Pericardial Disease in SA

Question 1

Name the layers of the pericardium .

Answer 1

• Inner – “visceral” layer – surface of heart
• Outer – “parietal” layer

Question 2

What is the function of the pericardium?

Answer 2

• Not essential
• Fixes the heart anatomically
• Reduce friction
• Equalizes gravitational forces (pericardial fluid)
• Prevention of overdilation (pericardial restraint)
• Regulation between stroke volumes of both ventricles (ventricular coupling)

Question 3

What can go wrong with the pericardium?

Answer 3

• Pericardial sac can fill with fluid:
• Mass can be present within the pericardial space, heart or the pericardium
• The pericardium can become stiff – ‘constrictive’
• Occasional trauma case associated with pus in the pericardium, but generally see blood

Question 4

What fluids may fill the pericardium?

Answer 4

• Blood (most common)
• Transduate
• Exudate

Question 5

What neoplasias may be associated with the pericardium?

Answer 5

Haemangiosarcoma, mesothelioma, chemodectoma, metastatic tumours – thyroid, osteosarcoma, mast cell tumours etc

Question 6

How do acute cases of pericardial disease present?

Answer 6

Sudden onset exercise intolerance, weakness, collapse, shock, rapid death if untreated

Question 7

How do chronic cases of pericardial disease present?

Answer 7

2 week history of ascites, progressive exercise intolerance, lethargy, GIT signs, collapse

Question 8

List other clinical signs of pericardial disease.

Answer 8

• Jugular distension
  
  • Right sided heart failure
• Positive hepatojugular reflex
  
  • Very characteristic of right sided heart failure
• Ascites
  
  • Typically presented with dull, lethargic dog with ascites
• Tachycardia
• Muffled heart sounds
• Weak femoral pulses (+/-pulsus paradoxus)
• Pale mucous membranes
• Tachypnoea / dyspnoea
• GIT signs

Question 9

How do you diagnose pericardial disease?

Answer 9

• Triad of clinical signs (Jugular distension, poor pulses, right sided heart failure)
• ECG
• Echocardiography (Gold standard)
• Radiography

Question 10

What ECG changes would you see with pericardial disease?

Answer 10

• Tachycardia
• Small complexes
  
  • Due to interference with the conduction of electrical activity to the surface of the heart due to fluid.
• Electrical alternans
  
  • Variable height of the QRS complexes

Question 11

How is pericardial disease treated?

Answer 11

• “Drugs don’t work”
• Emergency care
  
  • Oxygen
  • i/v fluid (shock rate)
• Pericardiocentesis / pericardial strip

Question 12

What are the common causes of pericardial effusion in dogs?

Answer 12

• Cardiac neoplasia (most common cause, usually haemangiosarcomas)
• Idiopathic (haemorrhagic)
• Left atrial rupture (acute and sudden death)
• Coagulopathies, uremic, infection (bacterial and fungal)

Question 13

What causes pericardial effusion in the cat?

Answer 13

• Congestive heart failure
• FIP

Question 14

Which canine breeds are more likely to get cardiac haemangiosarcomas?

Answer 14

Older GSD and Golden Retrievers

Question 15

Where do haemangiosarcomas tend to be in the heart?

Answer 15

Right atrial/right auricular appendage

Metastatic disease is common (often by the time we detect them clinically)

Question 16

Where do Mesotheliomas arise?

Answer 16

• Arise from serous membranes:
  
  • Pericardium
  • Pleura (more likely than pericardial)
  • Peritoneum
  • Tunica vaginalis of the testes

Question 17

Which canine breeds are more predisposed to idiopathic pericardial effusion?

Answer 17

• Large breed dogs
  
  • Saint Bernards
  • Golden retrievers

Question 18

What congenital condition may present with the pericardium?

Answer 18

• Peritoneal Pericardial Diaphragmatic Hernia
• Communication between the pericardial and the peritoneal cavities allowing herniation of abdominal contents

Question 19

What breeds are more predisposed to Peritoneal Pericardial Diaphragmatic Hernia?

Answer 19

Weimaraners and Persian

Question 20

How are Mesotheliomas treated?

Answer 20

Pericardiectomy

Question 21

How is Idiopathic pericardial effusion treated?

Answer 21

• Pericardiocentesis
• Pericardiectomy at 3^rd recurrence

Question 22

How is Peritoneal Pericardial Diaphragmatic Hernia treated?

Answer 22

Surgical correction

Question 23

Where should you carry out pericardiocentesis?

Answer 23

• Left lateral recumbency
• Between the 4^th and 6^th intercostal space at the level of the costochondral junction (elbow crosses the costochondral junction)

Question 24

What are the complications of Pericardiocentesis?

Answer 24

• Cardiac puncture
• Arrhythmias
• Dissemination of infection or neoplasia
• Atrial fibrillation
• Myocardial stunning
• Recurrence

Question 25

What are the indications for Pericardectomy?

Answer 25

• Severe chronic pericardial disease
• Restrictive pericardial disease
• Palliative surgery for neoplastic aetiologies of pericardial effusion