Vascular and Pericardial Disease in LA Flashcards
Most common causes of pericardial disease in different large animal species?
- Traumatic / Septic
- most common from in cattle
- Idiopathic
- most common from in horses
- Bacterial
- most common form in pigs
- Neoplastic
- uncommon in large animals
- Viral
- uncommon in large animals
How does traumatic pericarditis occur?
- A manifestation of hardware disease (traumatic reticuloperitonitis)
- ingested wires migrate through the wall of the reticulum, into the peritoneal cavity and through the diaphragm into the pericardial sac
- accumulation of septic fluid and gas within the pericardial sac
Traumatic pericarditis clinical signs?
- Early signs: non-specific
- fever, anorexia, depression
- stand with elbows abducted, or with forequarters elevated
- reluctant to move
- positive grunt test
- Later signs: right-sided heart failure
- venous congestion, peripheral oedema
Cardiovascular exam findings with traumatic pericarditis?
- Tachycardia
- Muffled heart sounds
- Splashing “washing machine” murmurs
- Venous distension
- Weak pulses
Treatment of traumatic pericarditis?
- the vast majority of affected cattle are culled
- surgical procedures to strip out the pericardium and remove septic debris have been described
Causes of pericarditis in horses?
- the majority of cases are idiopathic
- equine viral arteritis, equine influenza
- Strep. Pneumoniae (E.Coli, Actinobacillus
Clinical signs of pericarditis in horses?
- Venous distension
- Ventral oedema
- Muffled heart sounds
- Pericardial friction rubs (triphasic sounds in time with heart)
- Pleural effusion
Diagnosis of pericarditis in the horse?
- Echocardiography
- fluid and fibrin in pericardial sac
- compression of cardiac chambers
- Electrocardiography
- small complexes
- Cytology of pericardial fluid
Treatment of pericarditis in the horse?
- Pericardial drainage and lavage are indicated if the right atrium is collapsing (i.e. cardiac tamponade is present)
- Indwelling drain and twice daily lavage with antibiotic containing fluids greatly improves prognosis
Prognosis of pericarditis in the horse?
- good provided treatment is early and aggressive
- constrictive disease may occur in chronic cases
- Can return to full performance
Causes of pericarditis in the pig?
Haemophilus parasuis, Strep. Suis
Signs of pericarditis in the pig?
- Non-specific signs - fever, depression
- Also fibrinous serositis and effusion in CNS, pleural, peritoneum, and synovia
Clinical signs of septic jugular thrombosis?
- hot
- painful
- discharging tracts (chronic)
Clinical signs of non-septic jugular thrombosis?
- thickening “cording” of the vein
- reduction in patency
What causes jugular thrombosis?
- Most (all) cases of jugular thrombosis are associated with intravenous catheterisation or injection
- Predisposing factors
- Systemic inflammatory response syndrome
- Multi-organ dysfunction Syndrome
- irritant drugs
- poor catheter placement
- poor catheter use
What does the venous occlusion from jugular thrombosis cause?
- Swelling in the supraorbital area
- Cheek and lips
- Tongue
- Leading to dysphagia
- Upper airway obstruction
- Nasal airflow test
- Proximal venous distension
What is ultrasonography used for with jugular thrombosis?
used to:
- Assess extent of thrombus
- Identify sepsis (cavitation)
- Assess patency of vein
- Distinguish perivenous swelling from thrombosis
- Select site for aspiration
Treatment of jugular thrombosis?
- Broad spectrum antibiotics
- Anti-inflammatories
- Systemic (aspirin, other NSAIDs)
- Topical (DMSO, hot packs)
- Heparin
- Vasodilators (Gyleryltrinitrate)
- Raise head
Complications of jugular thrombosis?
- Embolic disease
- Bacterial endocarditis
- Septic Pneumonia
- Long-term poor performance due to:
- Recurrent laryngeal neuropathy
- Upper airway oedema during exercise
What is systemic inflammatory response system (SIRS)?
