Pericardial Disease- CardioRush

PPDH (Peritoneopericardial diaphragmatic hernia), pericardial defects or absence, cystsWhat are some examples of congenital pericardial disease?Pericardial effusion, constrictiveWhat are some examples of acquired pericardial disease?Pericardial effusionWhat is the most common cause of acquired pericardial disease?ConstrictiveWhat type of acquired pericardial disease is more common in cattle due to hardware disease?Pericardial effusionWhat is the term for an increased fluid volume inside the pericardial sac?Pericardial fluid increases enough so that pressure rises above that is RV filling pressure, interferes with diastolic fillingWhat occurs in cardiac tamponade?No, only diastolicIs systolic function usually affected in cardiac tamponade?1Which line is showing pressures as fluid increases in constrictive pericarditis?2Which line is showing pressures in a normal pericardium as fluid increases?3Which line is showing pressures as fluid increases in chronic pericardial effusion?25mmHgOver what pressure in the pericardial sac will interfere with RV filling pressure?Severe thickening, reduced compliance, small volume effusionWhat happens to the pericardium in constrictive pericarditis?Knock due to abrupt end to diastolic fillingWhat is the characteristic sound on auscultation in constrictive pericarditis?Square root signWhat is the shape of the curve for cardiac filling pressure in constrictive pericarditis?Elastic limit of pericardium abruptly reachedWhat causes the square root sign shape of filling pressures in constrictive pericarditis?PPDHWhat congenital disease occurs when there is incomplete development of the diaphragm and caudal pleuropericardial membrane?Abdominal contents herniate into pericardial spaceWhat is the result of failure of the diaphragm and caudal pleuropericardial membrane to close in PPDH?Liver, stomach, omentum, SI, spleen, rarely colonWhat abdominal contents can end up in the pericardial space in PPDH?Sternal deformitiesWhat other deformity is sometimes associated with PPDH?False (it is only congenital, never acquired)True or false: PPDH can be acquiredOften asymptomatic for long periods, GI signs, resp signs, CV signs less commonWhat are the clinical signs of PPDH?Vomiting, anorexia, weight loss, diarrheaWhat are some GI signs that may occur with PPDH?Tachypnea, cough, shortness of breathWhat are the respiratory signs that may occur with PPDH?Shock, collapse, signs of tamponadeWhat are some CV signs that may occur with PPDH?Drains into abdomenWhy don't we usually see signs of cardiac tamponade with PPDH, even if pericardial effusion is being produced?Muffled heart sounds, absent or displaced cardiac sounds or apex beat, tachypnea, absence of abdominal organs on palpation of bellyWhat are some PE findings consistent with PPDH?PPDHWhat is the radiographic finding?PPDHWhat is the radiographic finding?False (if no signs, no need to correct, it's just an incidental finding then)True or false: PPDH always needs to be corrected surgicallyAcquiredWhich is more common: congenital or acquired pericardial disease?Neoplasia, idiopathic, hemorrhage, uremic pericarditis, transudateWhat are some general causes of pericardial effusion in dogs?Hemangiosarcoma, heart base tumor, mesothelioma, metastatic neoplasia, lymphomaWhat are some examples of neoplasias that may cause canine pericardial effusion?Cats, cattleWhat species are more likely to get pericardial effusion from lymphoma?Vit K antagonist, LA tearWhat are 2 causes of pericardial hemorrhage?RA HemangiosarcomaWhat is this tumor?R auricular tip, R AV grooveWhat are the most common places on the heart we see hemangiosarcoma?Heart base tumor (chemodectoma in this case)What is this tumor?False (sometimes incidental, can become too large and compress the great vessels)True or false: Heart base tumors, like chemodectomas, are always incidental findingsMesotheliomaWhat is this tumor?CHF, FIP, lymphoma, metastatic neoplasia, bacterial infection, uremia, hemorrhageWhat are some causes of pericardial effusion in cats?False (Depends on cause and severity, some