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Pericardial disease
Introduction
- Sporadic in the cat. Effusion or inflammation within the pericardium or congenital pericardioperitoneal diaphragmatic hernia (PPDH) relatively common.
- Cause: neoplasia, bacterial infection, renal failure, coagulopathies, congenital pericardioperitoneal, diaphragmatic hernia, trauma.
- Signs: usually insignificant amount of fluid, but can produce cardiac tamponade and right heart failure.
- Diagnosis: clinical signs, radiography, electrocardiography, ultrasonography, pericardiocentesis.
- Treatment: depends on identification of cause.
- Prognosis: poor with neoplasia, guarded with pericarditis.
Presenting signs
- Clinical signs often unassociated with effusion.
- Insidious onset of lethargy and signs of right-sided heart failure.
- Sudden death if acute tamponade.
Acute presentation
- Circulatory collapse if less severe sudden onset pericardial effusion.
Age predisposition
- Usually middle-aged to old if neoplasia.
- Usually young if FIP.
Cost considerations
- Depends on investigation and treatment required.
Special risks
- Same as congestive heart failure Heart: congestive heart failure.
- Must recognize and treat appropriately and promptly. DO NOT administer high doses of diuretics or vasodilators (including ACE inhibitors); sudden reduction of venous return (preload) in combination with tamponade and severely compromises cardiac output.
Pathogenesis
Etiology
- Neoplasia: lymphoma Lymphoma, mesothelioma Mesothelioma, metastatic carcinoma.
- Trauma: hemopericardium.
- Congenital: pericardioperitoneal diaphragmatic hernia Peritoneal-pericardial diaphragmatic hernia (PPDH). Often an incidental finding.
- Effusions:
- Pericarditis Pericardial disease.
- FIP Feline immunodeficiency virus.
- Toxoplasmosis Toxoplasmosis.
- Cardiomyopathies Heart: dilated cardiomyopathy (DCM).
- Right heart failure Heart: congestive heart failure.
- Coagulopathies Hemostatic disorders: acquired.
- Hypoproteinemia Hypoproteinemia.
- Renal failure Kidney: chronic kidney disease.
- Bacterial infection.
- Idiopathic.
Pathophysiology
- Pericardial disease → restricts ventricular dilation and impedes atrial and ventricular filling (particular right side) → right side more susceptible (thinner walled; lower pressure system) → decreased end-diastolic volumes → poor cardiac output (by the Frank-Starling mechanism) → sympathetic nervous system and renin-angiotensin-aldosterone system activated → tachycardia, vasoconstriction, retention of sodium and water → increased end-diastolic pressures in atria → increased ventricular filling pressures → backward heart failure → increased central venous pressure Central venous pressure (distended jugular veins, hepatic venous congestion, ascites).
Timecourse
- Slow insidious subclinical course with apparent acute onset described by owners.
- Peracute presentation: may result from hemorrhage (ruptured neoplasm, trauma, coagulopathy).
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Rush J E, Keene B W & Fox P R (1990) Pericardial disease in the cat: a retrospective evaluation of 66 cases. JAAHA 26 (1), 39-46 VetMedResource.