Pericardial Disease Flashcards
What are 3 congenital disorders associated with the pericardium?
- peritoneopericardial diaphragmatic hernia
- pericardial cyst (rare, not reported in cats)
- pericardial defects (rare, not reported in cats)
What are the clinical signs of PPDH?
- about 50% = asymptomatic/ incidental
- c/s = respiratory or GI, such as dyspnea, respiratory distress, vomiting, anorexia
What is PPDH?
Peritoneopercardial diaphragmatic hernia
- the pericardium fails to develop properly at the ventral edge, resulting in abdominal organs (ex. liver & gallbladder most commonly) herniating
How is PPDH diagnosed>?
- On PE: muffled heart/lung sounds, thin, tachypnea, sternum malformation
- On CXR: gas opacity/ bowel loops in chest, cranial shift of gastric axis, increased size of heart silhouette and loss of distinction between heart and diaphragm
- Echo = confirmatory
ddx = consolidation (hepatization) of the accessory lung lobe - increased ALT in dogs, increased Ca2+ in cats
How is PPDH treated?
surgery
What are some ddx for pericardial defects?
can look like a right or left auricle bulge on CXR
ddx: neoplasia, AV disease leading to secondary dilation
What are 2 acquired pericardial diseases?
- pericardial effusion
- restrictive pericarditis
What’s the most common pericardial disease in dogs and cats?
pericardial effusion
What’s cardiac tamponade?
impaired ventricular filling due to increased pericardial pressure, leading to a decreased stroke volume and cardiac output
How does acute pericardial effusion cause cardiogenic shock?
- right side of the heart = more compliant = more affected by the pericardial effusion –> collapse of the R side of the heart
- decreased R diastolic filling –> decreased L ventricular filling –> decreased cardiac output –> cardiogenic shock
What are the systemic signs related to chronic pericardial effusion?
right sided congestive heart failure predominates
- atrial natriuretic peptide is not activated in cardiac tamponade –> limit natriuresis, sustains volume overload and increased venous pressure
What’s the pathophysiology of pulsus paradoxus?
- it’s an exaggerated change in left ventricular stroke volume
- upon inspiration, there is increased in intrathoracic pressure – the blood will flow to lower pressure area such as the cava, pulmonary vein, R atrium & ventricle
- this will decrease the L sided filling, thus a reduction in stroke volume
- with pericardial effusion, the outward expansion of the ventricle is limited –> ventricular interdependence
- the septum will bow towards the L during the R sided filling, further decreasing the L ventricular filling volume and thus stroke volume
- this plus the normal decrease in L ventricular stroke volume with inspiration = pulsus paradoxus
What’s the most common cause of pericardial effusion in the dog?
neoplasia
followed by idiopathic
other uncommon causes = infectious, cardiovascular, metabolic and toxic (rare)
What are the hallmark physical abnormalities associated with acute cardiac tamponade?
- pale MM
- tachypnea
- weak pulse
- muffle heart sound
What are the typical signs of chronic cardiac tamponade?
- distended jugular vein/ pulsation
- positive hepatojugular reflux test
- hepatomegaly
- ascites
Which imaging modality can provide definitive diagnosis for pericardial effusion?
Echo –> cannot ddx between idiopathic and mesothelioma
- CXR may not see the classic signs unless it’s chronic
What are some possible neoplasia associated with the heart?
Right atrium/ auricle: hemangiosarcoma
Heart base: neuroendocrine (chemodectoma), thyroid carcinoma, mesothelioma
- lymphoma, sarcoma, etc also possible
How is pericardial effusion treated?
Acute/ cardiogenic shock: pericardiocentesis, aggressive fluid therapy
Chronic cardiac tamponade: echo then do centesis
For idiopathic: subtotal pericardectomy
Hear base mass: partial pericardectomy
Infective pericarditis: subtotal pericardectomy, post-op chest tube, long term (min 6m) antibiotics
What’s constrictive pericarditis?
it’s when either (or both) the parietal or the visceral pericardium develops fibrosis without sticking to each other.
Can effusion be present with constrictive pericarditis?
Yes, sometimes there is a small volume of pericardial effusion - constrictive-effusive pericarditis
What are some clinical signs associated with constrictive pericarditis?
- ascites = consistent feature
- jugular distension = common
- pulsus paradoxus = uncommon
What are some causes of constrictive pericarditis?
- previous pericardial effusion
- infectious pericardial effusion (ex. C immitis) or idiopathic - intrapericardial foreign body
- osseous metaplasia
- idiopathic
How is constrictive pericarditis diagnosed?
R heart catheterization –> looking at the filling pressure “dip & plateau”
- echo is not helpful
- will see hepatic vein distension
How is constrictive pericarditis treated?
subtotal pericardiectomy and removal of constrictive pericardium
- parietal has better prognosis than visceral
What’s the most common cause of feline pericardial effusion?
Pericardial effusion = most common pericardial disease in cats
- usually don’t result in cardiac tamponade
- most common cause = CHF, followed by neoplasia (rare), infective (rare)
- effusion = looks like pleural effusion, rarely hemorrhagic like dogs
How is feline pericardial effusion treated?
Pericardiocentesis if echo evidence of cardiac tamponade is present
