Pericardial disease

Question 1

What is the function of the peicardium?

Answer 1

• Pericardial fluid – 0.25 mL/kg lubricant
• Prevents over dilation
• Systolic function (torsion)
• Co-ordinates LV-RV interaction
• Protects heart
• Maintains position

Question 2

What are acquired pericardial diseases?

Answer 2

Pericardial effusion :
* Idiopathic
* Neoplasia
* CHF (LA rupture, cats)
* Coagulopathy
* Hypoproteinaemia
* PPDH
* Infections, FIP, FB
* Renal failure

• Constructive / effusive constructive pericarditis

Question 3

What are congenital pericardial diseases?

Answer 3

• PPDH - Peritoneopericardial diaphragmatic hernia
• Pericardial cyst
• Pericardial defect / absence

Question 4

What causes pericardial effusions in dogs?

Answer 4

• Idiopathic
• Neoplasia
• seen in older large dogs

Question 5

What causes pericardial effusions in cats?

Answer 5

• CHF
• FIP
• Infectious, lymphoma, mesothelioma, rhabdomyosarcoma, coagulation, uraemia

Question 6

What needs to be excluded with idiopathic PE in dogs?

Answer 6

• No mass on echo
• Cytology negative for neoplasia
• Occult neoplasia
• Mesothelioma
• St Bernard, GR, labrador

Question 7

What dogs get haemangiosarcoma? Tx?

Answer 7

• GSD, GR, setters
• v malignant
  Tx
• Pericardiocentesis
• Percadectomy
• Chemotherapy +/- therapy
• poor prognosis - euthanasia

Question 8

What is the prognosis of Chemodectoma?

Answer 8

• Benign - good prognosis
• slow growing
• Tx = palliative pericardiectomy
• Seen in brachycephalic breeds

Question 9

What is the prognosis of mesothelioma?

Answer 9

• POOR
• difficult to diagnose

Question 10

What are neoplastic causes of PE?

Answer 10

• Haemangiosarcoma
• Chemodectoma
• Mesothelioma

Rare=
* Ectopic thyroid carcinoma
* Lymphoma
* Rhabdomyosarcoma
*

Question 11

What happens due to pericardial effusion?

Answer 11

• Pressure on heart = reduced right ventricular filling
• Reduced stoke volume = RAAS activation = R-CHF, Ascites, pleural effusion
• Weak pulses, collapse, tachycardia
• Pulsus paradoxus - pulse disappear when you breath in

Question 12

What is a cardiac tamponade?

Answer 12

• 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

Question 13

What are clinical signs of PE in dogs?

Answer 13

Non-specific signs
* decreased appetite
* Lethargy
* Gastrointestinal upset
Specific signs
* Abdominal enlargement
* Decreased exercise intolerance
* Mild coughing
* Syncope / collapse

• cats will present in congestive heart failure

Question 14

What is seen with chronic PE in dogs?

Answer 14

• R-CHF
  -organomegaly
  -abdominal effusion
  -Positive hepatojugular reflux
  -Jugular distension/pulsation
  -Tachycardia
• Femoral pulses
  -Weak
  -Pulsus paradoxus
• Muffled heart sounds

Question 15

What is seen with acute PE in dogs?

Answer 15

*Weak
*Collapsed
*Tachycardic
*Pale MM
*Arrhythmic potentially
*Signs of haemorrhagic shock
*Signs of forward failure
*Weak pulses

Question 16

What diagnostic procedures can be carried out?

Answer 16

*Patient PCV (BEFORE pericardiocentesis) - acute vs chronic
*Haem, biochem, CTnI (BEFORE pericardiocentesis)
*Coags
*BP
*ECG - tachycardia + small QRS (pressure + swinging in fluid to + away from electrodes)
*Echocardiography
*Radiography - looks like DCM
*Abdominal ultrasound
*FLUID ANALYSIS

Question 17

What should not be used in dogs with PE?

Answer 17

• NEVER give furosemide in dogs with PE
• Drain pericardium + give fluids

Question 18

How would you perform a pericardiocentesis?

Answer 18

• DO NOT USE DIURETIC!
• Check patient PCV
• Mild sedation - opiates ideal
• Left lateral recumbency
  -Right lateral access 5th -6th ICS
  -Avoid coronary artery
  -Window – no lungs
• Prepare area 3rd-8th ICS
• Echo = check incision point
• Local anaesthetic - Skin & pleura - 2 % lidocaine
• 14G over the needle catheter - with side holes (blade)
• Pericardiocentesis kit
• Scalpel blade
• Lidocaine
• Extension
• 3 way tap
• Tubes, bowl
• Sterile gloves
• ECG

PERICARIDAL EFFUSION LOOKS LIKE BLOOD but won’t clot

Question 19

What should be done with pericardial fluid analysis?

Answer 19

• Measure amount
• EDTA tube - PCV
• Cytology - reactive mesothelial cells, RBCs, Neoplastic cells, phagocytic cells
• Check coagulation - blood?
• Culture

Question 20

What is seen during pericardiocentesis?

Answer 20

• Reduced HR
• Improvement in pallor
• Improved pulses
• Taller QRS on ECG

Question 21

What is seen after pericardiocentesis?

Answer 21

• Natural diuresis - dog will pee A LOT (natriuretic peptide release)
• Hospitalise 12-24 hrs
• atrial fib
• ventricular arrhythmias
• weigh twice a day
• If quick recurrence = poor prognosis = neoplasia

Question 22

What is different with constrictive pericarditis?

Answer 22

• RARE
• Thickened fibrotic pericardium - idiopathic or secondary to recurrent PE, neoplasia, foreign body
• R-CHF, cardiac temponade + little fluid
• Difficult to diagnose

Question 23

What is PPDG seen in?

Answer 23

Weimaraners + Persian cats
-abdominal organs within pericardial sac

Question 24

What is left atrial rupture?

Answer 24

*Advanced MDVD
*Severe LA enlargement
*Atrial tears
*If tamponade - Pericardiocentesis, Blood transfusion, Thoracotomy
*Guarded prognosis

Question 25

What causes infectious pericarditis? What should be done?

Answer 25

*Foreign body, penetrating wound, infectious agent
*FIP in cats

*Aggressive antibiosis
*Fluid Culture
*Exploratory thoracotomy
*Pericardiectomy