- A self-amplifying dysregulated systemic inflammatory response
- Triggered by
- Bacterial toxins
- Previously referred to as endotoxaemia
What is multi-organ dysfunction syndrome?
- Altered organ function in an acutely ill animal such that haemostasis cannot be maintained without intervention
- Classified as either primary or secondary
What is primary multi-organ dysfunction syndrome?
- resulting from well-defined insult where organ dysfunction occurs early and is a direct consequence of the insult itself
- Eg burns and neoplasia
What is secondary multi-organ dysfunction syndrome?
- Organ failure not in direct response to the insult but as a consequence of a host response (SIRS)
What is disseminated intravascular coagulation (DIC)?
- Pathological activation of coagulation
- Associated with
- SIRS, SEPSIS, SEPTIC SHOCK
Clinical signs of disseminated intravascular coagulation?
- In large animals, DIC is usually manifested by thrombosis rather than spontaneous haemorrhage
- petechial haemorrhages
- bleeding at following trauma
- Venipuncture
- Surgical sites
- Nasogastric intubation
Diagnosis of disseminated intravascular coagulation?
- 4 out of 5 abnormalities of
- Thrombocytopaenia
- Prolonged prothrombin time
- Activated partial thromboplastin time
- Fibrin degradation products
- Antithrombin 3
Standard procedure for intravenous injection?
- Inject in the proximal one third of the neck
- avoids the carotid artery
- which is less superficial
- Remove the needle from the syringe
- 18 gauge, 1/5 inch needle
- Push the needle right into the hub
What is aortoiliac thrombosis?
Partial or complete occlusion of the terminal aorta, and external and internal iliac arteries by an organising thrombu
Clinical signs of aortoiliac thrombosis?
- Poor performance
- Exercise-associated hindlimb lameness
- Breeding failure in stallions
- After exercise
- Cold limb
- Weak pulses
Diagnosis of aortoiliac thrombosis?
- palpate thrombus, turgid vessel on rectal examination
- visualise the thrombus with transrectal ultrasonography
- vascular phase scintigraphy
Treatment of aortoiliac thrombosis?
- Non-steroidal anti-inflammatory drugs
- Aspirin
- Fenbendazole
Prognosis of aortoiliac thrombosis?
guarded
When does caudal vena caval thrombosis develop?
- Formation of thrombus in the caudal vena cava following extension of sepsis from a liver abscess
- Young, beef cattle
Clinical signs of caudal vena caval thrombosis?
- Early signs vague, may appreciate distension in the superficial epigastric veins without jugular distension
- Respiratory signs
- Severe epistaxis
- Reduction in rumen motility, hyperkeratosis, loss of mucosal integrity
When does vascular rupture tend to occur?
- Vascular rupture is the commonest form of sudden death during exercising horses, accounts for around 30% of cases
- Any intra-abdominal or intra-thoracic vessel can rupture
- aorta and pulmonary artery appear to be most common sites
- Vascular rupture and haemoperitoneum is an important differential in horses that present with severe distress following strenuous exercise (particularly if colic-type pain is noted)
When does rupture of the uterine vessels occur?
- Occurs in periparturient broodmares, particularly immediately before or after foaling, but up to three weeks after
- Colic
- Mass palpable in the broad ligament, or may bleed directly into abdomen
Management of rupture of uterine vessels?
- Conservative
- Support circulation
- Analgesics
What is Aorto-cardiac fistula?
- Congenital or acquired absence defect of the aortic wall
- Seen mainly in intact males
Clinical signs of aorto-cardiac fistula?
- Rupture occurs during exercise or breeding
- Sudden death
- Distress
- Ventricular tachycardia
- Loud continuous murmur
Diagnosis of aorto-cardiac fistula?
Echocardiography
Prognosis of aorto-cardiac fistula?
Hopeless
