Page 312 - Clinical Small Animal Internal Medicine

280 Section 3 Cardiovascular Disease

(a) Advanced Imaging
VetBooks.ir Computed tomography and magnetic resonance imag-

ing can provide additional information including
tumor location and the presence of metastatic
disease.

Therapy

The urgency of pericardiocentesis depends on the clini-
cal status of the patient at the time of evaluation.

Acute Therapy
Critically ill animals require immediate stabilization
with intravenous fluid therapy to help restore cardiac
(b) output, and pericardiocentesis to resolve tamponade.
Dyspneic patients may benefit from a combination of
oxygen supplementation and removal of pleural effusion
and/or ascites if the volume(s) are significant enough to
contribute to respiratory difficulty. Diuretic therapy with
furosemide is generally contraindicated because diuret-
ics do not consistently remove free fluid from the peri-
cardium and can contribute to further hemodynamic
compromise. One exception is the judicious use of
furosemide in cats and dogs with pericardial effusion
secondary to congestive heart failure.

Pericardiocentesis
Pericardiocentesis is performed primarily in dogs and is
recommended when pericardial effusion is large volume
(c)
and/or contributing to hemodynamic compromise (tam-
ponade). The majority of cats have small volume
effusions secondary to heart failure that resolve with
heart failure management.
Several techniques for pericardiocentesis have been
described and the technique selected depends on the
clinical status of the patient, veterinarian comfort level
with the procedure, equipment availability, and technical
support. The objective of the procedure is to remove as
much pericardial fluid as possible. Complications can
occur during pericardiocentesis if the catheter contacts
the heart, resulting in arrhythmias, or lacerates lung or
other cardiac structures. Pericardial fluid removal typi-
cally provides an immediate clinical benefit noted by a
Figure 28.3 Transthoracic echocardiographic images from reduction in heart rate to a more normal range and an
dogs with cardiac tumors and pericardial effusion. (a) Images improvement in pulse quality and blood pressure.
obtained from the left cranial window document a mass (*) in
direct apposition with the aorta typical of heart base tumors. Equipment and Supplies
(b) Right parasternal short‐axis view of the heart base
documenting a mass (*) near the aorta consistent with a heart Over‐the‐needle catheter with a length appropriate for
base mass. (c) Images obtained from the left cranial window ● the patient size (for example: 14 g × 5.25 inch, 16 g ×
document a mass (*) within the right auricle, most likely a
hemangiosarcoma based on location. Ao, aorta; LA, left atrium; 3.25 inch).
RA, right atrium. ● Extension IV set.
Three‐way stopcock.
●
Syringe (20–60 mL).
●