Pericardial Effusion

Question 1

What 3 things happen as fluid accumulates in the pericardial sac?

Answer 1

1. ability of the pericardium to stretch is exceeded
2. volume and pressure within the pericardial space increases
3. cardiac function is compromised secondary to decreased diastolic filling

Question 2

What is cardiac tamponade? What 4 things does it impair?

Answer 2

form of cardiogenic shock that develops when the interpericardial pressure equals or exceeds right atrial pressure

1. venous return
2. ventricular filling
3. stroke volume
4. cardiac output

Question 3

What neoplasms are most likely to cause pericardiac effusion in dogs and cats?

Answer 3

DOGS: HSA, chemodectoma, mesothelioma, LSA, thyroid carcinoma

CATS: LSA, carcinomas, HSA, aortic body tumors, FSA

Question 4

Other than neoplasms, what are 5 common causes of pericardial effusion in dogs?

Answer 4

1. right-sided heart failure
2. atrial rupture
3. coagulopathy (rodenticides)
4. bacterial infections
5. idiopathic

Question 5

Other than neoplasms, what are 2 common causes of pericardial effusion in cats?

Answer 5

1. congestive heart failure
2. FIP

Question 6

What are the 5 most common causes of pericardial effusion in horses?

Answer 6

1. idiopathic
2. extension of viral infections - equine viral arteritis, equine influenza
3. septicemia
4. extension of bacterial infection from lungs
5. neoplasia

Question 7

What is the most common cause of pericardial effusion in cattle?

Answer 7

ingestion and penetration of a foreign object (TRP/Hardware disease)

• FB settles in reticulum and may penetrate the reticulum and pericardium that lies just cranial to the reticulum

Question 8

What are the 3 most common signs of pericardial effusion? What else may be seen?

Answer 8

1. attenuated heart sounds - muffled form effusion around heart
2. jugular vein distention - increased RA pressure
3. poor peripheral pulse quality

fever, anorexia, depression, weight loss, dyspnea, abdominal distention (hepatomegaly, ascites), peripheral edema, colic, elevated HR and RR

Question 9

What are 4 clinicopathologic findings indicative of pericardial effusion?

Answer 9

1. anemia secondary to blood loss or chronic disease
2. elevations of coagulation parameters
3. pre-renal azotemmia
4. pulsus paradoxus - exaggeration of normal inspiratory decrease in systolic blood pressure

Question 10

What are 3 signs of pericardial effusion on radiographs?

Answer 10

1. enlargement of cardiac silhouette (rounded appearance)
2. pleural effusion and enlarged vena cava
3. hepatomegaly or decreased abdominal detail due to ascites

Question 11

What are 4 signs of pericardial effusion on ECG?

Answer 11

1. sinus tachycardia
2. ventricular premature contractions
3. low voltage QRS complexes
4. electrical alternans - alternating variation in R-wave amplitude

Question 12

What is the gold standard in diagnosing pericardial effusion?

Answer 12

echocardiography –> anechoic fluid in pericardial space

Question 13

What are 2 possible treatments for pericardial effusion in small animals?

Answer 13

1. pericariocentesis - done immediately with cardiac tamponade
2. chemotherapy - if underlying cause is a treatable neoplasm

Question 14

What are 3 possible complications associated with pericardiocentesis?

Answer 14

1. VPCs
2. laceration of the coronary artery
3. sudden death

Question 15

When is a pericardiectomy preferred for treating pericardial effusion?

Answer 15

idiopathic pericardial effusion

Question 16

How is pericardial effusion most commonly treated in horses?

Answer 16

placement of an indwelling chest tube into the pericardial sac and subsequent drainage and lavage of the pericardial space followed by local infusion of anitmicrobials

Question 17

What is treatment of pericardial effusion like in cattle?

Answer 17

unrewarding –> treatment of Hardware disease is usually directed at salvage or short term survival with repeated pericardial drainage and lavage