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Cardiology and Respiratory SA Med > Pericardial Diseases > Flashcards

Pericardial Diseases Flashcards

1
Q

What are the two parts of the pericardium?

A
  • Parietal pericardium

- Visceral pericardium

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2
Q

What is the true pericardium?

A
  • Parietal pericardium
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3
Q

What must occur for cardiac tamponade to occur?

A
  • Pressure from pericardium is normally 0
  • When pericardial pressure exceeds the pressure of the right atrium, tamponade can occur
  • Pericardial pressure must exceed 5
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4
Q

When do you start to get clinical signs with pericardial effusion?

A
  • When you have cardiac tamponade
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5
Q

What would clinical signs be with pericardial effusion?

A
  • Heart sounds muffled, but lung sounds are fine

- Precordium can be absent or shifted

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6
Q

What would clinical signs be with cardiac tamponade?

A
  • Collapsed
  • Sedated
  • Exercise intolerant
  • Jugular distension or pulsation and possible ascites
  • Often animals are tachycardic because they can’t get enough blood into their heart
  • Pulsus paradoxus
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7
Q

Pulsus paradoxus definition

A
  • When the animal inspires, the pulses are weaker; when you expire they are stronger
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8
Q

Pathophysiology of pulsus paradoxus

A
  • In a normal individual, when your chest gets wider, your pleural pressures drop
  • Negative pressure pulls your pericardium and right heart wider
  • Improved right ventricular filling and decreased left heart filling because the interventricular septum is shared
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9
Q

Historical findings of animals with pericardial effusion?

A
  • Collapse/syncope
  • Weakness/depression/exercise intolerance
  • Tachypnea
  • Right sided abdominal enlargement
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10
Q

Radiographic findings of pericardial effusion

A
  • Enlargement of the cardiac silhouette (+/- globoid)
  • Sharp, well demarcated edges of the heart
  • Distension of the caudal vena cava (as right atrium is getting squashed)
  • Small pulmonary vessels** (lungs are not receiving as much blood)
  • Mass effects (mediastinal deviation of the trachea)
  • Abdominal effusion
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11
Q

Three radiographic hallmarks of pericardial effusion**

A
  1. Enlarged cardiac silhouette (globoid or subtle)
  2. Small pulmonary vasculature
  3. Distension of the caudal vena cava
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12
Q

ECG findings for pericardial effusion

A
  • Decreased QRS amplitude (often <1 mV)
  • Electrical alternans (short and tall Q wave)
  • Other - VPCs, supraventricular tachycardia due to irritation of the myocardium
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13
Q

Echocardiogram findings of pericardial effusion

A
  • Ultrasound shows a distinction between cardiac enlargement and pericardial effusion
  • Right atrium may be compressed if you have cardiac tamponade
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14
Q

Emergency treatment for pericardial effusion short term goal

A
  • Increase preload to force blood into the heart
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15
Q

What is the emergency short term treatment for pericardial effusion?

A
  • IV catheter - rapid IV fluid administration
  • Crystalloids
  • Start with a quarter shock bolus while you prepare to tap (90 mL/kg * 4 = 20mL/kg IV bolus OR trick is to take weight in lbs and add a zero)
  • E.g. give a 60 lb dog 600 mLs
  • NO DIURETICS!!!
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16
Q

Long term goal of pericardial effusion therapy

A
  • Relieve tamponade and determine etiology
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17
Q

What are the two purposes of pericardiocentesis?

A
  • Diagnostic and therapeutic
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18
Q

What samples do you collect for pericardiocentesis?

A
  • Cytology and culture

- Purple and red top

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19
Q

What are the three primary types of fluid you could get back from a cytology?

A
  • Exudates
  • Transudates
  • Hemorrhage
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20
Q

What are some dfdx for transudates?

A
  • Hernias
  • Cysts
  • CHF
  • Hypoproteinemia
  • Heart basedmass (chemodectoma)
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21
Q

DfDx for exudates?

A
  • Foreign body (e.g. grass awn, quills)
  • Nocardia
  • Fungal
  • FIP in cats
  • Idiopathic inflammation
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22
Q

Dfdx for hemorrhagic effusion?

A
  • Neoplasia (#1 hemangiosarcoma, #2 chemodectoma, #3 way down ectopic thyroid carcinoma, lymphosarcoma)
  • Coagulopathy (retroperitoneal bleeding, peritoneal bleeding)
  • Idiopathic (Golden Retrievers might be more predisposed)
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23
Q

Cytology for pericardial fluid analysis - are many of them diagnostic?

A
  • No, less than 8% of cytologies were diagnostic

- Only really send it off if you think it will be exudative or if it looks strange

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24
Q

What is the #1 differential for a case of hemorrhagic pericardial effusion?

A
  • Hemangiosarcoma
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25
Q

Where is the most common location for a hemangiosarcoma in the heart?

A

Right auricular tip

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26
Q

Where do chemodectomas tend to hang out in the heart?

A
  • Base of the heart at the aortic base
27
Q

What are the major risks of pericardiocentesis?

