21
Q

Why is lactate increased in patients with pericardial effusion?

A

The body attempts to save BP before everything else

Low CO -> vasoconstriction to maintain BP—> hypoperfusion —> tissue damage and lactate

22
Q

What is electical alterans?

A

ECG with beat-to-beat variation in QRS amplitude

Due to heart moving location within the effusion

23
Q

What is the treatment for pericardial effusion?

A

Pericardiocentesis
Volume resuscitation with crystalloids

Antiarrhythmic therapy and indicated

Thoracocentesis if pleural effusion
Abdominocentesis if peritoneal effusion

24
Q

T/F: furosemide is the drug of choice for treating cardiac tamponade

A

FALSE

Diuretic treatment is contraindicated with cardiac tamponade
—> due to high intrapericardial pressure, the amount of blood into the heart is already decreased, you do not want to further decrease preload with a diuretic

25
Q

What diagnostics should you do in a animal with pericardial effusion?

A

Coagulation profile —> rule out coagulopathy

Minimum database

Thoracic radiographs

Fluid analysis and cytology of effusions

Echo

Staging with abdominal ultrasounds or CT (neoplastic cases)0

26
Q

What is the most common cause of pericardial effusion?

A

Neoplasia (hemangiosarcoma

27
Q

What is the most common location of hemangiosarcoma ?

A

Right atrium/auricle

28
Q

T/F: metastasis are common with hemangiosarcoma

A

True

—> lungs and spleen

29
Q

What are the treatment options with hemangiosarcomas found at the heart bases?

A

Resection usually not feasible due to location

Chemo /Radiaiton

Yunnan Baiyao - Chinese herb with prothrombin properties
Aminocaproic acid -antifibrinolytic

30
Q

What is a chemodectoma?

A

AKA heart base tumor

Tumor involving the chemoreceptor cells in the ascending aorta

31
Q

What breeds are predisposed to chemodectoma?

A

Brachycephalic

32
Q

What are clinical signs that are seen with chemodectoma ?

A 
Exercise intolerance 
Syncope 
Dyspnea 
Cough 
Ascities
33
Q

What cardiac neoplasms usually do not have a discrete mass?

A

Mesothelioma

Lymphoma

34
Q

T/F: arrhythmias are a potential complication of any cardiac tumor

A

True

35
Q

What is idiopathic pericarditis?

A

Effusion that slowly develops (can be large volume)
—> may have viral and immune-mediated etiology

Disease response in 50% of dogs after initial treatment

36
Q

What is the treatment of choice for recurrent pericardial effusion?

A

Subtotal pericardiectomy

37
Q

What is the disease name where the parietal/visceral pericardium becomes fibrotic?

A

Constrictive pericarditis

38
Q

What is the pathophysiology of constrictive pericarditis?

A

Fibrous pericardium is stiff —> limits diastolic filing —> systemic venous pressure rises —> R sided CHF

39
Q

What are causes of constrictive pericarditis?

A

Chronic inflammation

  • idiopathic
  • foreign body

Fungal
Idiopathic

40
Q

What is the treatment of choice for constrictive pericarditis?

A

Subtotal pericardectomy

-corticosteroids used in some idiopathic cases

41
Q

What would your DDX be for hemorrhagic PE?

A

Coagulopathy

Left atrial tear

Trauma

42
Q

What is your DDx for transudate PE?

A 
Hypoalbuminemia 
CHF
Vasculitis 
PPDH 
Pericardial cyst
43
Q

What is your DDX for exudative PE?

A

Infectious

  • migrating foreign body (nidus)
  • bacterial
  • fungal
  • viral
  • protozoal
44
Q

How do pericardial effusions usually appear in cats?

A

Small volume and chronic

Tamponade is rare

45
Q

What is the most common cause of PE in cats?

A

Congestive heart failure

2nd most common is neoplasia (lymphoma, adenocarcinoma, thymoma, mesothelioma)

RUSVM SAM 1 (26 decks)

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