Pericardial disease (Yr 4)

Question 1

what are the layers of the pericardium?

Answer 1

fibrous outer layer
serous inner layer (parietal and visceral)

Question 2

what is the function of the pericardium?

Answer 2

produce lubricant
prevent over dilation
coordinate left/right ventricle contraction
protect heart
helps maintain position in thorax

Question 3

what are the causes of pericardial effusions in dogs?

Answer 3

idiopathic
neoplastic

Question 4

what are the causes of pericardial effusion in cats?

Answer 4

congestive heart failure
FIP
infection/neoplasia

Question 5

what breeds of dog are predisposed to idiopathic pericardial effusions?

Answer 5

(large breeds)
st. bernard
golden retriever
labradors

Question 6

what is one of the main neoplastic causes of pericardial effusion in dogs?

Answer 6

haemangiosarcoma

Question 7

how do idiopathic pericardial effusions present?

Answer 7

chronic effusions that slowly build up over time

Question 8

what is the difference between he presentation of neoplastic and idiopathic pericardial effusions in dogs?

Answer 8

neoplastic - acute (due to haemorrhage)
idiopathic - chronic

Question 9

where are haemangiosarcomas most commonly found on the heart?

Answer 9

right atrium (check liver and spleen)

Question 10

what dog breeds are predisposed to haemangiosarcomas?

Answer 10

German shepherd
golden retrievers
setters

Question 11

how are pericardial effusions from haemangiosarcomas treated?

Answer 11

palliative (drain, removal…)
chemotherapy

Question 12

what is the prognosis for cardiac haemangiosarcomas?

Answer 12

very poor/grave

Question 13

what neoplasias can cause pericardial effusions in dogs?

Answer 13

haemangiosarcoma
chemodectoma
mesothelioma
lymphoma

Question 14

how severe are chemodectomas in dogs?

Answer 14

good prognosis - slow growing, minimally invasive, low metastatic rate, benign tumour

Question 15

what breeds are chemodectomas most commonly seen in?

Answer 15

brachycephalic breeds

Question 16

where are chemodectomas found?

Answer 16

on the heart base

Question 17

what is the prognosis for mesotheliomas that cause pericardial effusions?

Answer 17

poor

Question 18

which chamber of the heart is most effected by pericardial effusion?

Answer 18

right atrium (the chambers with the lowest pressure will be effected the most by the pressure exerted by the effusion)

Question 19

what is the pressure exerted on the heart by a pericardial effusion called?

Answer 19

cardiac tamponade

Question 20

what is pulsus paradoxus?

Answer 20

with pericardial effusions the pulse gets weaker as you breath in you increase right sided filling which squashes the left side so there is less output from the left ventricle and hence a weaker pulse

Question 21

what sided heart failure occurs with cardiac tamponade?

Answer 21

right sided (right atrium has the lowest pressure so you get increased preload)

Question 22

what are the clinical signs of pericardial effusions in dogs?

Answer 22

non-specific (decreased appetite, lethargy, GI upsets)
specific (decreased exercise tolerance, cough, syncope, abdominal enlargement from ascites)

Question 23

how do cats with pericardial effusions present?

Answer 23

congestive heart failure

Question 24

how does chronic pericardial effusion present in dogs?

Answer 24

right sided congestive heart failure - organomegaly, abdominal effusion, positive hepatojugular reflux, jugular distension, tachycardia
weak femoral pulse
muffled heart sounds

Question 25

how does acute pericardial effusion of dogs present?

Answer 25

weak, collapse, tachycardia, pale MM, signs of haemorrhagic shock
(occurs due to haemorrhage)

Question 26

what should be done before pericardiocentesis?

Answer 26

check PCV
do haematology, biochemistry, troponin

Question 27

why does PCV need to be checked before doing pericardiocentesis?

Answer 27

if PCV of blood and effusion is the same you are draining blood

Question 28

why should troponin be taken before pericardiocentesis?

Answer 28

it measure cardiac damage, if you take it after you can’t be certain it is from pathology and not an injury from draining

Question 29

how is an ECG effected by pericardial effusions?

Answer 29

small QRS waves because the heart is squashed

Question 30

what are the radiographic features of a pericardial effusion?

Answer 30

enlarged caudal vena cava
cardiomegaly
distinct cardiac silhouette

Question 31

what treatment should not be used in with pericardial effusions?

Answer 31

furosemide

Question 32

what treatment can be used in cats with pericardial effusions but not dogs?

Answer 32

furosemide

Question 33

how is pericardiocentesis done?

Answer 33

check PCV
sedate (opiates ideal)
left lateral recumbency (right 5th-6th intercostal space)

Question 34

what colour will all pericardial effusions be?

Answer 34

blood coloured (most check PCV!!) unless infectious

Question 35

what parameters will begin to improve during pericardiocentesis (as you’re draining)?

Answer 35

reduced HR
improved pallor
improved pulses
taller QRS on ECG

Question 36

what happens after successful pericardiocentesis?

Answer 36

natural diuresis of ascites (dog will urinate)
arrhythmias (atrial fibrillation…)

Question 37

what is constrictive pericarditis?

Answer 37

thickened fibrotic pericardium which will present like a pericardial effusion with little/no fluid

Question 38

how is constructive pericarditis treated?

Answer 38

pericardectomy (guarded prognosis without)

Question 39

what breeds are predisposed to peritoneopericardial diaphragmatic hernia?

Answer 39

dogs - weimaraners
cats - Persians

Question 40

what is the main cause of left atrial rupture?

Answer 40

degenerative mitral valve disease curing severe LA enlargement and can tear