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Y4 SA - Cardio-Respiratory > Pericardial disease > Flashcards

Pericardial disease Flashcards

1
Q

Describe the anatomy/layers of the pericardium

A

Outer = fibrous pericardium
Inner = serous pericardium - contains two layers (parietal and visceral) and the pericardial fluid between them

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2
Q

The main innervation of the pericardium comes from which nerves?

A

Vagus nerve (X)
Laryngeal recurrent nerve (XI)
Sympathetic nerve fibres
Phrenic nerves course over lateral surfaces of pericardium

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3
Q

Blood supply to the pericardium comes from branches of which arteries?

A

Aorta
Internal thoracic artery
Musculophrenic arteries

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4
Q

What are the functions of the pericardium?

A
  • Pericardial fluid – 0.25 mL/kg lubricant
  • Prevents over dilation
  • Systolic function (torsion)
  • Co-ordinates LV-RV interaction
  • Protects heart
  • Maintains position
  • IS NOT A VITAL ORGAN
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5
Q

List the different types of acquired pericardial disease

A
  • Pericardial effusion: haemorrhagic, transudate, exudate
  • Constrictive or effusive-constrictive pericarditis
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6
Q

List some causes of a haemorrhagic pericardial effusion

A

Idiopathic
Neoplasia
Coagulopathy
Rupture of the LA
Trauma

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7
Q

List some causes of a transudate pericardial effusion

A

CHF
Hypoproteinaemia
Neoplasia
Peritoneopericardial diaphragmatic hernia (PPDH)
Renal failure

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8
Q

List some causes of an exudate pericardial effusion

A

FIP
Infection
Foreign body

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9
Q

What are the two most common causes of pericardial effusions in dogs?

A

Idiopathic
Neoplasia

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10
Q

What are the most common causes of pericardial effusions in cats

A

CHF
FIP
Infectious, lymphoma, mesothelioma, rhabdomyosarcoma, coagulation, thickening

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11
Q

Pericardial effusions are most commonly seen in which dogs?

A

Older, large breed

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12
Q

Describe the features of idiopathic pericardial effusions in dogs

A
  • Exclusion diagnosis: No mass on echo, cytology negative for neoplasia
  • St. Bernard, GR, Labrador,..
  • Can recur
  • Pericardectomy if recurrence
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13
Q

Name three neoplastic causes of pericardial effusions

A

Haemangiosarcoma
Chemodectoma/aortic body tumours
Mesothelioma

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14
Q

Haemangiosarcomas are most commonly seen in which dogs?

A

Older
GSD, golden retriever

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15
Q

Where is a haemangiosarcoma mass found in the heart/body?

A
  • Mass associated with right atrium or right auricular appendage
  • Commonly spleen +/- liver affected (if atrial mass then 30% chance of splenic involvement, if splenic mass then 10% chance of atrial involvement)
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16
Q

How does a haemangiosarcoma cause a pericardial effusion?

A

Bleed from the tumour into the pericardial space – has a compressive effect on the heart

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17
Q

How does a dog with a haemangiosarcoma present?

A

Acutely – collapse, pallor, rapid HR, signs of shock

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18
Q

How is a haemangiosarcoma treated?

A

Palliative
- Pericardiocentesis
- Pericardectomy
- Balloon pericardiotomy
Chemotherapy +/- surgery
Grave prognosis

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19
Q

How does a dog with a pericardial effusion die to a haemangiosarcoma appear on an echo?

A

Fluid (black) can be seen surrounding the heart
A mass can be seen on the right side of the heart – blood filled (need a sample)

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20
Q

Chemodectoma/aortic body tumours are most commonly seen in which dogs?

A

Older dogs, especially brachycephalic breeds (Boxer, English Bulldog, Boston Terrier)

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21
Q

Describe the pathogenesis of a Chemodectoma

A

Benign, slow-growing and locally invasive (around Ao and PA) – low metastatic rate (lungs, liver)
Can grow to be very large

22
Q

How is a Chemodectoma treated?

