Pericardial disease Flashcards
Describe pericardial dieases.
■ Pericardial diseases are uncommon, but can be life-threatening.
■ Pericardial effusion is the most common pericardial
abnormality.
■ Tamponade is a common cause of right-sided congestive heart failure but treatment is very different from other causes of it.
■ Normal pericardium has Fibrous and serous layers that are Paper thin.
– Contains a Small volume (0.25ml/kg) fluid normally present.
Common cause of right-sided congestive heart failure.
cardiac tamponade due to pericardial effusion
Congenital causes of pericardial diseases. (3)
Absence of pericardium,
pericardial cysts,
peritoneo-pericardial diaphragmatic hernia (PPDH)
Aquired causes of pericardial diseases. (3+)
Effusion:
Primary: idiopathic, neoplastic, infectious,
traumatic, toxic, LA rupture;
Secondary: CHF, hypoalbuminaemia.
Neoplasia:
– Haemangiosarcoma: right auricular appendage:
German Shepherd dogs
– Heart base tumours (chemodectoma): Boxers
– Pericardial: mesothelioma: small-to-medium breeds
Idiopathic pericardial effusion is most common.
Clinical signs of percardial disease. (6)
Vague signs: inappetence, lethargy, ex intolerance;
Severe/acute cases: collapse, dyspnoea, abdominal
enlargement.
signs due to pericardial effusion.
Physical examination in percardial disease.
muffled heart sounds,
jugular distension,
ascites;
weak pulses,
pulsus paradoxus (variable pulse quality)
Pulsus paradoxus is an abnormal decrease in systolic blood pressure (typically greater than 10 mmHg) during inhalation (inspiration). Normally, the systolic pressure slightly drops during inhalation, but in pulsus paradoxus, the drop is exaggerated.
Percardial disease.
Radiography:
Echo:
ECG:
■ Radiography: large rounded heart, CaudalVenaCava dilation
■ Echo: fluid around the heart, right atrial collapse
■ ECG: electrical alternans
Electrical alternans is a phenomenon observed on an electrocardiogram (ECG) where there is a beat-to-beat variation in the amplitude or axis of the QRS complex. This finding is often associated with pericardial effusion, especially when it evolves into cardiac tamponade.
Tx of cardiac tamponade.
Pericardiocentesis performed from the RIGHT to avoid the phrenic nerve and other important stuctures on the left side.
Right heart can also cope better with accidental needle stick too.
Use as large a bore needle as possible. its okay if residual fluid leaks into the thorac cavity fom where it’ll be absorbed.
Do NOT give furo! Contraindicated!
Pericardiocentesis technique.
■ Ultrasound guided
■ Local anaesthesia
■ Butterfly, IV catheter, Seldinger technique
– Check for clotting and do Laboratory analysis otherwise.
If the fluid is clotted, it may suggest that the pericardial effusion is hemorrhagic, which means that blood is present in the pericardial space. Hemorrhagic effusions are often caused by trauma, malignancy, or conditions like aortic dissection or anticoagulant therapy.
In contrast, non-clotted fluid (clear or straw-colored) is more typical of a serous effusion, which may be seen in conditions like viral pericarditis or heart failure.
– Complications
■ Ventricular arrhythmias
■ Cardiac puncture
■ Infection
Fluid analysis of pericardial effusion.
If the fluid is clotted, it may suggest that the pericardial effusion is hemorrhagic.
■ Haemorrhagic – idiopathic, neoplasia, trauma,
coagulopathy, atrial rupture
Non-clotted fluid (clear or straw-colored) is more typical of a serous effusion.
■ Transudate - hypoproteinaemia
■ Modified transudate – right-sided CHF, neoplasia, PPDH.
■ Exudate – FIP, infection (bacterial, fungal, foreign body)
ECG: electrical alternans =
Electrical alternans is a phenomenon observed on an electrocardiogram (ECG) where there is a beat-to-beat variation in the amplitude or axis of the QRS complex.
This finding is often associated with pericardial effusion, especially when it evolves into cardiac tamponade.
Cause: The effusion causes the heart to swing or “bob” within the fluid-filled pericardium, resulting in varying electrical vectors from beat to beat.
