Pericardial disease Flashcards
What is the function of the peicardium?
- Pericardial fluid – 0.25 mL/kg lubricant
- Prevents over dilation
- Systolic function (torsion)
- Co-ordinates LV-RV interaction
- Protects heart
- Maintains position
What are acquired pericardial diseases?
Pericardial effusion :
* Idiopathic
* Neoplasia
* CHF (LA rupture, cats)
* Coagulopathy
* Hypoproteinaemia
* PPDH
* Infections, FIP, FB
* Renal failure
- Constructive / effusive constructive pericarditis
What are congenital pericardial diseases?
- PPDH - Peritoneopericardial diaphragmatic hernia
- Pericardial cyst
- Pericardial defect / absence
What causes pericardial effusions in dogs?
- Idiopathic
- Neoplasia
- seen in older large dogs
What causes pericardial effusions in cats?
- CHF
- FIP
- Infectious, lymphoma, mesothelioma, rhabdomyosarcoma, coagulation, uraemia
What needs to be excluded with idiopathic PE in dogs?
- No mass on echo
- Cytology negative for neoplasia
- Occult neoplasia
- Mesothelioma
- St Bernard, GR, labrador
What dogs get haemangiosarcoma? Tx?
- GSD, GR, setters
- v malignant
Tx - Pericardiocentesis
- Percadectomy
- Chemotherapy +/- therapy
- poor prognosis - euthanasia
What is the prognosis of Chemodectoma?
- Benign - good prognosis
- slow growing
- Tx = palliative pericardiectomy
- Seen in brachycephalic breeds
What is the prognosis of mesothelioma?
- POOR
- difficult to diagnose
What are neoplastic causes of PE?
- Haemangiosarcoma
- Chemodectoma
- Mesothelioma
Rare=
* Ectopic thyroid carcinoma
* Lymphoma
* Rhabdomyosarcoma
*
What happens due to pericardial effusion?
- 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
What is a cardiac tamponade?
- 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
What are clinical signs of PE in dogs?
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
What is seen with chronic PE in dogs?
- R-CHF
-organomegaly
-abdominal effusion
-Positive hepatojugular reflux
-Jugular distension/pulsation
-Tachycardia - Femoral pulses
-Weak
-Pulsus paradoxus - Muffled heart sounds
What is seen with acute PE in dogs?
*Weak
*Collapsed
*Tachycardic
*Pale MM
*Arrhythmic potentially
*Signs of haemorrhagic shock
*Signs of forward failure
*Weak pulses
What diagnostic procedures can be carried out?
*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
What should not be used in dogs with PE?
- NEVER give furosemide in dogs with PE
- Drain pericardium + give fluids
How would you perform a pericardiocentesis?
- 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
What should be done with pericardial fluid analysis?
- Measure amount
- EDTA tube - PCV
- Cytology - reactive mesothelial cells, RBCs, Neoplastic cells, phagocytic cells
- Check coagulation - blood?
- Culture
What is seen during pericardiocentesis?
- Reduced HR
- Improvement in pallor
- Improved pulses
- Taller QRS on ECG
What is seen after pericardiocentesis?
- 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
What is different with constrictive pericarditis?
- RARE
- Thickened fibrotic pericardium - idiopathic or secondary to recurrent PE, neoplasia, foreign body
- R-CHF, cardiac temponade + little fluid
- Difficult to diagnose
What is PPDG seen in?
Weimaraners + Persian cats
-abdominal organs within pericardial sac
What is left atrial rupture?
*Advanced MDVD
*Severe LA enlargement
*Atrial tears
*If tamponade - Pericardiocentesis, Blood transfusion, Thoracotomy
*Guarded prognosis
What causes infectious pericarditis? What should be done?
*Foreign body, penetrating wound, infectious agent
*FIP in cats
*Aggressive antibiosis
*Fluid Culture
*Exploratory thoracotomy
*Pericardiectomy