causes, like CHF, will resolve when the underlying issue is treated)True or false: pericardiocentesis is always indicated when effusion is presentBacterial infectionWhat is the main cause of pericardial effusion in horses?Traumatic reticulitis and pericarditis, lymphomaWhat are the main causes of pericardial effusion in cattle?Peripheral edema, jugular distension and pulses, tachypnea or dyspneaWhat are the clinical signs of traumatic reticulopericarditis in cattle?Muffled heart and ventral lung sounds, splashing sounds from gas formationWhat are the PE findings consistent with traumatic reticulopericarditis in cattle?Possible metallic FB, fluid lineWhat do radiographs of the heart in a cow with traumatic reticulopericarditis show?Hyperechoic fibrin deposit on epicardiumWhat can be seen on echo of a cow with traumatic reticulopericarditis?Place magnets, check yearlyHow can traumatic reticulopericarditis be prevented in cattle?False (often unrewarding treatment due to epicardial and myocardial involvement, typically only done to keep cow alive long enough to calf or go to slaughter)True or false: treatment of traumatic reticulopericarditis is typically straight forward and cattle recover well after placing a drain in the pericardiumMedium to large breeds, brachycephalics more common, middle age or older, male more commonWhat is the common signalment of dogs that present with pericardial effusion?GSD, Goldens, Labs, RottweilersWhat large breed dogs are more likely to develop pericardial effusion?History of acute collapse, abdominal distension, dyspnea, syncopeWhat is the typical history and clinical signs seen with dogs presenting for pericardial effusion?Muffled heart sounds, muffled lung sounds if pleural effusion present, weak arterial pulses, pulsus paradoxus, jugular vein distension, tachycardia, MM muddy, delayed CRT, ascites, hepatomegaly, pericardial knock (mainly in larger animals)What are the typical PE findings in a dog with pericardial effusion?Pulses weaker on inspiration, stronger on expirationWhat occurs in pulsus paradoxus?Acute with collapse, shock, low CO, or chronic buildup leading to RCHF signsWhat are the 2 main clinical scenarios seen with pericardial effusion?Generalized hepatomegaly, globoid heart, sharp edges to cardiac silhoutte on DV, enlarged CVC, variable vessels finding but often small, some pleural effusion commonWhat are the radiographic findings consistent with pericardial effusion in dogs?Pulmonary metastatic diseaseWhen evaluating a radiograph of an animal with pleural effusion, what should you search for?Enlarged globoid heart, sharp margins on DV, small volume pleural effusionWhat are the radiographic findings?Enlarged globoid heart, pericardial effusion, sharp edges on DV viewWhat are the radiographic findings?Sinus tachycardia, electrical alternans, low voltage QRS complexes, ST segment elevation, VPCs common esp post tapWhat are the ECG findings associated with pericardial effusion?Heart swings back and forth in pericardial fluidWhat occurs in the heart that results in electrical alternans?1 to 1 or 2 to 2 variation in appearance of QRS, fluid dampens peak of QRSWhat is the appearance of electrical alternans on the ECG?Electrical alternansWhat are the ECG findings?ST segment elevation with electrical alternansWhat are the ECG findings?Electrical alternansWhat are the ECG findings?Echo free space between peri and epicardium, RA diastolic collapse, heart swinging in pericardium, small LV sizeWhat are the characteristics of pericardial effusion on echo?RA appendage, junction of RA and RV, heart baseWhat are the places to check for cardiac masses when evaluating the heart on an echo?LVWhat is 1?RVWhat is 2?Pericardial effusionWhat is 3?LVWhat is 1?IVSWhat is 2?RVWhat is 3?Pericardial effusionWhat is 4?PericardiumWhat is 5?RA collapseWhat is happening between systole (left image) and diastole (right image)?Cavitated (some areas soft tissue, some fluid)This is a hemangiosarcoma mass on the RA. What is causing the variation in echogenicity?Central venous pressure, CBC, chem, FIP/FeLV in cats, cardiac