Pericardial and Vascular Disease Flashcards
What are the 5 categories of pericardial disease and which species is this most common?
- Traumatic / Septic
- most common from in cattle
- Idiopathic
- most common from in horses
- Bacterial
- most common form in pigs
- Neoplastic
- uncommon in large animals
- Viral
- uncommon in large animals
What is the pathogenesis of traumatic pericarditis?
- A manifestation of hardware disease (traumatic reticuloperitonitis)
- ingested wires migrate through the wall of the reticulum, into the peritoneal cavity and through the diaphragm into the pericardial sac
- accumulation of septic fluid and gas within the pericardial sac
What are the early and later signs of traumatic pericarditis?
- Early signs: non-specific
- fever, anorexia, depression
- stand with elbows abducted, or with forequarters elevated
- reluctant to move
- positive grunt test
- Later signs: right-sided heart failure
- venous congestion, peripheral oedema
What is seen on cardiac exam of traumatc pericarditis? (5)
- tachycardia
- muffled heart sounds
- If you cant hear the heart sounds with a good stethoscope and then you ECG. Do you need to U/s?
- splashing “washing machine” murmurs
- Gas fluid interface – usually anaerobic bacteria
- venous distension
- weak pulses
What is the treatment of pericarditis?
- The vast majority of affected cattle are culled
- Surgical procedures to strip out the pericardium and remove septic debris have been described. And lavage – valuable breeding stock
What does lymphosarcoma cause in cattle? What is seen on cytology?
- Right atrial infiltration (RAP increases, jugular distension)
- May have pericardial infiltration: may have pericardial effusion- haemorrhagic in appearance
- Cytology reveals neoplastic cells
- Lymphocytes – sporadic lymphoma
What is the aetiology and pathology of pericarditis in horses?
- the majority of cases are idiopathic
- equine viral arteritis, equine influenza
- Strep. Pneumoniae (E.Coli, Actinobacillus
- Penicillin drug of choice initially
- tend to develop fibrinous effusion
- Just idiopathic once or twice – shouldn’t come back. Leaves a small hole so can just drain and be absorbed
What are the clinical signs of pericarditis in horses? (5)
- venous distension
- ventral oedema
- muffled heart sounds
•pericardial friction rubs
(triphasic sounds in time with heart)
•pleural effusion
Hwo do you diagnose pericarditis in horses? (3)
- Echocardiography
- fluid and fibrin in pericardial sac
- compression of cardiac chambers
- Electrocardiography
- small complexes – make sure your leads are in an appropriate place before you diagnose
- main differential is obesity
- Cytology of pericardial fluid
What does this show?
Pericarditis
How can you treat pericarditis in horses? (2)
- Pericardial drainage and lavage are indicated if the right atrium is collapsing (i.e. cardiac tamponade is present)
- Indwelling drain and twice daily lavage with antibiotic containing fluids greatly improves prognosis
What is the prognosis for pericarditis in horses?
- good provided treatment is early and aggressive
- constrictive disease may occur in chronic cases
- Can return to full performance
- Serosanguous – transudate or exudate; not such a good prognosis
What causes pericarditis in pigs?
What are the signs?
- Haemophilus parasuis, Strep. Suis
- Non-specific signs - fever, depression
- Also fibrinous serositis and effusion in CNS, pleural, peritoneum, and synovia
What are the signs of non septic (2) and septic (3) jugular thrombosis?
- NON-SEPTIC
- thickening “cording” of the vein
- reduction in patency
- SEPTIC
- hot
- painful
- discharging tracts (chronic) – burst out following catherter complication
What is the aetiology of jugular thormbosis?
•Most (all) cases of jugular thrombosis are associated with intravenous catheterisation or injection – buscopan combo, oxytet, guarphenesin, diapentone
What are the predisposing factors for jugular thrombosis? (5)
- Systemic inflammatory response syndrome (SIRS)
- Gram +ve and –ve
- Multi-organ dysfunction Syndrome
- irritant drugs
- poor catheter placement
- poor catheter use
What are the clinical signs of jugular thrombosis?
VENOUS OCCULSION
- swelling in the supraorbital area
- cheek and lips
- tongue
- leading to dysphagia
- upper airway obstruction
- Nasal airflow test
- Affects performance
- proximal venous distension
What is ultrasound used for in jugular thrombophlebitiis? (5)
- assess extent of thrombus
- identify sepsis (cavitation)
- assess patency of vein
- distinguish perivenous swelling from thrombosis
- select site for aspiration
What can be seen on jugular thrombophlebitis?
