Pericardial disease Flashcards
What is the pericardium
membrane surrounding the heart
List the function of the pericardium
Not essential
prevents distension of the heart in the chest
reduces friction
equalises gravity
prevention of overdilation
regulation between stroke volumes
What is cardiac tamponade
acute compression of the heart caused by fluid accumulation in the pericardial cavity
What can chronic tamponade of the heart lead to
right congestive heart failure
what can acute tamponade of the heart lead to
a quick drop in blood pressure
Why do you occasionally get GI signs with pericardial effusion
the vascular bed becomes congested and the GIT isn’t perfused efficiently
List 9 clinical signs associated with pericardial effusion
Jugular distension
positive hepatojugular reflex
ascites
tachycardia
muffled heart sounds
weak femoral pulses
pale MM
tachypnoea
GIT signs
Describe the hepatojugular reflex
as you palpate cranial abdomen someone looks at jugular- will see wave up jugular- shows you have high RA pressure
How do you diagnose pericardial effusion
clinical signs
echo
ECG
what usually comes first in dogs- RCHF or pericardial effusion
pericardial effusion
what usually comes first in cats- CHF or pericardial effusion
CHF
How can we tell if the pericardial effusion of the CHF was first
if pericardial effusion was first, the right atrium will be collapsed
what is a classic sign of pericardial effusion on ECG
electrical alternans
what are electrical alternans
complexes are bigger then smaller on repeat
How do we see pericardial effusion on radiogrpahy
globoid cardiac silhouette with a sharp outline
Describe how you treat a pericardial effusion
oxygen
IV fluids
pericardiocentesis
when do we generally have to do a pericardial strip
if you have to repeat pericardiocentesis more than 3 times
why do we generally drain pericardial effusion from the right
avoids laceration of the main coronary vessels
List 5 possible complications of a pericardiocentesis
cardiac puncture
arrythmias
dissemination of infection or neoplasia
atrial fibrillation
myocardial stunning
how can you check if the blood you are draining during pericardiocentesis is from the pericardium or from the heart
blood from the ventricles will clot, blood from the pericardium will not
Why is there a risk of arrythmias post pericardiocentesis
because of the rapid filling and dilation of the RA and RV
What is myocardial stunning
temporary loss of contractile function that persists for hours to days after perfusion has been restored
list the 4 most common causes of pericardial effusion in dogs
cardiac neoplasia
idiopathic
left atrial rupture
coagulopathies, uremic, infection
List 4 common cardiac tumours
haemangiosarcomas
heart base tumours (chemodectoma)
mesotheliomas
lymophsarcoma
what is a chemodectoma
tumour of the chemical sensing cells in the aortic arch
what is a haemangiosarcoma
malignant tumour of vascular endothelium
describe heart base tumours
chemodectomas and ectopic thyroid carcinomas
describe mesotheliomas
cancers of the mesothelial cells
where do haemangiosarcomas commonly form within the heart
on the wall of the right atrium
where do chemodectomas commonly form
round the aortic arch
what is a left atrial rupture usually secondary to
chronic degenerative valve disease
why should we not do a pericardiocentesis if we suspect a LA tear
we may dislodge the clot
describe a peritoneal pericardial diaphragmatic hernia
communication between the pericardial and peritoneal cavities
what is a pericardial cyst
most common benign tumour of the pericardium
what causes constrictive pericardial disease
repeated pericardial draining
Describe how to treat constrictive pericardial disease
pericardectomy
can you see constrictive pericardium on ultrasound
yes- it will show as a bright white pericardium stuck to the heart wall
where do we make our incision for a pericardiocentesis
at the 5th intercostal space on the RHS
why does a large atria show on ECG as inverted QRS
if the right side is producing more power than the left side, then the QRS complexes will be inverted
List 3 indications for a pericardectomy
severe chronic pericardial disease
restrictive pericardial disease
Palliative surgery for neoplastic aetiologies of pericardial effusion