troponin I, pericardial fluid analysisWhat are some other lab tests that can be performed in cases if pericardial effusion?ElevatedWhat is typically the central venous pressure in cases of pericardial effusion: low, normal, or elevated?Anemia, thrombocytopenia, RBC changesWhat are some CBC findings consistent with pericardial effusion?Prerenal azotemia, increased LEs, low Na and Cl if ascitesWhat are the chemistry changes consistent with pericardial effusion?Usually elevated, highest with hemangiosarcomaWhat is the cardiac troponin I level in dogs with pericardial effusion?Lymphoma, bacterial or fungal cause, FIPWhat causes of pericardial effusion may we be able to diagnose based on pericardial fluid analysis?Neoplastic cells rarely shed into fluid, hemangiosarcoma and heart base tumors fluid usually just hemorrhagicWhy is cytology and pericardial fluid analysis often unrewarding, especially in dogs?Horses (most likely to get bacterial cause)Why species are we more likely to send for culture and sensitivity testing of pericardial fluid?Right 5-6th ICS at CCJWhere do you put the needle when performing pericardiocentesis?Less likely to hit coronary arteryWhy do we approach on the right when performing pericardiocentesis?One for local block, the other in case V tach developsWhy should you have 2 syringes of lidocaine ready for pericardiocentesis?Ventricular arrhythmias may developWhy should you continue ECG monitoring after performing pericardiocentesis?Check for evidence of hemorrhageWhy do we measure PCV/TS serially after performing pericardiocentesis?Pull red top tube and check for clotting, if no clotting then not in heartWhat is one way to tell if you are in the heart or if the fluid is hemorrhagic when performing pericardiocentesis based on clotting?Clotting, PCV/TS different than peripheral, supernatant xanthochromic, platelets present, echo bubbles in pericardial sacWhat are some general ways to determine if you are in the pericardial sac or the heart when performing pericardiocentesis?Sudden death, rebleed into pleural or pericardial space, coronary artery laceration, serious arrhythmiaWhat are some of the complications and risks associated with pericardiocentesis?False (may be an option depending on positioning)True or false: surgery is never an option for RA hemangiosarcoma3-6 monthsWhat is the typical survival time for animals with RA hemangiosarcoma that you are able to remove and follow up with chemotherapy?>1-2 years, depends on severity and progressionWhat is the typical survival time for dogs with a heart base tumor?In combo with chemo for lymphoma, sometimes repeated by itselfWhat are some ways we use pericardiocentesis for palliative therapy?Longterm abx based on culture and sensitivity, surgical explore or indwelling catheter placement for lavageWhat is the treatment for infectious pericarditis, which is mostly seen in large animals?PoorWhat is the prognosis with pericardial effusion due to FIP?Single tap may be curative, corticosteroids possible, surgical removal of pericardium if recurrentWhat are the characteristics of idiopathic pericardial effusion treatment?Pericardiocentesis, vitamin K or plasma, surgical explorationWhat are some treatments for pericardial hemorrhage?LA tear (will just continue to bleed)What is the only situation where pericardial effusion is present severely but shouldn't be removed as a first choice of treatment?Infection, FB, idiopathicWhat are 3 examples of causes of constrictive pericarditis?TrueTrue or false: constrictive pericarditis has similar clinical signs as pericardial effusion and is difficult to confirm a diagnosisPericardectomyWhat is the treatment of choice for constrictive pericarditis?False (more complications, more difficult because it is thickened)True or false: surgery to remove the pericardium in constrictive pericarditis is easier and less complications occur than if pleural effusion alone is the reason for pericardectomyArrhythmias, CHF myocardial infiltration, obstruction to blood flowWhat are some other issues caused by cardiac neoplasia other than pericardial effusion?