Pericardial Disease Flashcards
Describe the presentation, aetiology and other abnormalities found with PPDH.
Ventral diaphragm communicates with the pericardial sac
= abdominal organs found in the percardium
Wieneramers, Persians
Also found with ventral hernias, pulmonic stenosis and VSDs
What are the most common causes of pericardial effusions in dogs?
Idiopathic
Neoplasia
Seen in old, large breed dogs
What the most common causes of pericardial effusions in cats?
CHF
FIP
How can you diagnose idiopathic pericardial effusion?
Rule out a mass - FNA and cytology of pericardial effusion
Seen in GRT, Labradors, St. Bernard
Consider pericardectomy is recurrent
What is a common neoplastic cause of pericardial effusion?
Haemangiosarcoma
Seen in GSD, GRT and setters
typical sites: liver, spleen, right atrium / auricle
How can you diagnose haemangiosarcoma as a cause of pericardial effusion?
Pericardiocentesis Ultrasound of the heart - mass in right atrium - cardiac tamponade - pericardial effusion
How can you treat pericardial effusion due to a haemangiosarcoma?
Pericardiocentesis
Pericardectomy
Chemotherapy - MST 3-6m
Poor px - effusion recurs and non-curative
What is another neoplastic cause of pericardial effusion and how does it present?
Chemodectoma = aortic body tumour
Seen in brachycephalics
Slow growing benign tumour, locally invasive
Low metastatic rate
Tx: palliative pericardectomy
What is another cause of neoplastic pericardial effusion?
Mesothelioma
No breed predisposition - seen after chronic inflammation or asbestos exposure
Poor px - causes multiple cavitary effusions
Summarise the tumours that can lead to neoplastic pericardial effusions?
Haemangiosarcoma Chemodectoma Mesothelioma Rhabdomyosarcoma Ectopic thyroid carcinoma Lymphoma
Describe the pathophysiology of pericardial effusion
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
How does an acute pericardial effusion present?
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
What is pulsus paradoxus?
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
What is cardiac tamponade?
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
What effect does the chronic its of the disease have on the size of effusion?
In chronic pericardial effusion, more fluid can build up as the body is able to adjust
How should you work up a patient with pericardial effusion?
PCV Haematology + biochemistry ECG Echocardiography Cardiac troponin I - haemangiosarcoma Blood pressure Radiography Pericardial effusion fluid analysis
What do you expect to seen on an ECG of a dog with pericardial effusion?
Electrical alternans - R wave changes height due to the heart moving around in the pericardial sac
Damped QRS (smaller)
As you drain the pericardial effusion, what do you expect to see?
Heart rate will come down
QRS will increase in height
Blood pressure will improve
What are the radiographic signs seen with pericardial effusion?
Cardiomegaly
Normal lobar veins
Dilated caudal venacava
Ascites
What will you see on echo in pericardial effusion?
Anechoic fluid in the pericardial sac
Cardiac tamponade - right atrium being squashed
What must you never use before pericardiocentesis in a pericardial effusion patient?
Furosemide
- dehydrates the already Hypovolaemic patient further
What should you perform prior to pericardiocentesis?
A PCV so you can compare this to the effusion to ensure that you are not draining the heart
What landmark should you perform pericardiocentesis at?
5-6th intercostal space
Use echo to establish the incision point so that you are avoid the lung and coronary artery
What is the normal colour of a pericardial effusion and what should you check?
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
What tubes should you put samples of the pericardial effusion in to and what should you analyse?
EDTA - cytology, PCV
Plain - allow to clot to check you’re not in the heart, culture
What should you expect after draining a pericardial effusion?
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
What should you expect as the cause if there is not marked improvement or quick recurrence?
Neoplasia
What causes constrictive pericarditis and how should you treat it?
Thickening of the pericardium due to
- recurrent pericardial effusion, neoplasia, foreign body
Treatment: pericardectomy
What causes infectious pericarditis and how should you treat it?
Foreign body / penetrating wound
FIP
Antibiotics and thoracotomy
What is the prognosis for idiopathic pericardial effusion?
Good - may never recurr
