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Flashcards in Cardio - Pericardial Diseases Deck (41)
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1

What are some congenital pericardial diseases?

Absence of pericardium, PPDH

2

What are some acquired pericardial diseases?

Pericardial eff and cardiac tamponade, constrictive pericarditis

3

What are the 2 layers of the pericardium?

Fibrous and serous (parietal and visceral)

4

What are the 3 types of effusions and which is most common?

Hemorrhagic (most common), transudate, exudate

5

What are some DDx for hemorrhagic pericardial eff?

Neoplasia (HSA, chemodectoma, mesothelioma, ectopic thyroid CA, LSA), idiopathic

6

What are some DDx for transudate pericardial eff?

R-CHF, hypoAlb, chemodectoma, infections/toxemia, pericardial cysts, PPDH

7

What are some DDx for exudative pericardial eff?

Infectious (FB/hardware diz in cattle, fungal, bacterial, viral), sterile

8

What are the most common spp to have pericardial effusion?

Dogs and cattle

9

Pericardial effusion is a _____ dysfunction disease.

diastolic

10

What is cardiac tamponade?

Clinical syndrome that occurs when increased intrapericardial pressure interferes with normal cardiac filling

11

What is the pathophysiology of cardiac tamponade?

  1. Underlying disease causes pericardial effusion
  2. Increased pressure in pericardial space compresses the heart chambers (R > L)
  3. Reduced cardiac filling --> low CO and low BP
  4. Compensation over time --> sudden death

OR just #3 --> sudden death

12

When does sudden death due to cardiac tamponade occur?

If the CO is severely and/or acutely compromised

13

How does compensation work in cardiac tamponade?

Over time activation of RAAS results in fluid retention and vasoconstriction, stabilizing the BP

14

What is the appearance of the heart on rads when there is pericadial effusion?

Globoid

15

Cardiac tamponade can occur with low volume effusions if they occur _____.

rapidly

16

Why does slowly developing pericardial effusion have less consequences over time?

The pericardium has time to stretch and the heart can compensate

17

What are some CS of cardiac tamponade?

Collapse, weakness, decreased appetite, vomiting, lethargy, decreased milk production (cattle), polyurea, polydypsia

18

PE findings in cardiac tamponade are directly linked to the _____.

pathophysiology

19

What are PE findings with cardiac tamponade?

Muffled heart sounds, weak pulses (pulsus paradoxus), jugular distention, signs of R-HF

20

What is pulsus paradoxus?

Pericardial effusion --> RV free wall can't stretch --> IVS must stretch further --> decreased LV size --> less LV filling during inspiration --> less blood pumped out to body --> weak femoral pulses during inspiration

21

What are the 3 hallmark findings of pericardial effusion on rads?

  1. Enlarged, rounded cardiac silhouette
  2. Dilated CdVC
  3. Small pulmonary arteries and veins

22

What are "other" findings that can show with pericardial effusion?

Sharp, well-demarcated edges of cardiac silhouette (less motion artifact), no distinct chamber enlargement, mass effect or lung metastasis, pleural effusion (R-HF), metallic FB (cattle)

23

What ECG abnormalities may be observed in pericardial effusion?

Decreased QRS amplitude (< 1 mV), electrical alternans (heart "swings" in the fluid)

24

What is electrical alternans?

ECG finding where the R waves are of variable heights due to large effusions where the heart "swings" in the fluid

25

What does pericardial effusion look like on echo?

Anechoic (black) fluid between pericardium and heart (mixed echogenicity if exufate or new blood)

26

What finding can cardiac tamponade cause on echo?

Compression/collapse of RA +/- RV

27

What is the treatment for pericardial effusion if the patient is unstable / low BP?

IVF while preparing for a pericardiocentesis (shock bolus of crystalloids), reassess BP, repeat until ready

28

What are potential complications of a pericardiocentesis?

Infection, arrhythmias, hemorrhage, pneumothorax, cardiocentesis

29

How can infection be avoided in a pericardiocentesis?

sterile technique

30

How can arrhythmias be noted during a pericardiocentesis?

monitor ECG

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