PERICARDITIS IN ANIMALS

Dr. V.K.GuptaSenior Scientist,Medicine Division

I.V.R.I.IZATNAGAR(UP)

Heart

Pericarditis Effusive

Fibrinous

Constrictive

Etiology Cattle

Mannheimia hemolytica Black disease -if patients survive more than 24

hours Sporadic bovine encephalomyelitis Haemophilus spp., including Histophilus somni Tuberculosis Pseudomonas aeruginosa Mycoplasma spp. Klebsiella pneumoniae Actinobacillus suis Idiopathic effusive (nonseptic) pericarditis

Traumatic pericarditis

Development of toxemia and congestive heart failure

Horses

Streptococcus spp.- S. equi, S.

zooepidemicus and S. faecalis

Tuberculosis

Corynebacterium pseudotuberculosis

Actinobacillus equuli

EHV-1 infection

Idiopathic effusive

Small animalsCongenital pericardial disorderPeritoneopericardial diaphragmatic hernia b/w 4wks & 15 yrs , majority first 4yrs life Male Acquired Bacterial Fungal – CoccidioidesimmitisAspergillusnigerViral – feline infectious peritonitisProtozoal – visceral leishmaniasisIdiopathic – 19-23 %

Metabolic and/or toxic form

UremiaCoagulation disorder anticoagulant rodent toxicitySecondary to DICWarfarin toxicityCoagulopathies

Cardiovascular disorderCHFLeft atrial perforationMitral regurgitation in deg. Valvular disease

Neoplasia Cardiac hemangiosarcoma – in right. atrium

mostly 61% cause of effus. Pericarditis

Heart base tumor Associated with ascending artery and main

pulmonary arteryAortic body tumorEctopic thyroid tumorBreed predis.- english bulldog, boxer, boston

terrier , In chronic hypoxia induced hyperplasia and

neoplasia of chemoreceptors

Mesothelioma

diffuse neoplasm of the pericardium and other serosal surfaces

Lymphosarcoma

Rhabdomysarcoma

Fibrosarcoma

Sheep and goats Pasteurellosis Staphylococcus aureus Mycoplasma spp.

Pigs Pasteurellosis Mycoplasma hyorhinis Haemophilus spp. - Glasser's disease and

pleuropneumonia Streptococcus spp. Salmonellosis

Pathogenesis In the early stages Inflammation Hyperemia Deposition of Fibrinous Exudate Friction Sound Muffling of The Heart Sounds Atria and Right Ventricle Compression CHF

Toxemia Anaerobic bacteria gas-production washing machine sound of fluid splashing with each heart beat

In the recovery stagReabsorption of fluid adhesive

pericarditis

In suppurative pericarditis complete adhesion

CLINICAL FINDINGS

Clinical signsLethargyResp. difficultyCollapseReduced appetiteVomitingAbd. DistensionPolydipsiaWeaknessCoughing

Pulsus paradoxus Associated with cardiac tamponadePhasic variation in pulse quality with

respiration≥10 mm Hg decrease in systolic arterial BP

with inspiration during normal breathingLV stroke volume and systemic arterial BP

decreases with inspiration

Diagnosis Thoracic radiograph

Echocardiography

Echo

Echocardiograph

Hemangiosarcoma

Electrocardiography

Electrical alternans is evident on this lead II electrocardiogram from a 10-year-old male Bulldog with a large pericardial effusion. Note also the small voltage QRS complexes

Sinus Tachycardia (heart rate about 170 beats/min)

Hematology and biochemistryHemangiosarcoma Anemia , nucleated RBC ., Schistocyte , acanthocyte & thrombocytopenia Increased serum cardio tropin IIncreased liver enzymeMild prerenal azotemia In FIP – neutrophilia , lymphocytopenia ,

hyperglobulinemiaAscites fluid- protein transudate

Diff. diagnosis

Other cause of Rt. CHF – DCM, tricuspid dysplasia

, ascites( hepatic disease , Abd. Neoplasia)

Other cause of muffled heart sound- pleural

effusion, thoracic mass , diaphragmatic hernia

Other cuase of low voltage complexe- pleural

effusion, obesity, hypothyroidism

Other cause of cardiac enlargement – DCM,

tricuspid dysplasia, PPDH

Treatment & prognosis Important to differentiate cardiac tamponade

from other causes of right-sided CHF because the treatment is very different.

Positive inotropic drugs do not ameliorate the signs of tamponade; diuretics and vasodilators can further reduce cardiac output and exacerbate hypotension and shock

Pericardiocentesis is the immediate treatment of choice, and it also provides diag nostic information

Most signs of CHF resolve after pericar dial fluid is removed

Pericardial effusions secondary to other

diseases that cause CHF, con genital malformations, or hypoalbuminemia do not usually cause tamponade and often resolve with management of the underlying condition.

Antibacterial treatment of the specific infection should be undertaken if possible on the basis of susceptibility on organisms cultured from the pericardial fluid

The prognosis varies with the etiological agent but it is generally grave in cases of septic pericarditis

Fifth rib resection and pericardial

marsupialization Pericardial drainage and intrapericardial

lavage Antimicrobial administrationRecurrent effusion that does not respond to

repeated pericardiocentesis and anti inflammatory therapy is usually treated by subtotal pericardiectomy.

Removal of the pericar dium ventral to the phrenic nerves allows pericardial fluid drainage to the larger absorptive surface of the pleural space

Neoplastic pericardial effusions are also drained to relieve cardiac tamponade

Surgical therapy is likely to be more effective

than continuous drainage with an indwelling pericardial catheter, and it also allows removal of penetrating foreign bodies

PERICARDIOCENTESIS

Done immediately in animals with cardiac

tamponade.

diuretics or vasodilators without

pericardiocentesis may cause further

hypotension and cardiogenic shock.

Pericardiocentesis should be performed

under ultrasonographic guidance and with

ECG monitoring.