Pericardial disease Flashcards
Pericardial disease, effusions, and masses: The reported caused of pericardial effusion (PE) in animals include
- Pericardioperitoneal hernias,
- congestive heart failure,
- LA rupture,
- infection,
- neoplasia,
- trauma,
- benign idiopathic causes.
The pericardial effusion may lead to tamponade.
…….. is the most common cause of pericardial effusion in the cat and is often accompanied by pleural effusion and ascites.
FIP is the most common cause of pericardial effusion in the cat and is often accompanied by pleural effusion and ascites.
HCM is the most frequent frequent form of heart disease leading to pericardial effusion in cats. Other less-encountered forms of heart disease resulting in PE in the cat include?
Dilated and restrictive cardiomyopathies and mitral valve abnormalities.
……………………are the most common causes of pericardial effusion in the dog, with ……………………. heading the list.
-Intrapericardial neoplasia, -idiopathic hemorragic pericarditis, and
-LA rupture secondary to chronic MR
are the most common causes of pericardial effusion in the dog, with intracardiac and pericardial tumors heading the list.
Which tumors lead the list for highest incidence for PE?
Hemangiosarcoma
Chemodectoma
Mesothelioma
PE: There is a high incidence of pericardial effusion in large breed dogs with the highest incidence seen in?
Golden retrievers, German shepherd dogs, Saint Bernards, Labrador retrievers, and Newfoundlands.
Most dogs that present with pericardial effusions with echo evidence of a mass are older (median 9-11 years) than dogs that present without echo evidence of a mass (median 7-9 years) The exception is the … breed
Saint Bernard, which presented at a much younger median age of 2,3 years.
Congestive heart failure may also cause pericardial effusion in both dogs and cats, although the incidence is less common and the amount of effusion is typically small. Occasionally atrial rupture causes pericardial effusion in dogs.
Congestive heart failure may also cause pericardial effusion in both dogs and cats, although the incidence is less common and the amount of effusion is typically small. Occasionally atrial rupture causes pericardial effusion in dogs.
Pericardial effusion in the cat is relatively rare. When present, however, several studies have shown that congestive heart failure secondary to ……………………. are the most common underlying causes of pericardial effusion in cats.
hypertrophic, restrictive, and unclassified cardiomyopathy are the most common underlying causes of pericardial effusion in cats.
FIP, neoplasia, pericardial peritoneal diaphragmatic hernia, systemic infections, and uremia, are other reported causes of pericardial effusion in cats.
Of these, neoplasia, primarily …………and……………, and FIP are reported as the next most common causes of effusion in the cat.
Of these, neoplasia, primarily lymphoma, and adenocarcinoma, and FIP are reported as the next most common causes of effusion in the cat.
Echo features of pericardial effusion?
Presence of an echo free or hypo echoic space between the epicardium and the pericardial sac, swinging motion of the heart when the amount of effusion is significant, and if tamponade is present; diastolic collapse of the right atrium or ventricle
What helps differentiate pleural from pericardial effusions?
Pericardial effusion is typically not seen behind the left and right atrium on echo images because the parietal and visceral pericardiums are more adherent to each other at the base of the heart. This helps differentiate pleural from pericardial effusions
Fig 8.1, 8.2, 8.3, 8.4, 8.5
The boundaries of pericardial effusion are typically ……… and conform to the shape of the heart while pleural effusion is seen as more ………….. with ill-defined boundaries.
The boundaries of pericardial effusion are typically smooth and conform to the shape of the heart while pleural effusion is seen as more irregular with ill-defined boundaries.
In man, an echo-free space of less than ……… mm is considered to be a mild effusion, a space between ……….. mm is moderate in amount, and an anechoic space of greater than ….. mm is classified as a severe amount of fluid accumulation.
In man, an echo-free space of less than 5 mm is considered to be a mild effusion, a space between 5 and 10 mm is moderate in amount, and an anechoic space of greater than 10 mm is classified as a severe amount of fluid accumulation.
Pericardial effusion is typically not seen at the heart base below the atria while pleural fluid is present.
Pericardial effusion is typically not seen at the heart base below the atria while pleural fluid is present.
M-mode images show an echo-free space between the LV wall and the pericardial sac. The epicardium on these images will be very bright simply because of?
The epicardium on these images will be very bright simply because of the difference in acoustical impedance between the epicardium and fluid.
Fig 8.6
When the fluid space is not seen during …………… of the LV chamber, the fluid accumulation is not clinically significant.
When the fluid space is not seen during systolic contraction of the LV chamber, the fluid accumulation is not clinically significant.
Large amounts of thoracic or mediastinal fat have sometimes been misdiagnosed as pericardial effusion and care should be taken to set the ………… correctly and to image multiple cardiac planes.
Large amounts of thoracic or mediastinal fat have sometimes been misdiagnosed as pericardial effusion and care should be taken to set the gain correctly and to image multiple cardiac planes.