A

Palliative pericardiectomy

23
Q

Why are mesotheliomas challenging tumours?

A

Challenging to diagnose – reactive mesothelial cells show cytological features of malignancy.
Difficult to treat
Poor prognosis

24
Q

What are the impacts of a pericardia effusion on the heart?

A

Fluid surrounding the heart increases the pressure on the heart
Impeded ventricular filling during diastole
This is exerted on the chambers differently = Cardiac tamponade

25
Q

What are the consequences of reduced right ventricular filling during diastole?

A
  1. Reduced stroke volume -> reduced LV filling -> reduced LV stroke volume -> RAAS, tachycardia, weak pulses, collapse
  2. Reduced venous return to the right side -> R-CHF -> ascites, pleural effusion
26
Q

Describe cardiac tamponade

A
  • Intrapericardial pressure > RA (RV) pressure (pressure on the outside is bigger than the pressure on the inside)
  • RA collapses during diastole
  • Cardiac filling is severely impaired
  • Reduced right sided cardiac output
  • RAAS activation
  • Results in RIGHT sided CHF
27
Q

Describe acute pericardial effusions

A
  • Relatively small amounts of pericardial effusion can result in profound haemodynamic compromise.
  • Typically this is haemorrhage, therefore signs of forward failure in combination with haemorrhagic shock present
  • If the accumulation of effusion within the pericardial sac is gradual, it can stretch and tolerate larger volumes, signs of R-CHF predominate
28
Q

List the 3 non-specific signs of pericardial effusions in dogs

A

Decreased appetite
Lethargy
Gastrointestinal upset – diarrhoea due to malabsorption

29
Q

List the 4 specific signs of pericardial effusions in dogs

A
  • Abdominal enlargement
  • Decreased exercise tolerance
  • Mild coughing
  • Syncope/collapse
30
Q

Describe the clinical signs of right sided CHF in chronic pericardial effusion dogs

A
  • Organomegaly
  • Abdominal effusion
  • Positive hepatojugular reflux
  • Jugular distension/pulsation
  • Tachycardia
  • Muffled heart sounds
  • Weak femoral pulses
31
Q

Describe the clinical signs of acute pericardial effusions in dogs

A
  • Weak
  • Collapsed
  • Tachycardic
  • Pale MM
  • Arrhythmic potentially
  • Signs of haemorrhagic shock
  • Signs of forward failure
  • Weak pulses
32
Q

Describe the findings on a routine haematology and serum biochemistry in dogs with pericardial effusions

A
  • Pre-renal azotaemia is commonly found
  • Increased liver enzymes due to liver congestion.
  • The presence of anaemia and abnormalities in the RBC on the smear analysis should raise the suspicion of haemangiosarcoma
  • In cats, hypergammaglobulinemia can be seen in FIP and azotaemia in uremic pericarditis
32
Q

Describe the findings on a routine haematology and serum biochemistry in dogs with pericardial effusions

A
  • Pre-renal azotaemia is commonly found
  • Increased liver enzymes due to liver congestion.
  • The presence of anaemia and abnormalities in the RBC on the smear analysis should raise the suspicion of haemangiosarcoma
  • In cats, hypergammaglobulinemia can be seen in FIP and azotaemia in uremic pericarditis
33
Q

Describe the ECG in a patient with a pericardial effusion

A
  • Sinus tachycardia
  • Small complexes
  • Electrical alternans: rhythmic variation of the QRS amplitude due to changes in position of the heart swinging in the fluid
34
Q

How does a pericardial effusion present on radiography?

