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Small Animal Medicine II > Pericardial Effusion > Flashcards

Pericardial Effusion Flashcards

1
Q

What are the 4 functions of the pericardium?

A
  1. tethers heart into place in the chest
  2. limits cardiac filling and ventricular compliance
  3. physical protective barrier from lungs and thorax
  4. lubricates moving surfaces of the heart
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2
Q

What affect does pericardial effusion have on the heart?

A
  • increased intracardiac pressure around the entirety of the heart
  • this decreases venous return, ventricular filling, and CO
  • RV = increased venous pressure, jugular venous distension, hepatic congestion, ascites, peripheral edema
  • LV = systemic hypotension, weakness, tachycardia
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3
Q

Would Furosemide help treat pericardial effusion?

A

no —> decreases BP and preload, which are already low and only thing keeping blood in circulation

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4
Q

What cardiac tamponade? What does this cause?

A

cardiac compression resulting from a rise in intraparticardial pressure due to effusion build up in the pericardial sac

compression of RA, RV, and cranial vena cava = heart cannot fill properly

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5
Q

How does acute and chronic presentation with pericardial effusion differ?

A

ACUTE = reduced filling and hypotension - cardiogenic shock —> rapid onset of weakness, collapse, death

CHRONIC = low CO compensation causes right-sided CHF or biventricular failure —> exercise intolerance, abdominal distension, weight loss, coughing

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6
Q

What are the 4 most common PE findings indicative of pericardial effusion? What else is seen?

A
  1. muffled heart sounds
  2. poor pulse quality (will improve following a tap!)
  3. pale MM
  4. jugular distension, right heart failure
  • tachycardia
  • pulsus paradoxus
  • ascites
  • tachypnea
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7
Q

What is pulsus paradoxus? Why does this occur?

A

pronounced variation in cardiac filling over the respiratory cycle

arterial blood pressure decreases during inspiration (less LV filling), resulting in weaker femoral pulses

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8
Q

How is BP affected by pericardial effusion?

A

hypotensive

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9
Q

How does signalment affect etiology of pericardial effusion?

A

YOUNG - congenital PPDH or pericardial cyst

OLDER - neoplasia, idiopathic, heart failure, left atrial tear, infection, metabolic/toxins (uremia, coagulopathy)

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10
Q

PPDH:

A
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11
Q

Middle-aged to older patient with pericardial effusion:

A
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12
Q

What is the most common neoplasia in dogs that can lead to pericardial effusion? What dog is most commonly predisposed?

A

HSA of the right auricle —> high rate of malignancy, 8-25% of dogs with splenic tumors have RA tumors (observe heart before splenectomy)

Golden Retriever

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13
Q

Where are chemodectomas most commonly found? What breeds are predisposed?

A

heart base (aorta or pulmonary artery) —> late metastasis, slow growing = decent prognosis until it presses on heart and organs

M>F brachycephalics

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14
Q

What is restrictive pericarditis? What are 3 causes?

A

stiff pericardium +/- effusion impairs filling by preventing late diastolic expansion, causing signs of right-sided CHF

  1. chronic inflammation/infection
  2. recurrent hemorrhage
  3. calcification
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15
Q

What are the 2 most common causes of infective pericarditis? How does it appear grossly?

A
  1. bacterial/fungal contamination from migrating grass awns or penetrating FB
  2. FIP

flocculent and suppurative

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16
Q

What are 5 bacterial/fungal agents that can cause pericarditis?

A
  1. Bacterioides
  2. Actinomyces
  3. Streptococcus
  4. Pasteurella
  5. Coccidioides immitis (Valley Fever)
17
Q

What are the 2 most common cardiovascular causes of pericardial effusion?

A
  1. LA rupture - mitral regurgitation from CVD (small breeds!)
  2. CHF - rarely enough fluid to cause significant hemodynamic compromise (cat > dog)
18
Q

What are the 3 most common metabolic causes of pericardial effusion?

A
  1. uremia
  2. hypothyroidism - cholesterol-based effusion
  3. hyperthyroidism (cats) - small effusions without heart disease
19
Q

What toxin most commonly causes pericardial effusion?

A

anticoagulant rodenticide —> coagulation disorders, DIC

20
Q

What laboratory tests are most commonly recommended for possible cases of pericardial effusion?