How can you diagnose jugular thrombophlebitits? (4)
- catheter tip; take it out sterile can culture it
- ultrasound-guided aspirate fluid pocket from within thrombus
- swab from discharging tracts
- Contamination from the skin
- blood culture (take from other jugular vein in culture media)
How can you treat jugular thrombosis? (7)
- Nursing! Most important with time
- Feed from high to prevent head swelling
- Hot packs
- Compagel - break thrombus
- Broad spectrum antibiotics
- Anti-inflammatories
- Systemic
- aspirin
- other NSAIDs
- Topical
- DMSO
- hot packs
- Heparin
- Or analogues
- Vasodilators
- Gyleryltrinitrate
- Raise head
- Aspirin – stop the clot forming. Prevent platelets forming – give every 3 days
How can you manage jugular thrombosis?(3)
- Alternative venous access
- lateral thoracic
- cephalic
- With bilateral thrombosis, tracheostomy may be required
- Surgical procedures to strip and/or graft the vein have been described but are rarely undertaken
What are the jugular thrombosis complications? (4)
- Embolic disease
- Bacterial endocarditis
- Septic Pneumonia
- Long-term poor performance due to:
- Recurrent laryngeal neuropathy
- Due to the anatomical location cf the jugular
- Upper airway oedema during exercise
What is SIRS and what is it triggered by?
- A self-amplifying dysregulated systemic inflammatory response
- Triggered by
- Bacterial toxins
- Lipopolysaccharide derived from gram negative bacteria, but gram positive is also identified now
- S aureus
- Burns, Neoplasia, Pancreatitis (not equine)
- Can result in coagulopathies
- Previously referred to as endotoxaemia (not helpful as not the endotoxin causing the problems – it’s the inflammation)
- Inflammation leading cell death and apoptosis
- LPS has some direct roles
- Includes non-LPS bacteria
What is sepsis?
SIRS plus blood culture proven infection
What is severe sepsiss?
•Sepsis with organ hypoperfusion or dysfunction (high creatinine, low BP etc).
What is septic shock?
- Severe Sepsis + systemic hypotension
- Common in foals, rare in adults
What is multi organ dysfunction syndrome and how can we classify?
- Altered organ function in an acutely ill animal such that haemostasis cannot be maintained without intervention (can get renal failure as a result)
- Classified as either primary or secondary
- Primary
- resulting from well-defined insult where organ dysfunction occurs early and is a direct consequence of the insult itself
- Eg burns and neoplasia
- Secondary
- Organ failure not in direct response to the insult but as a consequence of a host response (SIRS)
What is disseminated intravascular coagulopathy?
What is it associated with?
- “Consumptive coagulopathy”
- Pathological activation of coagulation
- microvasculature clotting
- haemorrhagic diathesis
- consumption of procoagulants
- Associated with
- SIRS, SEPSIS, SEPTIC SHOCK
- MODS
- systemic neoplasia
- enteritis and colitis
More likely to see thrombosis In horses not haemhorrhage
What are the clinical signs of DIC?
- In large animals, DIC is usually manifested by thrombosis rather than spontaneous haemorrhage
- petechial haemorrhages
- bleeding at following trauma
- Venipuncture
- surgical sites
- nasogastric intubation
- DIC in horses – abnormal bleeding following trauma
How can we diagnose DIC? (5)
- thrombocytopaenia
- Prolonged prothrombin time
- activated partial thromboplastin time
- fibrin degradation products
- antithrombin 3
How should you do a IV jugular injection?
- Inject in the proximal one third of the neck (lower you go the closer to the CA and you will give the drug to the brain – will seizure, due or recover). O think it’s a drug reaction.
- avoids the carotid artery
- which is less superficial
- Remove the needle from the syringe – put needle in first. You will know if you have hit the carotid.
- 18 gauge, 1/5 inch needle
- Push the needle right into the hub
What are the factors you have to consider when choosing a catheter? (10)
- catheter insertion
- sterile technique
- minimal trauma
- secure appropriately in jugular furrow – don’t want it coming out
- catheter material
- catheter design
- catheter use
- sterile insertion
- catheter material
- cheaper but more thrombogenic (nylon, PVC or Teflon):
- teflon, nylon and polyvinylchloride
- Only leave 1-2days
- more expensive but less thrombogenic
- Polyurethane
- Long stay put in over a wire
- Can stay for up to 28 days
- catheter design
- catheter use
What do we need to do when using catheter? (7)
•extension sets to avoid excessive
manipulation of hub
- swab injection ports
- change ports and fluid lines q24hrs?