A
  • Globoid and enlarged cardiac silhouette
  • Very distinct cardiac silhouette (defined edges)– minimal movement during the cardiac cycle
  • Dorsal deviation of the trachea
  • Loss of divergent angle between trachea - spine
  • Dilated caudal vena cava
  • Abdominal effusion
  • Small pulmonary vessels – despite cardiomegaly
  • Clear lung fields
35
Q

Describe the features of a pericardial effusion seen on echocardiography

A
  • Presence of hypoechoic (black) fluid around the heart
  • Hyperechoic (white) pericardial line surrounding the fluid
  • Collapse of the right atrium (tamponade)
  • Swinging of the heart within the fluid
  • Pleural effusion might also be present
36
Q

Describe the drugs you could use to treat a pericardial effusion

A

Do NOT use Furosemide in dogs with PE
Note: cats can have PE from CHF therefore furosemide is indicated
If tamponade is present PERICARDIOCENTESIS should be performed promptly and is the only treatment option

37
Q

When would/wouldn’t you give fluids to a patient with a pericardial effusion?

A

In dogs to increase cardiac preload high-rate fluids can be given intravenously (during preparation of pericardiocentesis)
NOT in cats with a pericardial effusion secondary to CHF

38
Q

Describe preparation of a patient for a pericardiocentesis

A
  • DO NOT USE DIURETIC!
  • Check patient PCV
  • Mild sedation - Opiates ideal – butorphanol
  • Left lateral recumbency: Right lateral access 5th-6th ICS
  • Prepare area 3rd-8th ICS
  • Echo to check incision point
  • Local anaesthetic: skin & pleura
39
Q

Describe how a pericardiocentesis is carried out

A
  • Stab incision in skin approx. 1/3 of chest diameter up from sternum
  • Advance catheter + syringe AIM FOR OPPOSITE SHOULDER (left shoulder) – maintain gentle syringe suction until dark-red fluid
  • Advance catheter and withdraw needle
  • Attach to extension/three way tap
  • Take a sample of the fluid
  • Check PCV of sample! IF PCV IS THE SAME AS PATIENT BLOOD PCV STOP!!!!! Consider haemorrhagic effusion.
40
Q

Describe what is seen on cytology of pericardial fluid

A
  • Reactive mesothelial cells
  • RBC
  • Phagocytic cells, bacteria
  • Neoplastic cells
41
Q

During pericardiocentesis what changes should be seen in the patient?

A

Improvement of cardiovascular parameters:
- Reduction in HR
- Improvement in pallor
- Improved pulses
- Taller QRS on ECG

42
Q

What should you do if cardiovascular parameters are not improving during pericardiocentesis?

A

Check fluid PCV vs dog PCV as may be draining whole blood
- Iatrogenic cardiac puncture
- Bleeding cardiac neoplasia causing haemorrhagic effusion
In this case STOP draining otherwise EXSANGUINATION

43
Q

Describe post-op care following pericardiocentesis

A

Natural diuresis (ascites will resolve) via natriuretic peptide release – dog WILL need to pee!
Hospitalise 12-24 hours
- Atrial fibrillation
- Ventricular arrhythmias
- Weigh twice per day

44
Q

What is indicated if there is recurrence following Pericardiocentesis

A

If quick, or no marked improvement: neoplasia = poor prognosis

45
Q

Describe the features of constrictive pericarditis

A
  • Rare! And hard to diagnose
  • Thickened, fibrotic pericardium
  • Idiopathic
  • OR secondary to: recurrent pericardial effusions, neoplasia, FB/infection
  • R-CHF, cardiac tamponade with little fluid
  • Guarded prognosis without pericardiectomy
  • Difficult to diagnose: diagnosis of exclusion
  • Specialist Cardiology needed
46
Q

PPDH stands for?

A

Peritoneopericardial diaphragmatic hernia

47
Q

What is a Peritoneopericardial diaphragmatic hernia?

A

Defect in ventral diaphragm and pericardium → abdominal organs within pericardial sac
Often incidental finding

48
Q

Which breeds are predisposed to Peritoneopericardial diaphragmatic hernia?

A

Weimaraner’s and Persian cats

49
Q

What other malformations are seen with PPDH?

A

Sternal abnormalities
Ventral abdominal hernias
Congenital heart disease (PS, VSD)

50
Q

Describe the aetiology of infectious pericarditis

A

Foreign body, penetrating wound, infectious agent
FIP in cats

Y4 SA - Cardio-Respiratory (10 decks)

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