A
  • CBC/Chem
  • fluid cytology
  • culture
  • fungal titers
  • coagulation panel
  • biomarkers (not as helpful)
21
Q

How does the type of effusion give information about possible causes of pericardial effusion?

A
  • transudate/modified transudate - hernia, cyst, CHF, hypoproteinemia, chemodectoma
  • exudate - FB, idiopathic inflammation, Nocardia, fungal, FIP
  • hemorrhage - HSA, chemodectoma, ectopic thyroid, mesothelioma, lymphoma, metastasis, LA rupture, coagulopathy
22
Q

In what way is pericardial fluid analysis not as helpful for diagnosing cause of pericardial effusion? What are some occasional positive findings?

A

neoplasia —> typically do not exfoliate well (reactive mesothelial cells common)

  • lymphoma
  • infectious
23
Q

What is the most common rhythm seen on ECG in cases of pericardial effusion? What 2 changes are seen?

A

sinus tachycardia

  1. dampened amplitude of QRS complexes
  2. electrical alternans - heart swings in pericardium
24
Q

What are the 2 most common findings in cases of pericardial effusion on radiographs? What else is seen?

A
  1. globoid cardiac silhouette
  2. crisp cardiac margins
  • dorsal deviation of trachea
  • small/enlarged caudal vena cava
  • small pulmonary vasculature
  • pleural effusion
25
Q

What 3 limitations are there with diagnosing pericardial effusion of radiographs?

A
  1. cannot determine etiology (unless PPDH)
  2. severe cardiac dilation (DCM) can mimic effusion
  3. large amount of pleural effusion can high cardiac silhouette
26
Q

What is the gold standard for diagnosing pericardial effusion?

A

echo —> confirms effusion, determines etiology, can r/o structural heart disease

27
Q

What treatment is recommended in acute cases of pericardial effusion? What is avoided?

A
  • pericardiocentesis - do not delay if in cardiogenic shock
  • rapid fluid resuscitation (only if going to tap the heart!) - only way for heart to get blood is by increasing volume to the heart

diuretics —> decreases BP

28
Q

When is pericardiocentesis indicated? Is it commonly done in cats?

A
  • evidence of hemodynamic compromise - tachycardia, weakness, hypotension
  • moderate to large volume of pericardial effusion

no —> effusion is the main manifestation of heart failure

29
Q

What equipment is used for pericardiocentesis?

A
  • over-the-needle catheter
  • extension IV set
  • three-way stopcock
  • syringe
  • scalpel blade
  • collection bowl
  • graduated cylinder
  • red top and lavender top tubes
  • sterile gloves
  • local anesthetic block
  • continuous ECG
30
Q

How is pericardiocentesis performed? What sedation can be used?

A
  • place patient in lateral or sternal recumbency - safest on right side due to the cardiac notch, which helps avoid major cardiac vasculature on the left
  • shave and scrub 4th-6th ICS (if time allows)
  • tap cranial to the rib to avoid IC arteries, veins, and nerves

Butorphanol - rapid and short acting to not affect hypotension as much

31
Q

What does it mean if blood from a pericardiocentesis clots?

A

frank blood —> likely blood from chambers in the heart

  • fluid in pericardium will not clot due to loss of clotting factors and dilution decreasing PCV
32
Q

What 2 complications are associated with pericardiocentesis? What monitoring should be performed?

A
  1. arrhythmias, usually ventricular (Lidocaine!)
  2. laceration/puncture of heart/lungs (pneumothorax)
  • BP
  • attitude
  • observe in hospital for 12-24 hours and recheck in a week for reaccumulation, then every 2-4 weeks
33
Q

What are 3 options for treatment of chronic pericardial effusion?

A
  1. percardiectomy - not recommended for neoplastic causes (except chemodectoma!), only option for constrictive pericardial disease
  2. balloon pericardiotomy
  3. medical - steroids for idiopathic disease, chemotherapy and radiation to decrease bleeding and tumor growth
34
Q

What is the most common cause of pericardial effusion in cats? What are some other causes?

A

CHF

  • PPDH
  • neoplasia
  • FIP
  • hyperthyroidism (tapping not necessary)
35
Q

What treatment is most commonly recommended for pericardial effusion in cats? What is rarely needed?

A

treat underlying cause - Furosemide, Pimobendan

pericardiocentesis - only if there is a large amount of volume causing an issue, not heart-failure associated, or hemodynamically compromised

Small Animal Medicine II (57 decks)

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