The diagnosis of pericardial fat is typically made when an anechoic space is seen in the near field of the sector image, and although it may be present in the far field, it usually is not. Therefore, an echo-free space in both the near field and far field usually supports the diagnosis of?
True pericardial effusion.
However, this is not foolproof as pericardial fat can occasionally be seen in both areas.
Fat when present typically moves with the heart during contraction, and is somewhat ……………; features that can help differentiate fat from pericardial effusion.
Fat when present typically moves with the heart during contraction, and is somewhat echogenic, features that can help differentiate fat from pericardial effusion.
Cardiac tamponade:
Pericardial fluid accumulation that causes intrapericardial pressure results in:?
Diastolic collapse of the right ventricle and atrium,
Decreased cardiac output, and Signs of forward failure.
The amount of pericardial fluid does not determine if tamponade is present or not. Intrapericardial pressure is determined by?
- Pericardial compliance
- The rate of fluid accumulation
- The amount of fluid accumulation.
The compliance of the pericardial sac decreases with?
- age,
- with chronic pericardial inflammation,
- with pericardial neoplasia
So smaller amounts of fluid are needed to generate large amount of pressure on the cardiac chambers.
Additionally, a chronic slow developing effusion is less likely to develop…..
tamponade
Dogs that present with the clinical sign of collapse typically have tamponade and have a high incidence of being positive for the presence of cardiac neoplasia.
The collapse is thought to occur because of a ….?
The collapse is thought to occur because of a rapid accumulation of fluid secondary to the neoplastic lesion.
Dogs that are diagnosed with idiopathic effusions tend to accumulate larger volumes of effusion before tamponade develops. Why?
Presumably because of the slow and chronic nature of fluid accumulation, which allows the pericardial sac to expand slowly, delaying the development of high pressure within the pericardial space.
Signs of right heart failure including jugular dissension and ascites instead of collapse typically suggest …………?
Signs of right heart failure including jugular dissension and ascites instead of collapse typically suggest slow fluid accumulation.
The size of the effusion does not determine if tamponade is present. ………… collapse of the right atrium and/or ventricle confirms the presence of tamponade.
The size of the effusion does not determine if tamponade is present. Diastolic collapse of the right atrium and/or ventricle confirms the presence of tamponade.
The ………………….. collapse of the right ventricle secondary to tamponade is displayed on M-mode images as downward motion of the right ventricular wall during diastole.
The diastolic collapse of the right ventricle secondary to tamponade is displayed on M-mode images as downward motion of the right ventricular wall during diastole. This is a sensitive and specific finding.
When right ventricular hypertrophy is present, increased loading conditions ………….. …………. of the right ventricular chamber even in the presence of high intrapericardial pressure.
When right ventricular hypertrophy is present, increased loading conditions prevent collapse of the right ventricular chamber even in the presence of high intrapericardial pressure.
Abnormal diastolic downward motion of the RA wall is 100% sensitive for?
The presence of tamponade but is less specific.
LA collapse though not common is a very specific finding for tamponade in man after cardiac surgery.
LA collapse though not common is a very specific finding for tamponade in man after cardiac surgery.
2D imaging is superior to M-mode in identifying both pericardial effusion and the presence of tamponade. Real-time images will show the collapse of the right side of the heart.
2D imaging is superior to M-mode in identifying both pericardial effusion and the presence of tamponade. Real-time images will show the collapse of the right side of the heart.
Right parasternal long-axis images may be used to view the collapse since the heart is displaced from the thoracic wall and …………..-sided structures are easier to visualize, but multiple planes should be interrogated for diagnostic accuracy and for identification of an underlying cause.
Right parasternal long-axis images may be used to view the collapse since the heart is displaced from the thoracic wall and right-sided structures are easier to visualize, but multiple planes should be interrogated for diagnostic accuracy and for identification of an underlying cause. Figures 8.7, 8.8
Tapping the pericardial fluid results in visible increased chamber sizes. Rarely a sudden increase in venous return and volume overload of the heart resulting in acute pulmonary edema has been associated with pericardiocentesis in several animals and man.
Rarely a sudden increase in venous return and volume overload of the heart resulting in acute pulmonary edema has been associated with pericardiocentesis in several animals and man.
There are reports of clinical signs related to cardiac tamponade without echo evidence of diastolic collapse of the right-sided chambers. This is seen when there is increased right-sided pressure secondary to other cardiac disease such as …..?
pulmonary hypertension, Tetralogy of Fallot, intracardiac tumors and pulmonic stenosis.
Cardiac tamponade has been reported in man secondary to large pleural effusion without the presence of pericardial effusion.
Evidence of …………… is visible in these patients.
Evidence of diastolic collapse on the right side of the heart is visible in these patients.
