Pericardial Disease

Question 1

What is the visceral pericardium called?

Answer 1

Epicardium

Question 2

What is the parietal pericardium called?

Answer 2

True pericardium

Question 3

What is between the epicardium and the true pericardium? How much fluid is normal to be there?

Answer 3

Pericardial space, 1-3 ml fluid normal

Question 4

Is the right or the left heart more compressed by pericardial effusion?

Answer 4

Right

Question 5

T/F: Very fast accumulation of fluid in the pericardial space can be dire, whereas slow accumulation allows for stretching of the pericardium and is less serious.

Answer 5

True

Question 6

Describe physical exam findings of patients with pericardial effusion?

Answer 6

Muffled heart sounds, reduced/absent precordium, tachycardia, jugular distension with or without pulses, prolonged CRT, weak femoral pulses,

Right chronic heart failure- ascites, hepatomegaly

Or

Left chronic heart failure- tachypnea, hypoxia

Question 7

What is pulsus paradoxus?

Answer 7

Cyclical worsening of RV filling during expiration causing pulse strength to vary with respiratory cycle

Question 8

What radiographic changes do you expect to see with pericardial effusion?

Answer 8

• Cardiomegaly (globoid)
• rounding near LA
• Sharp well demarcated edges of heart
• Distension of caudal Vena Cava
• Small pulmonary vessels
• pleural effusion and or abdominal effusion

*know these!

Question 9

How might radiographs be different for acute pericardial effusion than chronic?

Answer 9

Acute- size might not be that bad because it hasn’t had time to stretch

• caudal vena cava humped up
• pulmonary artery tiny compared to pulmonary vein

Question 10

ECG findings of pericardial effusion?

Answer 10

Decreased QRS amplitude
Electrical alternans (variation in QRS amplitude) because the heart is moving around in the fluid
VPC- maybe
Supraventricular tachycardia

Question 11

What is the term for compression of the heart by fluid?

Answer 11

Tamponade

Question 12

What is the goal of emergency treatment for pericardial effusion?

Answer 12

Increase preload to force blood into the right heart while preparing for pericardiocentesis

IV catheter- rapid fluid administration- crystalloids
- 1/4 shock bolus (90ml/kg / 4)
Antiarrhythmics- as needed

Question 13

T/F: Because of the risks of pericardiocentesis, it should not be done in cases of pericardial effusion.

Answer 13

False- tamponade will kill them before complications!

Question 14

Should the needle for pericardiocentesis be inserted cranial or caudal to the rib?

Answer 14

Cranial- vessels are caudal to ribs

Question 15

During pericardiocentesis, the ECG is attached to detect what? If it does occur, what should you do?

Answer 15

VPC- if detected back the catheter out slightly

Question 16

T/F: Effusions can appear bloody but should not clot

Answer 16

True

Question 17

List some differentials that have transudate on cytology

Answer 17

Hernias
Cysts
CHF
Hypoproteinemia
Chemodectoma (heart base mass or aortic body tumor)

Question 18

List some differentials for exudates on cytology.

Answer 18

Foreign body
Nocardia
Fungal infection
FIP (cats)
Idiopathic

Question 19

List some differentials for hemorrhagic cytology:

Answer 19

Neoplasia
- HSA
- Chemodectoma
- Mesothelioma
- Lymphoma
Coagulopathy
Idiopathic

Question 20

What is a peritoneopericardial diaphragmatic hernia?

Answer 20

Congenital disease resulting in intestinal contents in the pericardium