Veterinary Internal Medicine 12 In case of non-suppurative pericarditis, resorbtion of the fluid...

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Transcript of Veterinary Internal Medicine 12 In case of non-suppurative pericarditis, resorbtion of the fluid...

  • 1

    Dr. Khaled M. Al-Qudah

    Veterinary Internal Medicine

    Cardiology

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    Pericarditis; Endocarditis; Myocarditis

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    Pericarditis

    Dr. Khaled M. Al-Qudah

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    Audible friction rub in early

    stage

    Muffling of the heart

    sounds in advance stage

    C.H.F

    Inflammation of the pericardial sac,

    characterized by:

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    • May be septic, nonseptic, neoplastic, or

    idiopathic

    • Common bacteria are Streptococcus and

    gram negatives in horses, plus anaerobes

    and Actinomycosis in cattle

    • Horses with pleuropneumonia or EHV1

    • Cattle with hardware

    Etiology:

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    Pericardial disease causes diastolic cardiac

    dysfunction with minimal alterations in systolic

    function

    Accumulation of fluid in pericardial sac and

    thickened and inflamed pericardium cause

    cardiac tamponade and restrictive pericarditis,

    which restrict diastolic filling resulting in

    cardiac insufficiency

    Etiology…

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    1. Early stage of inflammation hyperemia and

    deposition of fibrinous exudate

    Friction rub when the pericardium and epicardium

    rub together during cardiac movements.

    2. As effusion develops the inflamed surfaces

    are separated, and the friction rub is replaced

    by muffling of the heart sounds.

    Pathogenesis

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    fibrinous exudate

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    3. The accumulation of the fluid will compress

    the atria and

    ventricles preventing their complete filling

    C.H.F.

    4. Toxemia is present in case of suppurative

    pericarditis.

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    Fibrinous Pericarditis

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    In case of non-suppurative pericarditis,

    resorbtion of the fluid followed by adhesion

    between the pericardium and the epicardium.

    This kind of adhesion is not strong to impair

    cardiac movement.

    In suppurative pericarditis the adhesions are

    more serious and may cause complete

    attachment between the epicardium and the

    pericardium, which restrict the cardiac

    movement followed by C.H.F.

    5. In the recovery stage:

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    • Fever, depression, anorexia

    Nonspecific signs:

    • Pleurodynia (intercostal muscular pain)

    • Colic in horses

    • Cardiac tamponade

    Most specific signs:

    1) Jugular distention, edema

    2) Pleural effusion

    3) Splashy or muffled heart sounds and/or

    pericardial friction rubs

    • May also have arrhythmias

    Clinical signs and physical findings:

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    • Pain

     The animal avoid to move

     Abduction of the elbows

     Arching of the back

     Shallow abdominal respiration

     The animal lies down carefully

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    Diagnosis:

    Most specific diagnostic test is an echocardiogram

    demonstrating pericardial fluid and collapsed RA.

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    Aspirate of pericardial fluid for cytology and

    culture

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    Other nonspecific findings:

    Laboratory evidence of infection or inflammation:

     Leukocytosis

     Hyperfibrinogenemia

     hyperglobulinemia

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    • Pericardial drainage and lavage is very

    important

    • Antimicrobial therapy based on cytology

    and culture

    • Anti-inflammatory and analgesic therapy

    • Rumenotomy or pericardiotomy to remove

    foreign body in cattle if present with

    hardware disease

    • Treat arrhythmias and cardiac failure if

    present

    Treatment:

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    Endocarditis

    DR. Khaled M. Al-Qudah

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    Inflammation of the endocardium may

    interfere with the ejection of blood from

    the heart by causing insufficiency or

    stenosis of the valves.

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    Etiology

    [streptococcus spp

    Cattle [corynebacterium pyogenes

    [clostridium chauvoci (Black leg)

    [ myoplasma mycoides

    [actinobacillus equali

    Horses [streptococcus spp

    [strongylus spp (larvae)

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    Etiology….

     Focus of infection anywhere in the body that embolizes to the valves

    1)Actinomyces and Streptococcus most

    common in cattle

    2) Pasturella, Actinobacillus, and Streptococcus most common in horses

     Pre-existing valve lesions may predispose to bacterial colonization

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    Pathogenesis:

    Bacteremia

    M.O. colonize the heart valves and

    endocardium

    Bacterial endocarditis

    Vegetative and ulcerative lesions

    1. this will interfere with normal

    blood passage through the cardiac orfices

    CHF

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    Pathogenesis…..

    Fragments of vegetative lesions may become

    detached circulation.

     arteritis

     miliary pulmonary abscesses

     myocardial abscesses

     kidneys and joint abscesses

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    Pathogenesis…..

    Impaired valve function from bacterial

    colonization can lead to heart failure

    1) Signs depend on valve (s) affected

    2) Aortic and mitral valves (LAV) more

    common in horse

    3) Tricuspid valve (RAV) more common in

    cattle

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    Clinical Findings:

     Depend on valve (s) affected and severity

     May be subclinical …Cattle !!

     May cause heart failure

     The clinical signs of right-sided C.H.F.

     Tachycardia

     Jugular and mammary vein distention with palpable pulses.

     Ventral and submandibular edema

     Systolic murmur  only 50% have detectable murmurs.

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    Clinical Findings...

     Cyclic fever

     Tachycardia

     Anorexia

     Reduced performance

     Chest pain

     Often younger animals (< 5 years)

     50% of cattle also have shifting leg

    lameness .

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    Diagnosis:

    1. The history and physical examination.

    2. Blood culture is the single most useful

    procedure for the diagnosis of BE.

    Three venous blood samples should be

    collected aseptically during one or two hour

    period.

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    Necropsy photograph of the heart of the above calf.

    Note the large vegetation on the TV (arrow)

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    Most specific would be visualization of abnormal

    valves on an echocardiogram

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    Endocarditis Left AV valve

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    Vegetative Endocarditis

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    Vegetative Endocarditis

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    Nodular Endocarditis

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    Endocarditis in a calf about 6 months old

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    Treatment

    Not highly successful

     Antimicrobial therapy (4-6 wks) based on

    culture

     The thickness of the lesions prevents

    adequate penetration of the drugs.

     It is hard to treat before the isolation of the

    M.O. and the selection of the drug should be

    based on the sensitivity.

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    Treatment

    In case of negative culture:

    Penicillin with gentamicin

    or

    Potentiated sulfonamide for long period...

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    Prognosis

     Fair to good if treated early before significant

    valve lesions

     Poor to grave if significant valve lesions

    causing failure

     80% of horses with aortic or mitral valve

    endocarditis, die

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    Myocardial disease

    Dr. Khaled M. Al-Qudah

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    Etiology

     Inflammation of cardiac muscle caused by

    1) Endotoxemia

    2) Viral infection, EIA, EVA, FMD, AHS

    3) Parasitic migration (Strongylosis, Neospora canium,

    sarcocystis, cysticercosis infection)

    4) Bacterial endocarditis (Clostridium chauvoei, Str