Pericardial Disease

Question 1

Describe the presentation, aetiology and other abnormalities found with PPDH.

Answer 1

Ventral diaphragm communicates with the pericardial sac
= abdominal organs found in the percardium

Wieneramers, Persians

Also found with ventral hernias, pulmonic stenosis and VSDs

Question 2

What are the most common causes of pericardial effusions in dogs?

Answer 2

Idiopathic
Neoplasia

Seen in old, large breed dogs

Question 3

What the most common causes of pericardial effusions in cats?

Answer 3

CHF

FIP

Question 4

How can you diagnose idiopathic pericardial effusion?

Answer 4

Rule out a mass - FNA and cytology of pericardial effusion

Seen in GRT, Labradors, St. Bernard

Consider pericardectomy is recurrent

Question 5

What is a common neoplastic cause of pericardial effusion?

Answer 5

Haemangiosarcoma
Seen in GSD, GRT and setters

typical sites: liver, spleen, right atrium / auricle

Question 6

How can you diagnose haemangiosarcoma as a cause of pericardial effusion?

Answer 6

Pericardiocentesis 
Ultrasound of the heart 
- mass in right atrium
- cardiac tamponade
- pericardial effusion

Question 7

How can you treat pericardial effusion due to a haemangiosarcoma?

Answer 7

Pericardiocentesis
Pericardectomy
Chemotherapy - MST 3-6m

Poor px - effusion recurs and non-curative

Question 8

What is another neoplastic cause of pericardial effusion and how does it present?

Answer 8

Chemodectoma = aortic body tumour
Seen in brachycephalics
Slow growing benign tumour, locally invasive
Low metastatic rate

Tx: palliative pericardectomy

Question 9

What is another cause of neoplastic pericardial effusion?

Answer 9

Mesothelioma
No breed predisposition - seen after chronic inflammation or asbestos exposure

Poor px - causes multiple cavitary effusions

Question 10

Summarise the tumours that can lead to neoplastic pericardial effusions?

Answer 10

Haemangiosarcoma 
Chemodectoma
Mesothelioma
Rhabdomyosarcoma
Ectopic thyroid carcinoma
Lymphoma

Question 11

Describe the pathophysiology of pericardial effusion

Answer 11

Fluid accumulates in the pericardial sac
Right atrium compressed = reduced diastolic filling
Less blood to right ventricle
Less blood pumped around the left circuit
= signs of forward heart failure

Question 12

How does an acute pericardial effusion present?

Answer 12

Weak pulses
Collapse
Tachycardia
Decreased appetite and lethargy 
GIT upset

Right sided CHF
Abdominal effusion
Jugular pulses
Pleural effusion - muffled heart sounds 
Positive heptatojugular reflex 
Weak femoral pulses

Question 13

What is pulsus paradoxus?

Answer 13

When a patient with pericardial effusion breathes in, intrathoracic pressure increases, in addition to the pericardial effusion this stops cardiac output
= pulse disappears when the patient breaths in

Question 14

What is cardiac tamponade?

Answer 14

In pericardial effusion, when the pressure in the pericardial sac is higher than the pressure in the right atrium during diastole
= right atrium can’t fill
Dog collapses due to reduced cardiac output

Question 15

What effect does the chronic its of the disease have on the size of effusion?

Answer 15

In chronic pericardial effusion, more fluid can build up as the body is able to adjust

Question 16

How should you work up a patient with pericardial effusion?

Answer 16

PCV
Haematology + biochemistry 
ECG 
Echocardiography
Cardiac troponin I - haemangiosarcoma 
Blood pressure 
Radiography
Pericardial effusion fluid analysis

Question 17

What do you expect to seen on an ECG of a dog with pericardial effusion?

Answer 17

Electrical alternans - R wave changes height due to the heart moving around in the pericardial sac

Damped QRS (smaller)

Question 18

As you drain the pericardial effusion, what do you expect to see?

Answer 18

Heart rate will come down
QRS will increase in height
Blood pressure will improve

Question 19

What are the radiographic signs seen with pericardial effusion?

Answer 19

Cardiomegaly
Normal lobar veins
Dilated caudal venacava
Ascites

Question 20

What will you see on echo in pericardial effusion?

Answer 20

Anechoic fluid in the pericardial sac

Cardiac tamponade - right atrium being squashed

Question 21

What must you never use before pericardiocentesis in a pericardial effusion patient?

Answer 21

Furosemide

- dehydrates the already Hypovolaemic patient further

Question 22

What should you perform prior to pericardiocentesis?

Answer 22

A PCV so you can compare this to the effusion to ensure that you are not draining the heart

Question 23

What landmark should you perform pericardiocentesis at?

Answer 23

5-6th intercostal space

Use echo to establish the incision point so that you are avoid the lung and coronary artery

Question 24

What is the normal colour of a pericardial effusion and what should you check?

Answer 24

Port wine colour
Run a PCV on your sample to check that it is lower than the blood
If it is equal to the blood then you are either draining the heart or the patient is haemorrhaging into the pericardial sac

Question 25

What tubes should you put samples of the pericardial effusion in to and what should you analyse?

Answer 25

EDTA - cytology, PCV

Plain - allow to clot to check you’re not in the heart, culture

Question 26

What should you expect after draining a pericardial effusion?

Answer 26

Improved CV parameters - reduced HR, increased BP
Urination (atrial stretch releases ANP which causes urination)
Hospitalise for 12-24h after
- risk of VPCs and AF

Question 27

What should you expect as the cause if there is not marked improvement or quick recurrence?

Answer 27

Neoplasia

Question 28

What causes constrictive pericarditis and how should you treat it?

Answer 28

Thickening of the pericardium due to
- recurrent pericardial effusion, neoplasia, foreign body

Treatment: pericardectomy

Question 29

What causes infectious pericarditis and how should you treat it?

Answer 29

Foreign body / penetrating wound
FIP

Antibiotics and thoracotomy

Question 30

What is the prognosis for idiopathic pericardial effusion?

Answer 30

Good - may never recurr