- Change fluid bags in sterile manner
- appropriate life-span
- PVC - 72 hours
- polyurethane - 7 - 21 days
- covering and application of antiseptic are controversial - helpful in foals to stop them scratching the catheter out, may increase risk of infection. This is usually to prevent them pulling it out rather than a clean thing
- Always keep an eye on the catheter
What are the complications of IV catheterisation? (3)
- jugular thrombosis
- catheter breakage
- May be attached to jugular wall, therefore can remove
- adults - travel to lungs and rarely cause problems
- foals - stick within heart and require surgical removal
Whatis aortoiliac thrombosis? and what is the aetiology?
- Partial or complete occlusion of the terminal aorta, and external and internal iliac arteries by an organising thrombus
- Aetiology unknown
What are the results of aortoiliac thrombosis? (4)
- Poor performance
- Exercise-associated hindlimb lameness (i.e. exacerbated by exercise: differential for extertional rhabdomyolysis)
- Breeding failure in stallions
- After exercise
- Cold limb
- Weak pulses
How do you diagnose AORTO-ILIAC THROMBOSIS? (3)
- palpate thrombus, turgid vessel on rectal examination
- visualise the thrombus with transrectal ultrasonography
- Doppler is good
- vascular phase scintigraphy
How do you treat AORTO-ILIAC THROMBOSIS and what is the prognosis?
TREATMENT
- non-steroidal anti-inflammatory drugs
- aspirin
- fenbendazole (larvicidal, anti-thrombotic effect?)
PROGNOSIS
•guarded
Where is caudal vena caval thrombosis seen and what are the signs?
- Production animal disease – due to poor diet. Loss of rumen integrity due to acidosis. Bacteria cross.
- Formation of thrombus in the caudal vena cava following extension of sepsis from a liver abscess
- Young, beef cattle
- Early signs vague, may appreciate distension in the superficial epigastric veins without jugular distension
- Respiratory signs
- Severe epistaxis
What is seen in caudal vena caval thrombosis? (6)
- Palatable high energy diet, low roughage, less saliva
- Increase in SCFA, lactic acid increase
- Incorrect bacterial population
- Rumen pH <5.5
- Reduction in rumen motility, hyperkeratosis, loss of mucosal integrity
- Bacteria = hepatic portal vein = liver abscessation
What is vascular rupture and how common?
- Any intra-abdominal or intra-thoracic vessel can rupture
- aorta and pulmonary artery appear to be most common sites
- Vascular rupture is the commonest form of sudden death during exercising horses, accounts for around 30% of cases
What is this?
Aneurism causing PA rupture
What are the differentials for vascular rupture? (3)
- Stress fractures
- Exertional rhabdomyolysis
- Arrhythmias
How do you know whetehr blood in the abdomen is from a rupture or you’ve hit a vein?
Blood in the abdomen which has been sat there for a while – so there are no platelets in this. This is how you know it is haemoabdomen not just hitting a vein
What is teh aetiology vascular rupture? (3)
- pre-existing aneurysm
- medial degeneration
- congenital
- parasitic
- large strongyles are more likely to affect the cranial mesenteric arteries and be associated with colic
- the role of migrating strongyles in other vascular diseases may have been over-emphasised
When does RUPTURE OF THE UTERINE VESSELS –uterine artery, external iliac artery occur?
How do we manage? (3)
- Occurs in periparturient broodmares, particularly immediately before or after foaling, but up to three weeks after
- Colic
- Mass palpable in the broad ligament, or may bleed directly into abdomen
- Management
- conservative
- support circulation
- Analgesics
- If its bad enough you need to do something about it – it is too late…
- If it is small enough – don’t worry about it
AORTO-CARDIAC FISTULA:
What is it, where is it seen?
- Congenital or acquired absence defect of the aortic wall
- Seen mainly in intact males
When does the rupture occur with AORTO-CARDIAC FISTULA? (2)
Excerise
Breeding
What are the signs of AORTO-CARDIAC FISTULA? (4)
- Sudden death
- Distress
- ventricular tachycardia
- loud continuous murmur
How do we diagnose AORTO-CARDIAC FISTULA and what is the prognosis?
- Diagnosis:
- Echocardiography
- Prognosis:
- Hopeless
What is the most important vascular disease in horses?
Jugular thrombosis
