Page 314 - Clinical Small Animal Internal Medicine

282 Section 3 Cardiovascular Disease

(a)
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(b)

(c)

(d)

Figure 28.5 Electrocardiogram recordings from dogs with pericardial effusion. (a) Sinus tachycardia. (b) Sinus rhythm with small QRS
complexes. (c) Sinus rhythm with electrical alternans, a beat‐to‐beat variation in R‐wave amplitude (arrows). (d) Predominantly
ventricular rhythm (V) with a single fusion beat (F). Sinus complexes have ST segment elevation (arrow). All traces are lead II recorded at
25 mm/s and 10 mm/mV.

the catheter into the pericardial space until fluid, typi- which point the needle is removed and the extension
cally hemorrhagic appearing (Figure 28.6e,f), is with- set tubing connected.
drawn into the extension set tubing. Contact with the 5) Once pericardial effusion is encountered, detach the
heart will make the catheter move with the heartbeat extension set tubing from the needle, remove the nee-
and induce arrhythmias (typically ventricular) as dle from the catheter, and reattach the extension set
noted on a simultaneous electrocardiogram. If either tubing directly to the catheter. Removing the needle
is encountered, the catheter should be withdrawn prevents contact with the heart as the pericardial
quickly. Alternatively, the catheter can be advanced fluid is removed.
without being attached to the extension set tubing 6) Place the initial sample of pericardial fluid in serum
and flash of hemorrhagic fluid will be detected when (red‐top) and EDTA (purple‐top) tubes for laboratory
the catheter is introduced into the pericardial fluid, at analysis. Fluid can be reserved for culture and sensitivity,