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Pericarditis 774.e3

• Consider screening for infectious (e.g., serol- drainage into pleural space, depending on • Subtotal pericardiectomy is recommended for
ogy for C. immitis) or immune-mediated • Subtotal pericardiectomy with histopatho- recurrent PE that appears to be idiopathic
cause.
VetBooks.ir Advanced or Confirmatory Testing logic confirmation of underlying diagnosis • Subtotal pericardiectomy may lead to the Diseases and Disorders
pericarditis.
disease (e.g., antinuclear antibody test [p.
955]), if appropriate.
○ When pericardial window not recom-
development of pleural effusion postopera-
tively, requiring thoracocentesis.
• Effusion analysis (p. 1150) mended, such as in cases of constrictive • Mesothelioma can be difficult to differentiate
pericarditis
○ Cytologic exam alone is unreliable: 74% ○ May require epicardial stripping if peri- from idiopathic benign pericarditis without
of malignancies are not detected, and cardium is severely thickened histopathology.
13% of benign cases are misdiagnosed ○ Continuous chest drainage immediately • Follow-up echocardiography is beneficial in
as neoplasia. after the pericardiectomy managing constrictive pericarditis.
○ Pericardial fluid pH analysis is controversial • Intensive antimicrobial therapy for infectious • A normal cardiac silhouette on radiographs,
○ Elevated serum troponin I concentration peritonitis based on culture and susceptibility a negative culture, and the absence of
is inconsistent with benign disease and fever may exist in patients with infectious
more suggestive of hemangiosarcoma. Behavior/Exercise pericarditis.
• Microbial culture of the effusion (infectious Most animals with PE with cardiac tamponade • Most intravenously administered antibiotics
pericarditis) naturally limit their activity. Weakness and/or achieve good intrapericardial concentrations.
○ Protein content is > 2.5 mg/dL; often collapse may be observed.
> 3.5 mg/dL. Prevention
○ Neutrophils and erythrocytes are predomi- Drug Interactions Infectious pericarditis:
nant cell types. Diuretics are contraindicated if cardiac tam- • Treat local infections, wounds, and bactere-
○ Others: macrophages, cells, degenerative ponade is diagnosed: mia aggressively.
neutrophils, pathogenic agent • Contract intravascular volume • Minimize pathogen exposure.
○ Always do aerobic and anaerobic cultures. • Reduce venous filling pressure and stroke
Contamination is common (e.g., skin volume Technician Tips
■
organisms). • If heart sounds are difficult to auscultate,
• Histopathologic exam: findings depend on Possible Complications pulses are weak and/or vary, and/or mucous
cause • May lead to constrictive pericarditis membrane color is pale during status checks,
• Contrast CT scan and cardiac MRI: • Spread of the disease process to the thorax alert the attending veterinarian because
investigational (e.g., pyothorax) pericardial disease may be the cause.
• Dyspnea due to PE or ascites • The PE in dogs with benign idiopathic PE
TREATMENT • Failure to recognize or resolve systemic is often bloody in appearance. Place a small
disease volume of effusion in a serum tube to observe
Treatment Overview for clotting; blood from accidental vascular
Pericardiocentesis can relieve cardiac tamponade Recommended Monitoring puncture will clot, while bloody appearing
as well as provide diagnostic information (e.g., • Follow-up exam and echocardiography 24 PE will not clot.
fluid analysis, culture). If two or more pericar- hours after the pericardiocentesis or sooner
diocenteses are required to address recurrent PE if response to treatment is inadequate Client Education
without evidence of a neoplastic cause, consider • Periodic reassessment for recurrent effusion • If infectious pericarditis is treated aggressively
subtotal pericardiectomy with histopathologic with pericardiectomy, continuous chest drain-
evaluation of excised pericardium. In cases of PROGNOSIS & OUTCOME age, and appropriate antibiotics, prognosis
infectious pericarditis, antibiotic therapy is is good in early stages.
ideally based on culture and susceptibility Idiopathic benign PE: • Prognosis worsens with time and degree of
results. Aggressive therapy such as continuous • Often favorable with initial pericardiocentesis fibrosis (pericardial and epicardial scarring).
chest drainage may be indicated in chronic ± glucocorticoid therapy • Pericarditis may spontaneously recur after
cases in which pericardiectomy ± epicardial • Typically favorable after subtotal pericardi- an apparent cure.
stripping has been performed. ectomy (for cases with recurrent PE) • Some animals with idiopathic benign
Infective pericarditis: pericarditis may require long-term gluco-
Acute General Treatment • If treated aggressively with pericardiectomy, corticoid use, which can lead to iatrogenic
• Pericardiocentesis for cardiac tamponade continuous chest drainage, and appropriate hyperadrenocorticism.
(p. 1150) antibiotics, prognosis can be good for acute
• Thoracocentesis for respiratory compromise phase. SUGGESTED READING
due to pleural effusion (p. 1164) • If the animal is systemically ill, there is
• Abdominocentesis (p. 1056): usually unneces- evidence the disease extends beyond the MacDonald KA, et al: Echocardiographic and
clinicopathologic characterization of pericardial
sary but can be performed if ascites is causing pericardium, treatment is not aggressive, or effusion in dogs: 107 cases (1985-2006). J Am
discomfort and/or respiratory compromise there is no effective therapy for the pathogen Vet Med Assoc 235:1456-1461, 2009.
• For suspected idiopathic benign PE, gluco- (e.g., FIP), the prognosis is poor.
corticoids may be indicated at immunosup- ADDITIONAL SUGGESTED
pressive doses (e.g., prednisone 2-4 mg/kg PEARLS & CONSIDERATIONS
PO q 24h), taper to antiinflammatory dose READINGS
1 mg/kg PO q 24h in 2 weeks. Comments Berg RJ, et al: Pericardial effusion in the dog: a review
• Echocardiography is the gold standard for of 42 cases. J Am Anim Hosp Assoc 20:721-730,
Chronic Treatment diagnosing PE. 1984.
• Repeat pericardiocentesis as needed to prevent • Cytologic exam of PE is the most useful test Cagle LA, et al: Diagnostic yield of cytologic analysis
of pericardial effusion in dogs. J Vet Intern Med
or treat tamponade (perform at least twice for differentiating infectious from noninfec- 28:66-71, 2014.
before considering subtotal pericardiectomy) tious pericardial disease, but it cannot reliably Costa A, et al: Fungal pericarditis and endocarditis
• Consider partial pericardial fenestration using differentiate neoplastic from non-neoplastic secondary to porcupine quill migration in a dog.
balloon pericardiotomy technique to allow disease. J Vet Cardiol 16:283-290, 2014.

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