Experimental models in man of pleural effusion have shown that pleural effusion can cause echo signs of cardiac tamponade, with both right atrial and right ventricle diastolic collapse. Signs of tamponade have been reported in a dog with pleural effusion and no echo evidence of pericardial effusion or cardiac pathology
Experimental models in man of pleural effusion have shown that pleural effusion can cause echo signs of cardiac tamponade, with both right atrial and right ventricle diastolic collapse. Signs of tamponade have been reported in a dog with pleural effusion and no echo evidence of pericardial effusion or cardiac pathology
Flow alterations with tamponade can be documented with spectral Doppler. ………….. and ………………. inflow velocities increase with ………………… in the presence of tamponade.
Flow alterations with tamponade can be documented with spectral Doppler. Pulmonary artery and right ventricular inflow velocities increase with inspiration in the presence of tamponade.
Pulmonary artery and right ventricular inflow velocities increase with inspiration in the presence of tamponade. Flow velocities in the left side of the heart at the aorta and mitral valve …………. accordingly with inspiration.
Flow velocities in the left side of the heart at the aorta and mitral valve decrease accordingly with inspiration.
Cardiac tamponade: Vena caval flow into the right atrial chamber will show increased systolic ……………… with inspiration and increased diastolic ……………… of flow with expiration.
Vena caval flow into the right atrial chamber will show increased systolic velocities with inspiration and increased diastolic reversal of flow with expiration.
Cardiac function with pericardial effusion: Pericardial fluid with or without tamponade reduced the amount of filling and output from the right side of the heart. This will …………. left-sided volume and output. Function is reduced when a significant volume of pericardial fluid is present, and the diagnosis of myocardial failure should wait until after resolution of the effusion.
This will reduce left-sided volume and output. Function is reduced when a significant volume of pericardial fluid is present, and the diagnosis of myocardial failure should wait until after resolution of the effusion.
Often adequate assessment of function is not possible simply because the heart motion is too erratic as it swings within the pericardial sac. These changes all disappear after pericardiocentesis. What else can impair cardiac function in these patients?
Presence of cardiac tumors: if they are infiltrative in nature or produce arrhythmias.
Neoplasia as a cause of pericardial effusion:
Cardiac neoplasia has a reported incidence of…. of all canine cases presented to institutions.
0.19-3.1%
Hemangiosarcoma is reported with the highest frequency:….%
40-69%
…..are reported in 5-17%
Chemodectomas
……………, ……………., and various less common neoplasias make up the rest of the cardiac tumors seen in dogs.
Thyroid carcinomas, lymphosarcomas, and various less common neoplasias make up the rest of the cardiac tumors seen in dogs.
Cardiac neoplasia is not common in cats, but of the reported cases, ……………..is the most common intrapericardial neoplasia
lymphosarcoma (up to 30%)
Other carcinomas, hemangiosarcomas, chemodectomas, and fibrosarcomas representing a low percentage.
Echocardiography cannot acutely identify the actual histological tyoe of neoplasia, but the location and the appearance of the mass tends to be highly suggestive of particular types of tumors.
Echocardiography cannot acutely identify the actual histological tyoe of neoplasia, but the location and the appearance of the mass tends to be highly suggestive of particular types of tumors.
The search for cardiac masses is easier when pericardial effusion is present. Masses may be found where?
within the cardiac chambers, within the myocardium, or associated with the pericardial sac.
The following intracardiac tumors have been reported:
Chondrosarcoma Fibroma Fibrosarcoma Hemangiosarcoma Hamartoma Mesenchymal tumor Myxoma Osteosarcoma Rhabdomyoma Rhabdomyosarcoma Ectopic thyroid tumor Spindle cell sarcoma Undifferentiated sarcoma
The right side of the heart is the most common location for masses in the dog while LV and LA masses are much less common.
The right side of the heart is the most common location for masses in the dog while LV and LA masses are much less common.
Occasionally tumors may also be associated with the right and LV outflow tracts. Diligently search in very possible cardiac plane for a potential mass.
Occasionally tumors may also be associated with the right and LV outflow tracts. Diligently search in very possible cardiac plane for a potential mass.
Heart tumors: Animals should be scanned lying down as well as in a standing position.
Animals should be scanned lying down as well as in a standing position (if not seen lying down).
masses have been found simply by repositioning the animal into a standing position when no evidence of a mass was seen in lateral recumbency. Even then, the absence of a mass does not rule out its presence especially when there is no pericardial effusion to highlight the auricular chambers and other structures at the base of the heart.
Detection of masses with echo has a sensitivity between………..%
between 16.7 and 80%.
This variation may be dependent upon the presence of pericardial effusion and/or the skill of the echocardiography. Discrete masses like hemangiosarcoma and chemodectoma are much easier to identify with echo than more diffuse neoplasia such as mesothelioma and lymphosarcoma.
