Recognizing and treating pericardial disease - Veterinary Medicine
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Recognizing and treating pericardial disease
The clinical signs of pericardial disease are similar to those of other heart problems whose treatment may conflict with how we treat pericardial effusion. And if tamponade develops, it's a true emergency. Here is the information you need to capably handle these cases, including a step-by-step protocol to perform pericardiocentesis.


VETERINARY MEDICINE


Idiopathic hemorrhagic pericardial effusion

This clinical entity is second in frequency to neoplasia as a cause of pericardial effusion in dogs, reportedly accounting for 20% to 75% of cases.7 It is a diagnosis of exclusion that is arrived at after a thorough echocardiographic examination to rule out cardiac neoplasia and other possible causes of intrapericardial fluid accumulation. This disorder is more common in large- and giant-breed dogs and is thought to be an inflammatory condition affecting the pericardial sac. One-time pericardiocentesis is curative in about half of cases.8 If multiple taps are required, pericardiectomy is recommended and is usually curative.

Congestive heart failure

Although congestive heart failure is a common cause of pericardial effusion in cats, it is a less common cause in dogs.9 When congestive heart failure leads to intrapericardial fluid accumulation, cardiac tamponade is rare, and pericardiocentesis is almost never indicated.10 In some cases, however, modification of congestive heart failure medications may be warranted.

Peritoneopericardial diaphragmatic hernia

Peritoneopericardial diaphragmatic hernia (or peritoneopericardial hernia) is a congenital disorder involving anomalous development of the diaphragm and pleuropericardial membranes that allows abdominal organ herniation into the pericardial sac in dogs and cats. These rare lesions can be present for a long period without resulting in clinical signs and are occasionally diagnosed serendipitously in middle-aged patients that are presented for nonthoracic diseases. In our experience, when necessary, surgical repair of this disorder is usually successful, although the procedure is technically demanding and often requires specialized materials, such as Dacron mesh. Adult, asymptomatic animals with a peritoneopericardial hernia require no treatment, but patients with clinical signs compatible with intestinal or gastric obstruction or vascular compromise must be treated aggressively.11 Pericardial effusion is rarely present with these lesions, and, therefore, clinical signs associated with cardiac tamponade are not typical.

Left atrial rupture

In some patients with chronic mitral valve disease and severe left atrial enlargement, left atrial tearing is a possible cause of pericardial effusion. The hemorrhage rapidly leads to cardiac tamponade, cardiogenic shock, and possibly death. The pericardial effusion may contain a clot because hemorrhage is acute. The clot is often visible on an echocardiogram as a hypoechoic structure within the fluid-filled (anechoic) pericardial space. Left atrial rupture in association with degenerative mitral valve disease is apparently more frequent in male poodles, dachshunds, and cocker spaniels.12 However, any dog with severe degenerative mitral valve disease is at risk for this catastrophic sequela.12 Therefore, small-breed dogs with pericardial effusion and systolic cardiac murmurs should be evaluated critically for possible left atrial tears. Pericardiocentesis in these patients may encourage continued bleeding into the pericardial space. Therefore, in general, pericardiocentesis is not recommended in these patients. Instead, supportive care with fluid therapy and echocardiographic monitoring of effusion accumulation are preferred. If the patient destabilizes because of cardiac tamponade, pericardiocentesis is performed, but the prognosis is guarded at best.


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Source: VETERINARY MEDICINE,
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