Pericaradial Disorders Flashcards
What are the layers of the pericardium?
Outer fibrous = parietal pericardium
Inner serous= visceral pericardium
T/F: there is normally some fluid in the pericardial space
True
about 0.25ml/kg
What are acquired causes of pericardial effusion?
Neoplastic Idiopathic pericarditis Infectious Cardiovascular Metabolic Toxic/coagulopathy Trauma
What are the congenital pericardial diseases?
Peritoneopericardial diaphragmatic hernia (PPDH)
Pericardial cyst
Pericardial defects
What is the most common pericardial disorder in dogs and cats?
Pericardial effusion
What type of fluid is usually present in a pericardial effusion of a dog?
Sanguineous (hemorrhagic)
As long as intrapericardial pressure is _________ than intracardiac pressure, diastolic filling is maintained
Lower
When intrapericardial pressure equals or exceeds intracardiac pressure, diastolic filling decreases resulting in _____________
Decreased stroke volume and cardiac output
What is a cardiac tamponade?
Pressure put on the heart by fluid in the pericardium
As CO falls due to cardiac tamponade, what occurs systemically?
Systemic venous pressure rises —> congestion and effusion
Can result in hepatomegaly, ascities, and pleural effusion
What is the signalment of animals with pericardial effusion?
Dogs > cat
Middle age to older
Large and medium breeds >small breeds
-golden retriever, GSD, lab, brachycephalic
Males>females
What is the main presenting complaint in dogs with pericardial effusion?
Collapse/weakness
-can have vomiting within the last 24/48hrs
What are clinical signs associated with chronic pericardial effusion?
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)
How does the heart sound on auscultation if a pericardial effusion is present?
Muffled - significantly decreased intensity
Lung sounds may also be decreased in plural effusion is present
What is the heart rate, and how do the femoral pulses feel win animals with pericardial effusion?
High-normal heart rate
Weak femoral pulses
Jugular venous distention and hepatomegaly result from pericardial effusion as a consequence of?
Increased systemic venous pressure and congestion
If a tamponade is profound, arterial hypotension and hypoperfusion will be severe. What clinical signs would you observe?
Weakness
Depressed or dull mentation
Comatose
Cardiopulmonary arrest
What can confirm a suspect pericardial effusion diagnosis?
Thoracic FAST
- evaluate right atrial wall for collapse=cardiac tamponade
- evaluate for pleural and peritoneal effusion
If a cardiac tamponade is present, what treatment does this animal need ASAP?
Pericardiocentesis
—>patients with cardiac tamponade can “look good” but it is ALWAYS a life threatening condition and is an emergency
What would you see on radiographs in a animal with pericardial effusion?
Markedly enlarged and globoid cardiac silhouette
- if PE is small volume, may be normal or only mildly increased
Why is lactate increased in patients with pericardial effusion?
The body attempts to save BP before everything else
Low CO -> vasoconstriction to maintain BP—> hypoperfusion —> tissue damage and lactate
What is electical alterans?
ECG with beat-to-beat variation in QRS amplitude
Due to heart moving location within the effusion
What is the treatment for pericardial effusion?
Pericardiocentesis
Volume resuscitation with crystalloids
Antiarrhythmic therapy and indicated
Thoracocentesis if pleural effusion
Abdominocentesis if peritoneal effusion
T/F: furosemide is the drug of choice for treating cardiac tamponade
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
What diagnostics should you do in a animal with pericardial effusion?
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
What is the most common cause of pericardial effusion?
Neoplasia (hemangiosarcoma
What is the most common location of hemangiosarcoma ?
Right atrium/auricle
T/F: metastasis are common with hemangiosarcoma
True
—> lungs and spleen
What are the treatment options with hemangiosarcomas found at the heart bases?
Resection usually not feasible due to location
Chemo /Radiaiton
Yunnan Baiyao - Chinese herb with prothrombin properties
Aminocaproic acid -antifibrinolytic
What is a chemodectoma?
AKA heart base tumor
Tumor involving the chemoreceptor cells in the ascending aorta
What breeds are predisposed to chemodectoma?
Brachycephalic
What are clinical signs that are seen with chemodectoma ?
Exercise intolerance Syncope Dyspnea Cough Ascities
What cardiac neoplasms usually do not have a discrete mass?
Mesothelioma
Lymphoma
T/F: arrhythmias are a potential complication of any cardiac tumor
True
What is idiopathic pericarditis?
Effusion that slowly develops (can be large volume)
—> may have viral and immune-mediated etiology
Disease response in 50% of dogs after initial treatment
What is the treatment of choice for recurrent pericardial effusion?
Subtotal pericardiectomy
What is the disease name where the parietal/visceral pericardium becomes fibrotic?
Constrictive pericarditis
What is the pathophysiology of constrictive pericarditis?
Fibrous pericardium is stiff —> limits diastolic filing —> systemic venous pressure rises —> R sided CHF
What are causes of constrictive pericarditis?
Chronic inflammation
- idiopathic
- foreign body
Fungal
Idiopathic
What is the treatment of choice for constrictive pericarditis?
Subtotal pericardectomy
-corticosteroids used in some idiopathic cases
What would your DDX be for hemorrhagic PE?
Coagulopathy
Left atrial tear
Trauma
What is your DDx for transudate PE?
Hypoalbuminemia CHF Vasculitis PPDH Pericardial cyst
What is your DDX for exudative PE?
Infectious
- migrating foreign body (nidus)
- bacterial
- fungal
- viral
- protozoal
How do pericardial effusions usually appear in cats?
Small volume and chronic
Tamponade is rare
What is the most common cause of PE in cats?
Congestive heart failure
2nd most common is neoplasia (lymphoma, adenocarcinoma, thymoma, mesothelioma)
