TV4101 - Pericardial Disease

Pericardium Anatomy
Attached to?
Comprised of?
Contains?
Purpose?

• Attached base of large vessels (aorta, PA)

• Sac that covers heart

Comprised of 2 layers

• Parietal (facing outwards)

• Visceral (facing heart)

•Small amount of fluid in sac (0.3-1ml) – lubcricant

•Prevents over stretch of heart

Diseases of pericardium?

Pleural space disease

• Fluid

• Herniation

Restrictive Pericarditis (rare)

What is this?

Features?

Congenital pericardial diseases

Peritoneopericardial Diaphragmatic Hernia (PPDH)

•Communication between pericardium and peritoneum

•GI contents in pericardial space

PPDH - presenting signs

•Tachycardia, coughing, respiratory distress, exercise intolerance

•Vomiting

•Anorexia

•Some are asymptomatic

PPDH - CX

•Muffled heart sounds

•“empty abdomen”

•Thoracic borborygmus

•Pectus excavatum - chest wall deformity that causes a sunken or caved-in appearance of the chest

•Tachycardia

PPDH DX

Radiographs

• Might not be definitive if pericardial effusion - most cases dx with rads

• Bowel loops in pericardial space

• Cranial gastric axis displacement

• Barium can confirm DX

Echocardiography

• Pericardial effusion, bowels in pericardium

CT

• DX but not usually necessary

PPDH - TX?

Cases with CX - surgery
Older cats - no clinical sign: may benefit from surveilance

Pericardial Effusion in dogs, what fluids we see?

•Blood

•Transudate

•Exudate

•Serosanguinous is most common

PE clinical consequences

1. Fluid accumulation in pericardium

2. Ventricles can’t fill → Diastolic failure → Cardiac tamponade and weak pulses

3. Venous return is reduced → venous distension

4. Congestion → Ascites / Liver distension

PE clinical presentation

Acute

•Collapse

•Tachycardia

•Pallour

Chronic

•Abdominal distension/ascites

•Exercise intolerance

PE physical exam signs

Beck’s triad

•Muffled heart sounds

•Jugular distension

•Weak pulses/BP

Tachycardia

Tachypnoea

Pale mucous membranes

Abdominal distension

Not all PE findings are present in all cases

PE - DDX

DCM

MVD

Liver disease (Ascites)
Sytemic illness

Respiratory disease

Heart sounds “muffled” in deep chested / overweight dogs

PE - dogs

Caused by?

Neoplasia

• Haemangiosarcoma

• Heart-base mass (chemodectoma)

• Mesothelioma

• Thyroid carcinoma

Idiopathic pericarditis (20-75% of cases)

Infective pericarditis (Rare)

PE TX?

•2 priorities

• Emergency management

  • Oxygen

  • Anxiolytics

  • Emergency pericardiocentesis

Long term management 

• Idiopathic

  • Drainage

  • Partial pericardiectomy in recurrent cases

• Neoplasia

  • Depends on type

PE TX - prognosis

•Depends on cause

•Idiopathic – good with a appropriate therapy

•Neoplasia – variable

PE in cats - Causes and tx?

•FIP - Antiviral drugs

•Lymphoma - Guarded prognosis

•Heart failure - Drain and rx heart failure