Pericarditis

From Dog
Hemopericardium due to hemangiosarcoma-induced hemorrhage within the pericardial sac and secondary cardiac tamponade[1]

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[2].

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[3].

Causes of pericarditis include, in order of importance:

  • Idiopathic pericardial effusion
- Lymphocytic plasmacytic pericarditis[4]
- primary chylopericardium[8]
- influenza type A[9]
  • Primary or metastatic neoplasia - metastatic tumors are more common than primary cardiac neoplasms
- pericardial mesothelioma[10][11]
- chemodectoma[12]
- hemangiosarcoma[13]
- lymphoblastic lymphoma
- granular cell tumour, chondrosarcoma, osteosarcoma, fibrosarcoma, malignant mixed mesenchymal tumour, lymphangiosarcoma, fibroma, rhabdomyoma, angiolipoma, myxoma
- idiopathic osseus metaplasia[14]
  • Septic pericarditis (pericardial abscess formation)
- Staphylococcus aureus (botryomycosis)[15][16]
- Coccidioides immitis[17]
- Aspergillus niger[18]
- Actinomyces spp, Mycobacterium spp
- Echinococcus spp
- Trypanosoma cruzi (metacyclic trypomastigote stage)[19]

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[24], pulmonary edema, chylothorax[25] 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[26].

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[27].

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[28]. Pleural effusion and frequent relapses after pericardiocentesis are common[29].

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[30].

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)[31].

References

  1. Study Blue
  2. Baumgartner C & Glaus TM (2004) Acquired cardiac diseases in the dog: a retrospective analysis. Schweiz Arch Tierheilkd 146(9):423-430
  3. Martin MW et al (2006) Idiopathic pericarditis in dogs: no evidence for an immune-mediated aetiology. J Small Anim Pract 47(7):387-391
  4. Kerstetter KK et al (1997) Pericardiectomy in dogs: 22 cases (1978-1994). J Am Vet Med Assoc 211(6):736-740
  5. Kumagai K et al (2000) Single site radiofrequency catheter ablation of atrial fibrillation: studies guided by simultaneous multisite mapping in the canine sterile pericarditis model. J Am Coll Cardiol 36(3):917-923
  6. Kurt S & Kovacevic A (2012) Atrial rupture and pericardial effusion as a complication of chronic mitral valve endocardiosis. Schweiz Arch Tierheilkd 154(9):397-401
  7. Ohad DG et al (2007) Incomplete atrioventricular canal complicated by cardiac tamponade and bidirectional shunting in an adult dog. J Am Anim Hosp Assoc 43(4):221-226
  8. Boston SE et al (2006) Idiopathic primary chylopericardium in a dog. J Am Vet Med Assoc 229(12):1930-1933
  9. Zini E et al (2009) Evaluation of the presence of selected viral and bacterial nucleic acids in pericardial samples from dogs with or without idiopathic pericardial effusion. Vet J 179(2):225-229
  10. Balli A et al (2003) Cardiac tamponade due to pericardial mesothelioma in an 11-year-old dog: diagnosis, medical and interventional treatments. Schweiz Arch Tierheilkd 145(2):82-87
  11. Peters M et al (2003) Embolized mesothelial cells within mediastinal lymph nodes of three dogs with idiopathic haemorrhagic pericardial effusion. J Comp Pathol 128(2-3):107-112
  12. Shaw SP & Rush JE (2007) Canine pericardial effusion: pathophysiology and cause. Compend Contin Educ Vet 29(7):400-403
  13. Warman SM et al (2006) Congestive heart failure caused by intracardiac tumours in two dogs. J Small Anim Pract 47(8):480-483
  14. Wright KN et al (1996) Effusive-constrictive pericardial disease secondary to osseous metaplasia of the pericardium in a dog. J Am Vet Med Assoc 209(12):2091-2095
  15. Casamián-Sorrosal D et al (2008) Septic pericardial effusion associated with pulmonary and pericardial botryomycosis in a dog. J Small Anim Pract 49(12):655-659
  16. Peterson PB et al (2003) Septic pericarditis, aortic endarteritis, and osteomyelitis in a dog. J Am Anim Hosp Assoc 39(6):528-532
  17. Shubitz LF et al (2001) Constrictive pericarditis secondary to Coccidioides immitis infection in a dog. J Am Vet Med Assoc 218(4):537-540
  18. Carpenter DH et al (2001) ECG of the month. Cardiac tamponade secondary to A. niger-induced constrictive pericarditis. J Am Vet Med Assoc 218(12):1890-1892
  19. Bahia MT et al (2002) Comparison of Trypanosoma cruzi infection in dogs inoculated with blood or metacyclic trypomastigotes of Berenice-62 and Berenice-78 strains via intraperitoneal and conjunctival routes. Rev Soc Bras Med Trop 35(4):339-345
  20. Gillette SM et al (1992) Late radiation response of canine mediastinal tissues. Radiother Oncol 23(1):41-52
  21. Parra JL et al (2009) Pericardial effusion and cardiac tamponade caused by intrapericardial granulation tissue in a dog. J Vet Emerg Crit Care (San Antonio) 19(2):187-192
  22. Elliott JM & Mayhew PD (2011) Diagnostic challenges and treatment options of a suspected pericardial metallic projectile foreign body in a dog. J Vet Emerg Crit Care (San Antonio) 21(6):684-691
  23. Yue-Chun L et al (2010) Establishment of a canine model of cardiac memory using endocardial pacing via internal jugular vein. BMC Cardiovasc Disord 10:30
  24. Lee S et al (2012) An Algorithm to Measure Beat-to-Beat Cycle Lengths for Assessment of Atrial Electrogram Rate and Regularity During Atrial Fibrillation. J Cardiovasc Electrophysiol Nov 9
  25. Campbell SL et al (1995) Chylothorax associated with constrictive pericarditis in a dog. J Am Vet Med Assoc 206(10):1561-1564
  26. Scansen BA (2011) Interventional cardiology for the critical list. J Vet Emerg Crit Care (San Antonio) 21(2):123-136
  27. Day MJ & Martin MW (2002) Immunohistochemical characterisation of the lesions of canine idiopathic pericarditis. J Small Anim Pract 43(9):382-387
  28. Heinritz CK et al (2005) Subtotal pericardectomy and epicardial excision for treatment of coccidioidomycosis-induced effusive-constrictive pericarditis in dogs: 17 cases (1999-2003). J Am Vet Med Assoc 227(3):435-440
  29. Bussadori C et al (1998) Percutaneous pericardiotomy with balloon catheter in the treatment of malignant pericardial effusion in dogs. Radiol Med 96(5):503-506
  30. Zhang Z et al (2011) n-3 polyunsaturated fatty acids prevents atrial fibrillation by inhibiting inflammation in a canine sterile pericarditis model. Int J Cardiol 153(1):14-20
  31. Fine DM et al (2003) Use of pericardial fluid pH to distinguish between idiopathic and neoplastic effusions. J Vet Intern Med 17(4):525-529