Pericardial disease

Question 1

What is the inner player of the pericardium?

Answer 1

Visceral layer
Epicardium
Intimately attached to myocardium

Question 2

What is the outer layer of the pericardium?

Answer 2

Parietal layer
Contiguous with blood vessel layer

Question 3

What is the function of the pericardium?

Answer 3

Fixes the heart anatomically
Reduced friction
Equalises gravitational forces
Prevents over-dilation
regulation between stroke volumes of both ventricles

Question 4

What can go wrong with he pericardium?

Answer 4

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

Question 5

What are the most common neoplasia in the pericardium?

Answer 5

Haemangiosarcoma
Mesothelioma
Chemodectoma
Metastases

Question 6

Types of masses in the pericardium

Answer 6

Neoplasia
Pericardial peritoneal diaphragmatic hernias (cats)
Pericardial cysts

Question 7

What is cardiac tamponade?

Answer 7

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

Question 8

Result of chronic tamponade

Answer 8

RCHF

Question 9

Result of acute tamponade

Answer 9

Low CO and shock
(Uncommon)

Question 10

Acute history

Answer 10

Sudden onset exercise intolerance
Weakness
Collapse
Shock
Rapid death if untreated

Question 11

Chronic history

Answer 11

○ Slow onset of ascites
Enlarged abdomen
Progressive exercise intolerance
Lethargy
Collapse
GI signs

Question 12

Clinical signs of pericardial disease

Answer 12

Jugular distension
Positive hepatojugular reflex
Ascites
Tachycardia
Muffled heart sounds
Weak femoral pulse
Pale mm
GIT signs

Question 13

What is a positive hepatojugular reflex

Answer 13

Squeezing liver causes wave of blood up jugular veins
Sign of high atrial pressure

Question 14

Signs on ECG

Answer 14

Tachycardia
Small complexes
Electrical alternans (due to movement in pericardium)

Question 15

Radiographical findings of pericardial effusion

Answer 15

Globoid enlargement of cardiac silhouette
Sharp outline
Herniation of intestinal organs possible

Question 16

Treatment for pericardial effusion

Answer 16

DO NOT GIVE FUROSEMIDE
* CO is already compromised
* Don’t want to reduce CO further by reducing blood volume

Give emergency oxygen
Drain pericardium

Question 17

Haemangiosarcomas

Answer 17

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

Question 18

Heart Base Tumours

Answer 18

Seen in older brachiocephalic dogs
Chemodectomas
Ectopic thyroid carcinoma
Around the aortic arch
Rarely metastasise
Chronic tamponade
Presented in RHF
No surgical treatment possible

Question 19

Mesotheliomas

Answer 19

Arise from serous membranes
○ Pericardium
○ Pleura
○ Peritoneum
○ Tunica vaginalis of the testes
* Severe pleural & pericardial
effusion
* Histopathological diagnosis
* Chronic tamponade
* Presented in RHF
* Pericardiectomy

Question 20

Idiopathic pericardial effusion

Answer 20

Large breed dogs
○ Saint Bernards
○ Golden retrievers
Chronic tamponade
Presented in RHF
Pericardiocentesis
Pericardiectomy at 3rd recurrence

Question 21

Left atrial rupture

Answer 21

Bleeds into pericardium
RARE
Due to severe MVD
Can’t do pericardioceentesis

Question 22

Pericardial Peritoneal Diaphragmatic Hernia

Answer 22

○ Often incidental finding
○ Weimaraners and Persian
UNCOMMON
Surgical correction

Question 23

Which side do you do pericardiocentesis and why?

Answer 23

RHS
Avoids laceration of main coronary vessels