A
  • VPCs
  • Location of the coronary artery (these are on the left side)
  • Lung laceration and resultant pneumothorax, hemorrhage
  • Dissemination of infection/neoplastic cells to the pleural space
  • Chance of bleeding out post-centesis
  • Bottom line: TAMPONADE WILL KILL THEM FIRST!
28
Q

Pericardiocentesis supplies essentials

A
  • Large gauge catheter
  • Extension set
  • 3 way stop cock
  • Syringe
  • Shave and do a sterile prep
29
Q

Other supplies

A
  • Clippers
  • Sterile scrub
  • Sterile gloves
  • Tapping kit: Scalpel blade, 14 or 16 gauge needle (consider long large gauge peripheral catheter for smaller patients), two red top tubes, 1 purple top tube, 60 mL syringe, 3 way stop cock, 2 IV extension sets
  • 2 mg/kg dose of lidocaine
  • ECG machine
  • Extra hands: holder, tapper, aspirator
  • +/- ultrasound
  • +/- sedation (2 mg/kg Butorphanol IV)
  • /- local block
30
Q

What tubes do you need for a pericardiocentesis?

A
  • 1 lavender top tube

- 2 red top tubes

31
Q

How do you position a patient for pericardiocentesis?

A
  • If you have an echo table, put in right lateral recumbency to be able to access the patient’s ride side
  • Sternal recumbency too
  • Want the right sided cranioventral thorax to be accessible
32
Q

Where do you clip for a pericardiocentesis?

A
  • Clip right ventral thorax at the intercostal space 3 to 6 (where elbow touches the chest)
33
Q

How to prep the area for pericardiocentesis?

A
  • Surgical scrub of the shaved area
34
Q

What should you be monitoring during the pericardiocentesis?

A
  • ECG leads!

- Monitor for VPCs throughout procedure

35
Q

What is your mnemonic for where to tap?

A
  • “Go right ahead and tap”

- On the right and ahead of the rib

36
Q

Where do you insert the catheter relative to the rib?

A
  • Insert catheter cranial to the rib to avoid the intercostal arteries that are caudal to the rib
37
Q

Method for the actual tapping

A
  • Go cranial to the rib
  • Go perpendicular to the body wall
  • Slowly advance the catheter until you are able to aspirate fluid
  • If you go too far and see VPCs, then back the catheter out
38
Q

What should you be doing with the two red top tubes and one lavender top tube?

A
  • Monitor one red top tube for clotting

- Monitor red top and purple top for cytology and culture

39
Q

What does it mean if your red top tube clots?

A
  • That you are in the heart

- Hemorrhagic effusion does not clot

40
Q

What should effusion PCV be compared to peripheral PCV?

A
  • Should be lower than peripheral PCV
41
Q

What should you see happen to the heart rate as pericardial effusion resolves?

A
  • Improved heart rate as cardiac filling and output resolves
  • QRS should get taller (better contraction) and tachycardia should resolve
42
Q

What should you monitor post-pericardiocentesis?

A
  • Heart rate, blood pressure, respiratory rate, PCV/TS
  • Tamponade and hemorrhage
  • Want to make sure they don’t re-effuse quickly
  • Ensure free access to water
43
Q

With a coagulopathy and hemorrhagic effusion, should you remove the blood?

A
  • Ideally want to try and manage with IVF

- If they are in tamponade, you need to remove the fluid

44
Q

Treatment and prognosis for HSA

A
  • +/- chemotherapy

- 6-12 weeks

45
Q

Treatment and prognosis for chemodectoma

A
  • Ectomy or window

- 1-3 years

46
Q

Treatment and prognosis for mesothelioma

A
  • Pericardectomy

- 12-20 weeks

47
Q

Treatment and prognosis for CHF

A
  • Tx underlying

- depends

48
Q

Treatment and prognosis for hypoalbuminemia

A
  • Tx underlying and depends
49
Q

Treatment and prognosis for vasculopathy

A
  • Tx underlying and depends
50
Q

Treatment and prognosis for infectious disease (bacterial, fungal, FIP)

A
  • Drain/flush
  • +/- pericardectomy
  • Fair to poor prognosis
51
Q

Treatment and prognosis for idiopathic (due to viral or immune mediated)

A
  • Centesis, steroids
  • Window
  • Good prognosis
52
Q

What is it called when there is retention of abdominal contents in the pericardium?

A
  • Peritoneal-pericardial diaphragmatic hernia
53
Q

What causes a peritoneal-pericardial diaphragmatic hernia?

A
  • Failure of embryologic separation
54
Q

Signalment of PPDH

A
  • Usually young
  • No trauma history
  • Most common in cats
  • I guess Weimeraners are predisposed too
55
Q

Clinical signs of PPDH

A
  • Variable; respiratory or GI
56
Q

Physical exam findings of PPDH

A
  • Muffled heart sounds

- No ascites, etc.

57
Q

Diagnosis of PPDH

A
  • Radiographs, ultrasound
58
Q

Treatment for PPDH

A
  • If asymptomatic, leave them alone
59
Q

What is the most common organ that goes into the pericardium?

A
  • Omentum!
60
Q

Which is more common in cats: PPDH or pericardial effusion?

A
  • PPDH
61
Q

What do radiographs look like with PPDH in ca at?

A
  • Diaphragm and heart base will be touching (not common in cats)
  • May see intestines or gas within the heart
  • Very wide base enlargement
  • Pericardial silhouette will be less crisp
62
Q

Prognosis for PPDH if no clinical signs and treatment

A
  • No surgery

- Typically good prognosis if no clinical signs

63
Q

PPDH prognosis if clinical signs are present

A
  • Variable

- May need surgery

Cardiology and Respiratory SA Med (15 decks)

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