Pericardial Disease in Dogs and Cats

What is the epicardium?

Visceral layer of serous pericardium with a monolayer of mesothelial cells

Directly adhered to heart

What is the parietal layer of serous pericardium?

Single layer of mesotheilal cells

Fuses with VP at great vessels

What is the fibrous pericardium?

Dense, nonpliable collagen fibrils

What is in the pericardial fluid space?

Normally 0.25mL/kg that is a phospholipid rich lubricantW

hat are the functions of the pericardium?

Limits movements within thorax

Protects from infection and trauma

Lubricates

Prevents excessive dilation

What are the common pericardial disorders/diseases?

Congenital pericardial peritoneal diaphragmatic hernia

Pericardial effusion

Constrictive pericarditis

Neoplasia

What is the main pericardial disease?

Pericardial effusion

What fluids can be in the pericardiac sac?

Transudate

Exudate

Hemorrhage

What causes transudate in pericardial effusion?

CHF

Hypoalbuminemia

Pericardial cysts

What can cause exudate in pericardial sac?

Infection (valley fever in dogs, FIP in cats)

Cats

What can cause hemorrhage in pericardiac sacs?

Idiopathic

Neoplastic

Trauma

Cardiac rupture (LA most common)

Coagulopathy

What is the most common type of pericardial effusion?

Hemorrhagic (spin down fluid to check the Hct)

What causes most of the pericardial effusion in dogs?

Neoplasia (right atrial or auricular hemangiosarcoma and heart base tumors)

What neoplasia can cause hemorrhagic pericardial effusion in dogs?

Right atrial/auricular hemangiosarcoma

Heart base tumors (chemodectoma/aortic body tumor or thyroid carcinoma)

Mesothelioma

Lymphoma

How do you treat hemorrhagic pericardial effusion in dogs?

Pericardiectomy for HBTs (heart base tumors)

Palladia for HBTs

Amputation of right auricle for HSA

How do you diagnose mesothelioma?

Biopsy of pericardial sac

Why is amputation of right auricle not good enough to treat an auricular hemangiosarcoma?

There is probably already metastasis, need to add palladia

What do you need to not do when treating a auricular hemangiosarcoma?

CANNOT remove pericardial sac. It helps stops bleeding for HSA

Describe idiopathic pericardial effusion in dogs

Slowly hemorrhagic (different from HSA) common in large and giant breed dogs

How do you treat idiopathic pericardial effusion in dogs?

Pericardiocentesis (curative in 50% with single procedure)

Pericardiectomy if recurrent

Need to repeat echo to ensure that neoplasia was not missed if recurrent

What causes pericardial effusion in cats?

CHF is most common

Neoplasia

FIP

Infectious (nonFIP) bacterial, histo, toxo

Idiopathic

What neoplasia causes pericardial effusion most often in cats?

Lymphoma

What is cardiac tamponade?

Pressure in pericardial sac exceeds pressure in right atrium causing filling to be difficult

This reduces stroke volume

What must be present if there are C/S of pericardial effusion?

Cardiac tamponade

What is the clinical presentation of pericardial effusion?

Chronic: ascites, exercise intolerance, weak femoral pulses with tachycardia, pulsus paradoxus, muffles heart sounds

Acute: sudden collapse, tachycardia, pale mucous membranes, prolonged CRT, sudden death

What is pulsus paradoxus?

Variation in the strength of femoral pulse

Should furosemide be given to dogs with ascites secondary to pericardial effusion?

No because stroke volume is already decreased so when furosemide decreases preload you will make CO way worse

What are the diagnostic findings of an ECG?

Electrical alternans (QRS complex alters between tall and short)

Low voltage QRS complexes

S-T segment elevation

Rads: globoid cardiac silhouette, ascites, hepatomegaly

Echo is definitive

What is electrical alternans?

Sign of pericardial effusion were QRS complex height varies a lot due to swinging of the heart

Why does pericardial effusion cause electrical alternans?

Swinging of fluid in the sac sometimes allows for it to be tall

How do you do a pericardiocentesis?

Right side, 5th ICS

ECG monitoring

Catheter or needle

Fluid analysis after

What is the treatment for pericardial effusion?

Pericardiocentesis

What is a risk of a pericardiocentess?

Can cause arrhythmias

Why do you analyze pericardial fluid?

Usually not diagnostic, but sometimes you can with neoplasia or look at biomarkers

T/F you can normally see pericardial fluid on echo?

False

What are the etiologies of constrictive pericarditis?

Cocciodiodomycosis

Chylothorax

Idiopathic

What are the signs of constrictive pericarditits?

R-CHF (ascites)

How do you treat constrictive pericarditis?

Surgical pericardial stripping/pericardiectomy