Pericardial disease Flashcards
What is the inner player of the pericardium?
Visceral layer
Epicardium
Intimately attached to myocardium
What is the outer layer of the pericardium?
Parietal layer
Contiguous with blood vessel layer
What is the function of the pericardium?
Fixes the heart anatomically
Reduced friction
Equalises gravitational forces
Prevents over-dilation
regulation between stroke volumes of both ventricles
What can go wrong with he pericardium?
Pericardial effusion
* Blood (most common)
* Transudate (heart failure in cats)
* Exudate from penetrating trauma
Masses within pericardial space, heart or pericardium
Can become stiff
Impaired ventricular filling due to increased intrapericardial pressure
What are the most common neoplasia in the pericardium?
Haemangiosarcoma
Mesothelioma
Chemodectoma
Metastases
Types of masses in the pericardium
Neoplasia
Pericardial peritoneal diaphragmatic hernias (cats)
Pericardial cysts
What is cardiac tamponade?
Intrapericardial pressure equilibrates with RA/RV filling pressures
Lead to right sided diastolic failure - can’t fill properly
Leads to increase in systemic venous blood pressure
Ascites and pleural effusion
Result of chronic tamponade
RCHF
Result of acute tamponade
Low CO and shock
(Uncommon)
Acute history
Sudden onset exercise intolerance
Weakness
Collapse
Shock
Rapid death if untreated
Chronic history
○ Slow onset of ascites
Enlarged abdomen
Progressive exercise intolerance
Lethargy
Collapse
GI signs
Clinical signs of pericardial disease
Jugular distension
Positive hepatojugular reflex
Ascites
Tachycardia
Muffled heart sounds
Weak femoral pulse
Pale mm
GIT signs
What is a positive hepatojugular reflex
Squeezing liver causes wave of blood up jugular veins
Sign of high atrial pressure
Signs on ECG
Tachycardia
Small complexes
Electrical alternans (due to movement in pericardium)
Radiographical findings of pericardial effusion
Globoid enlargement of cardiac silhouette
Sharp outline
Herniation of intestinal organs possible
Treatment for pericardial effusion
DO NOT GIVE FUROSEMIDE
* CO is already compromised
* Don’t want to reduce CO further by reducing blood volume
Give emergency oxygen
Drain pericardium
Haemangiosarcomas
Seen in older GSD and Golden Retrievers
Right atrial/right auricular appendage
Metastatic disease is common
Causes acute tamponade (haemorrhage)
Can be a small volume if an acute bleed
Can present with forward failure
Surgical resection
Worth scanning the spleen
Heart Base Tumours
Seen in older brachiocephalic dogs
Chemodectomas
Ectopic thyroid carcinoma
Around the aortic arch
Rarely metastasise
Chronic tamponade
Presented in RHF
No surgical treatment possible
Mesotheliomas
Arise from serous membranes
○ Pericardium
○ Pleura
○ Peritoneum
○ Tunica vaginalis of the testes
* Severe pleural & pericardial
effusion
* Histopathological diagnosis
* Chronic tamponade
* Presented in RHF
* Pericardiectomy
Idiopathic pericardial effusion
Large breed dogs
○ Saint Bernards
○ Golden retrievers
Chronic tamponade
Presented in RHF
Pericardiocentesis
Pericardiectomy at 3rd recurrence
Left atrial rupture
Bleeds into pericardium
RARE
Due to severe MVD
Can’t do pericardioceentesis
Pericardial Peritoneal Diaphragmatic Hernia
○ Often incidental finding
○ Weimaraners and Persian
UNCOMMON
Surgical correction
Which side do you do pericardiocentesis and why?
RHS
Avoids laceration of main coronary vessels
