Test 1: lecture 19 pericardial effusion

Question 1

which side of the heart is more affected by pericardial disease

Answer 1

right

less pressure side

Question 2

functions of pericardium

Answer 2

holds heart in place
reduces friction between heart and other organs
physical barrier to inefection and cancer

Question 3

cardiac tamponade leads to — cardiac output and can lead to — sided CHF

Answer 3

low
right (ascites and edema)

Question 4

chronic vs acute cardiac tamponade

Answer 4

acute: rapid accumulation small volume can lead to high pressure, heart has not had time to adjust will have low cardiac output

chronic: slow build will allow for strecth and hypertrophy of the pericardium, will lead to Right sided CHF

Question 5

causes of cardiac tamponade

Answer 5

neoplasia

idiopathic

other: infectious, hemorrhage

Question 6

most common cardiac tumor

Answer 6

hemangiosarcoma

old large breed dogs

only few months to live

tumor in heart: right atrium, atrio-ventricular junction and spleen

Question 7

two heart base tumors

Answer 7

chemoreceptor cell tumors (brachycephalic breeds- aortic body tumors, chemodectoma)

ectopic thyroid carcinoma

Question 8

what type of dogs get chemoreceptor cell tumors

Answer 8

brachycephalic breeds

tumor of heart base (aortic body tumor, chemodectoma)

Question 9

— is a hard tumor to find, diffuse with no mass observed

Answer 9

mesothelioma

Question 10

cats and cows get — cancer in the heart

Answer 10

lymphoma

Question 11

idiopathic cardiac tamponade in a — dog is usually caused by —

Answer 11

large giant breed middle age

caused by hemorrhagic effusion

Question 12

signs of acute cardiac tamponade

Answer 12

syncope
acute weakness
shock

Question 13

signs of chronic cardiac tamponade

Answer 13

right sided CHF

abdominal enlargment (ascites)
tachynpnea
dyspnea
weight loss
anorexia

Question 14

PE of dog with cardiac tamponade

Answer 14

distant and muffled heart sounds

Elevated jugular venous pressure and decreased systemic blood pressure

Weak femoral pulse
– Pulsus paradox - the intensity of the pulse decreases during inspiration and increases with expiration

Tachycardia

Abdominal distention

Question 15

what is pulsus paradox

Answer 15

pulse decreases with inhale

pulse increases with exhale

on inhale: increased thoric pressure leads to low preload and low pulse

Question 16

xray of pericardial effusion

Answer 16

can’t see heart curves
looks like rounded ball

Question 17

Answer 17

pericardial effusion

electrical alternans: big wave then little wave (caused by heart swinging back and forth in the fluid)

can also see low voltage QRS complexes, ST elevation and rhythm distrurbances

Question 18

what is electrical alternans on an EKG

Answer 18

big peak little peak

can be caused by cardiac tamponade- heart swings back and forth in fluid

Question 19

differentials for intrapericardial masses in a dog

Answer 19

Neoplasia
* Inflammatory lesions
* Pericardial cysts
* Hematomas/Fibrin clots
* Herniated abdominal connective tissue or viscera associated with PPDH

Question 20

how to treat pericardial effusion

Answer 20

pericardiocentesis- drain fluid

give IV fluids (heart is squished, giving fluids will increase preload= better CO)

Question 21

where to do pericardiocentesis

Answer 21

5-6th intercostal (right side)

fluid will not clot and will have port wine apperance

Question 22

medical treatment for pericardial effusion

Answer 22

do NOT give lasix

this would decrease the already low preload- give IV fluids

can give steroids or antifibrotic drugs but no proven value

antibiotics for septic pericarditis

Question 23

if >3 pericardiocentesis what is recommened

Answer 23

remove pericardium
pericardectomy

pericardial window