Pericardial disease

Question 1

What is the pericardium

Answer 1

membrane surrounding the heart

Question 2

List the function of the pericardium

Answer 2

Not essential
prevents distension of the heart in the chest
reduces friction
equalises gravity
prevention of overdilation
regulation between stroke volumes

Question 3

What is cardiac tamponade

Answer 3

acute compression of the heart caused by fluid accumulation in the pericardial cavity

Question 4

What can chronic tamponade of the heart lead to

Answer 4

right congestive heart failure

Question 5

what can acute tamponade of the heart lead to

Answer 5

a quick drop in blood pressure

Question 6

Why do you occasionally get GI signs with pericardial effusion

Answer 6

the vascular bed becomes congested and the GIT isn’t perfused efficiently

Question 7

List 9 clinical signs associated with pericardial effusion

Answer 7

Jugular distension
positive hepatojugular reflex
ascites
tachycardia
muffled heart sounds
weak femoral pulses
pale MM
tachypnoea
GIT signs

Question 8

Describe the hepatojugular reflex

Answer 8

as you palpate cranial abdomen someone looks at jugular- will see wave up jugular- shows you have high RA pressure

Question 9

How do you diagnose pericardial effusion

Answer 9

clinical signs
echo
ECG

Question 10

what usually comes first in dogs- RCHF or pericardial effusion

Answer 10

pericardial effusion

Question 11

what usually comes first in cats- CHF or pericardial effusion

Answer 11

CHF

Question 12

How can we tell if the pericardial effusion of the CHF was first

Answer 12

if pericardial effusion was first, the right atrium will be collapsed

Question 13

what is a classic sign of pericardial effusion on ECG

Answer 13

electrical alternans

Question 14

what are electrical alternans

Answer 14

complexes are bigger then smaller on repeat

Question 15

How do we see pericardial effusion on radiogrpahy

Answer 15

globoid cardiac silhouette with a sharp outline

Question 16

Describe how you treat a pericardial effusion

Answer 16

oxygen
IV fluids
pericardiocentesis

Question 17

when do we generally have to do a pericardial strip

Answer 17

if you have to repeat pericardiocentesis more than 3 times

Question 18

why do we generally drain pericardial effusion from the right

Answer 18

avoids laceration of the main coronary vessels

Question 19

List 5 possible complications of a pericardiocentesis

Answer 19

cardiac puncture
arrythmias
dissemination of infection or neoplasia
atrial fibrillation
myocardial stunning

Question 20

how can you check if the blood you are draining during pericardiocentesis is from the pericardium or from the heart

Answer 20

blood from the ventricles will clot, blood from the pericardium will not

Question 21

Why is there a risk of arrythmias post pericardiocentesis

Answer 21

because of the rapid filling and dilation of the RA and RV

Question 22

What is myocardial stunning

Answer 22

temporary loss of contractile function that persists for hours to days after perfusion has been restored

Question 23

list the 4 most common causes of pericardial effusion in dogs

Answer 23

cardiac neoplasia
idiopathic
left atrial rupture
coagulopathies, uremic, infection

Question 24

List 4 common cardiac tumours

Answer 24

haemangiosarcomas
heart base tumours (chemodectoma)
mesotheliomas
lymophsarcoma

Question 25

what is a chemodectoma

Answer 25

tumour of the chemical sensing cells in the aortic arch

Question 26

what is a haemangiosarcoma

Answer 26

malignant tumour of vascular endothelium

Question 27

describe heart base tumours

Answer 27

chemodectomas and ectopic thyroid carcinomas

Question 28

describe mesotheliomas

Answer 28

cancers of the mesothelial cells

Question 29

where do haemangiosarcomas commonly form within the heart

Answer 29

on the wall of the right atrium

Question 30

where do chemodectomas commonly form

Answer 30

round the aortic arch

Question 31

what is a left atrial rupture usually secondary to

Answer 31

chronic degenerative valve disease

Question 32

why should we not do a pericardiocentesis if we suspect a LA tear

Answer 32

we may dislodge the clot

Question 33

describe a peritoneal pericardial diaphragmatic hernia

Answer 33

communication between the pericardial and peritoneal cavities

Question 34

what is a pericardial cyst

Answer 34

most common benign tumour of the pericardium

Question 35

what causes constrictive pericardial disease

Answer 35

repeated pericardial draining

Question 36

Describe how to treat constrictive pericardial disease

Answer 36

pericardectomy

Question 37

can you see constrictive pericardium on ultrasound

Answer 37

yes- it will show as a bright white pericardium stuck to the heart wall

Question 38

where do we make our incision for a pericardiocentesis

Answer 38

at the 5th intercostal space on the RHS

Question 39

why does a large atria show on ECG as inverted QRS

Answer 39

if the right side is producing more power than the left side, then the QRS complexes will be inverted

Question 40

List 3 indications for a pericardectomy

Answer 40

severe chronic pericardial disease restrictive pericardial disease Palliative surgery for neoplastic aetiologies of pericardial effusion