Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
40 Cards in this Set
- Front
- Back
What is the anatomy of the pericardium? |
Parietal pericardium --fibrous, acellular --composed of collagen fibers --ligamentous attachments anchor the heart Visceral pericardium --serous pericardium --adhered to surface of heart |
|
Pericardial fluid composition? |
--phospholipid-rich --lubricates pericardial sac --low protein, few cells |
|
Function of pericardium? |
--lubrication --barrier to infection --maintains position of the heart --innervated with mechanoreceptors, chemoreceptors, afferent input, etc. --restrainig effect on cardiac volume --contributes to diastolic interaction |
|
How does the pericardium have a restraining effect on cardiac volume? |
--elastic at low stress --tissue becomes stiff at high stretch |
|
What is the most common congenital disorder of the pericardium? Due to? |
--peritoneopericardial diaphragmatic hernia (PPDH) --due to abnormal development of the diaphragm |
|
When is PPDH repair indicated? |
--clinical signs --GI obstruction --impaired hepatic/splenic blood supply |
|
Diagnosis of PPDH? |
--radiographic contrast study |
|
Less common congenital disorders? |
--absence of the pericardium (usually incidental) >> herniation may occur with partial defect --intrapericardial cysts >> commonly present with cardiac tamponade |
|
What is constrictive pericarditis? Results in? |
--acquired dz where pericardium becomes stiff and fibrotic >> restricted filling >> signs of right-sided CHF |
|
Constrictive pericarditis may occur secondary to? |
-- may occur secondary to any cause of chronic pericarditis >> Coccidioides immitis >> neoplasia >> FB >> recurrent idiopathic PE >> septic peritonitis |
|
Diagnosis of constrictive pericarditis? |
--cardiac catheterization >> measure cardiac pressures --echocardiography >> look for myocardial disease, effusion >> may suggest pericardial constriction |
|
Treatment of constrictive pericarditis? |
--surgical pericardiectomy
>> removal of parietal pericardium +/- epicardial stripping --treatment of underlying disease |
|
What is the most common cause of pericardial disease?
|
--pericardial effusion |
|
Causes of pericardial effusion in dogs? |
--neoplasia >> hemangiosarcoma (GSD, goldens, lg. breeds) >> heart base tumors (brachycephalics) >> mesothelioma >> lymphoma --idiopathic |
|
Two types of heart base tumors in dogs? |
--chemodectoma --ectopic thyroid tumor |
|
Less common causes of pericardial effusion in dogs? |
--LA tear (often fatal) --coagulopathy --FB --CHF --infection |
|
Causes of pericardial effusion in cats? |
--congestive heart failure (L or R) --neoplasia (lymphoma) --feline infectious peritonitis |
|
What is the relationship between pericardial effusion volume and intrapericardial pressure? |
--inc. intrapericardial pressure w/ inc. volume --inc. ventricular diastolic pressure --impaired filling --dec. CO due to low stroke volume --fall in blood pressure >> rapidly approach cardiac tamponade |
|
Compensation for pericardial effusion? |
--expansion of pericardial sac (chronic) --activation of RAAS >> fluid retention >> inc. HR --absence of ANP secretion >> not promoting natriuresis |
|
Clinical signs of pericardial effusion on physical exam? |
--muffled heart sounds --jugular venous distension --weak femoral pulses --RHF with chronic effusions +/- pulsus paradoxus +/- ascites +/- pleural effusion |
|
What is pulses paradoxus? Cause? |
-- beats can be ausculted but are not felt on femoral a. --inc. venous return to right heart on inspiration >> interventricular septum is displaced toward LV due to high intrapericardial pressure >> dec. LV SV >> drop in BP |
|
Diagnosis of pericardial effusion on ECG? |
--low amplitude QRS -- +/- electrical alternans -- sinus tachycardia -- other arrhythmias (VPCs, etc) |
|
Diagnosis of pericardial effusion on rads? |
--globoid cardiac silhouette (lg. vol fluid) --enlarged vena cava -- +/- mass effect, pulmonary metastasis |
|
Diagnosis of pericardial effusion on ultrasound? Important to look for? |
--detection of intrapericardial fluid --evaluate for underlying heart disease -- ID tumor, if present >> more sensitive in the presence of effusion |
|
Where does hemangiosarcoma hang out? |
--right auricle or right atrium |
|
What causes cardiac tamponade? Emergency treatment, even prior to pericardiocentesis? |
-- intrapericardial pressure > intracardiac pressure >> heart can no longer fill >> limit of pericardial stretch exceeded -- fluid bolus to inc. filling pressure |
|
Pericardiocentesis preparation? |
-- start fluid bolus >> inc. intravascular vol. -- clip and prep right side of thorax -- attach ECG leads -- make a lidocaine bleb -- nick skin over bleb -- prepare over-the needle catheter (14 -16 ga) >> fenestrate to prevent occlusion |
|
Pericardiocentesis procedure? |
--advance catheter and stylet into pericardial space using sterile technique --remove stylet, attach catheter to extension line/syringe --draw off fluid (usually hemorrhagic) --monitor ECG for arrhythmias |
|
What should you do once you have drawn off some pericardial fluid? |
--put in red top tube, monitor for clotting |
|
If you have successfully performed pericardiocentesis, what should happen? |
-- HR should slow --no clots should form in red top tube --pulse quality should improve |
|
Pericardial fluid analysis? |
-- overall diagnostic yield low (7.7%) -- high diagnostic yield if HCT < 10% (20.3%) -- often diagnostic in cases of inf. or lymphoma |
|
If there are no signs of neoplasia on pericardial fluid analysis? |
--does not rule out neoplasia |
|
Additional diagnostic tests for pericardial effusion? |
--abdominal ultrasound --advanced imaging of thorax/abdomen --thoracotomy/thoracoscopy sx >> thorax explore and pericardiectomy >> histopath for pericardium/mass --bloodwork
|
|
Bloodwork for pericardial effusion? |
--CBC, chemistry, UA --T4 (suspect ectopic thyroid tumor) --elevated cTnl may suggest hemangiosarcoma >> cardiac troponin |
|
Long term treatment? |
--repeat pericardiocentesis >> prevent tamonade --pericardiectomy (idiopathic) >> esp. with recurrent PE with heart base mass --treatment for neoplasia |
|
Treatment for neoplasia causing pericardial effusion? |
--pericardiectomy --radiation therapy (heart base tumors) --radioactive iodine (ectopic thyroid tumors) --chemotherapy (hemangiosarcoma) >> +/- auriculectomy |
|
Prognosis of pericardial effusion? |
--idiopathic: long term survival (up to 3 y) reported >> most require repeat pericardiocentesis or pericardectomy --LA tear: usually fatal the first time it happens >> predisposed to reoccur if they survive first time |
|
Dogs with idiopathic pericardial effusion may actually have? |
--mesothelioma |
|
Prognosis of pericardial effusion due to neoplasia? |
--heart base mass: fair prognosis w/o surgery, good prognosis with pericardiectomy (~2y MST) --hemangiosarcoma: grave prognosis, 164 MST with surgery and chemo --mesothelioma: unknown |
|
Common neoplasms that cause pericardial effusion in cats? |
-- lymphoma |