L77a: pericardial diseases in small animals

how frequently will idiopathic pericardial effusion recur in small animals?

50% of cases

what is pulsus paradoxus?

increase in pulse pressure during expiration and decrease during inspiration

what side of the heart fails with cardiac tampanode?

right side

what is immediately on your differential list if you hear pulsus paradoxus in an animal?

pericardial effusion

what are the only two things make the heart big and round?

1. pericardial effusion

2. dilated cardiomyopathy (DCM)

A 10 year old MN lab retriever comes into the clinic. You perform an ECG on him and see alternating tall and small morphology. What do we call this ECG and what is the diagnosis?

“electrical alternans” → pericardial effusion

what causes a cardiac tamponade?

impaired filling due to increased pressure

what does it mean if you have an acute rate of accumulation with a cardiac tamponade?

reduced filling and hypotension → no cardiac output → animal will die

what does it mean if you have an chronic rate of accumulation with a cardiac tamponade?

compensatory mechanism → right or biventricular congestive heart failure (large amount of blood)

what is peritoneopericardial diaphragmatic hernia?

congenital defect of the septum transversum which allows abdominal organs to shift into the pericardial sac surrounding the heart

what is used to diagnose peritoneopericardial diaphragmatic hernia?

radiographs and echocardiogram

which breed cats do we see peritoneopericardial diaphragmatic hernia?

1. domestic longhair

2. persians

3. himalayans

what breed dog do we see peritoneopericardial diaphragmatic hernia?

weimaraner

what type of fluid accumulation is most common for pericardial effusion in dogs?

hemorrhagic

what are the types of fluid accumulation for pericardial effusion?

1. transudate

2. exudate

3. hemorrhagic

what is the diagnostic for pericardial effusion fluid?

fluid analysis via pericardiocentesis

what is the most common reason for a pericardial effusion?

idiopathic

what will an animal with pericardial effusion commonly have at the same time?

1. pleural effusion

2. enlarged vena cava

3. elevated CVPs

why do we perform pericardiocentesis?

1. relieve cardiac tamponade

2. retrieve samples for analysis

3. obtain diagnosis

why can we not treat pericardiocentesis with furosemide and an ACE inhibitor?

won’t get rid of the fluid as it does not address cardiac output in the heart

what does cardiac tamponade cause?

compression on coronary arteries → decreased oxygen to myocardium

why do we want a red top tube when performing a pericardiocentesis?

if you get blood it will let you know if you are in the right spot

• pericardial effusion → won’t clot

• ventriculocentesis → will clot

why do we put more hole with a scalpel in the angiocatheter for a pericardiocentesis?

• increase release rate of fluid

• there will be fibrin in heart that can lead to blocks in the catheter so want more holes to avoid blockage

what monitoring tool do we always have set up when doing a pericardiocentesis?

continous ECG

where do we put the local block for a pericardiocentesis?

above the costochondral junction

where do you do a pericardiocentesis on the right side?

4th or 5th intercostal space

where do you do a pericardiocentesis on the left side?

6th intercostal space

why might we do a pericardiocentesis on the left side?

less likely to pierce or lacerate the myocardium

why might we do a pericardiocentesis on the right side?

less likely to hit a coronary artery

what are the potential complications when performing a pericardiocentesis?

1. hemorrhage

2. arrhythmias

3. infection

4. pneumopericardium or pneumothorax

what do we monitor for when draining the effusion in a pericardiocentesis?

VPC from myocardial irritation

what are examples of when you may see transudate effusion?

1. hernia

2. cyst

3. congestive heart failure

4. hypoproteinemia

5. heart base mass

what are examples of when you may see exudate effusion?

1. perforation from foreign body

2. infection

what are examples of when you may see a hemorrhagic effusion?

1. idiopathic

2. cardiac or heart base tumors

3. coagulopathies

4. trauma

5. arterial tears