Pericarditis is a relatively uncommon heart disease of dogs characterized by inflammation of the pericardial sac surrounding the heart.
This disease, which has a multifactorial etiology, results form pericardial effusion or pericardial masses that cause conduction and contraction abnormalities of the heart and may result in congestive heart failure.
A major complication with pericarditis is the development of cardiac tamponade, a syndrome of increased pericardial pressure resulting reduced diastolic expansion of the heart. This can rapidly result in compressive cardiac dysfunction, reduced cardiac output and heart failure.
The involvement of immune-mediated disease is unlikely considering that serum antinuclear antibody and serum and pericardial fluid immunoglobulin (Ig) G, Ig M and Ig A concentrations are often unaffected.
Causes of pericarditis include, in order of importance:
- Idiopathic pericardial effusion
- - Lymphocytic plasmacytic pericarditis
- Sterile pericarditis - atrial fibrillation, congestive heart failure, cardiomyopathy, mitral valve endocardiosis, dilated cardiomyopathy, congenital defects such as incomplete atrioventricular canal
- - primary chylopericardium
- Primary or metastatic neoplasia - metastatic tumors are more common than primary cardiac neoplasms
- - pericardial mesothelioma
- - chemodectoma
- - hemangiosarcoma
- - lymphoblastic lymphoma
- - granular cell tumour, chondrosarcoma, osteosarcoma, fibrosarcoma, malignant mixed mesenchymal tumour, lymphangiosarcoma, fibroma, rhabdomyoma, angiolipoma, myxoma
- - idiopathic osseus metaplasia
- Septic pericarditis (pericardial abscess formation)
- - Staphylococcus aureus (botryomycosis)
- - Coccidioides immitis
- - Aspergillus niger
- - Actinomyces spp, Mycobacterium spp
- - Echinococcus spp
- - Trypanosoma cruzi (metacyclic trypomastigote stage)
- Toxins - doxorubicin, heparin, thoracic radiation therapy
- Pericardial trauma with hematoma formation, foreign body migration (e.g. projectile objects), placement of ventricular pacemakers
In dogs, the most common causes of pericardial effusion that require pericardiocentesis are cardiac neoplasia and idiopathic pericardial effusion.
Clinically affected dogs usually present with symptoms of right-sided congestive heart failure, including generalized weakness, syncope, ascites and dyspnea. Clinical complications include tachyarrhythmias and atrial fibrillation, pulmonary edema, chylothorax and thromboembolism.
A tentative diagnosis can be ascertained by auscultation of the heat (muffled sounds), radiographs (cardiomegaly - large and round heart), pulmonary edema) and ECG (reduced ECG voltages, bradycardia), but echocardiography is usually definitive.
Postmortem findings of heart tissue usually reveals pericardial fibrosis accompanied by a mixed inflammatory response, often with a greater intensity at the cardiac surface. Perivascular lymphoplasmacytic aggregates are frequently noted at the pleural surface and within the fibrosed pericardium. Histologically, it is often difficult to clearly distinguished idiopathic pericarditisthe from neoplasia-induced sampleswithout identification of neoplastic tissue.
Intervention may be required if co-existing atrial fibrillation is present. Drugs such as procainamide or [atenolol]] may be required.
Use of surgical correction by percutaneous or thoracic total or subtotal pericardectomy or pericardiocentesis is recommended in cases where an effusive constrictive pericarditis or cardiac tamponade is evident on echocardiography. Pleural effusion and frequent relapses after pericardiocentesis are common.
Treatment with n-3 polyunsaturated fatty acids has been shown to have a protective effect at preventing atrial fibrillation by inhibiting inflammation associated with sterile pericarditis in dogs.
Pericardial effusion resulting from neoplasia usually is associated with a poor prognosis (1 - 3 months), requiring intrapericardial chemotherapy (e.g. cisplatin), whereas idiopathic pericarditis frequently has a good prognosis (1 - 3 years).
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