Pericardial Disease in Dogs
A complete blood count (CBC) is performed to evaluate the red blood cells, white blood cells, and platelets. In some affected dogs, the red blood cell count may be low, indicating anemia. Elevation of the white blood cell count tends to indicate infection.
Various diagnostic tests are needed to diagnose pericardial disease and determine the underlying cause.
Serum biochemical profile is performed to evaluate serum electrolyte levels and organ functions. Various abnormalities may be detected, including concomitant kidney disease or liver disease.
Radiographs (X-rays) of the chest are helpful to help determine whether pericardial disease is present. When pericardial effusions are present, the heart is seen to be larger than normal and globoid in shape. If a hernia is present, loops of intestine may be seen overlying the heart.
A barium series may be recommended if a peritoneopericardial hernia is suspected but cannot be confirmed on plain radiographs. Barium is a liquid that, when ingested, shows up readily on X-ray. If loops of intestine are present within the pericardium, barium highlights their presence.
An ultrasound is the best way to diagnose pericardial disease. Ultrasound of the heart, called an echocardiogram, shows if whether a hernia or fluid is present. With the aid of ultrasound, fluid can be removed from around the heart by means of a needle and the fluid can be evaluated. In addition, the heart can also be assessed for evidence of a tumor.
Treatment varies on the type and severity of pericardial disease. Treatments may include the following:
For most cases of peritoneopericardial diaphragmatic hernia, no treatment is necessary since most dogs are clinically unaffected. If a dog with a hernia of this type becomes ill and has difficulty breathing, surgery must be performed to repair the hernia.
The treatment for pericardial effusion involves removal of the fluid and treatment of the underlying cause. Once a significant amount of fluid is removed with a catheter or needle, additional therapy can be administered. Sometimes, repeated removal of fluid may be needed.
Medical therapy for treatment of pericardial effusion is not commonly recommended. If an affected dog has collapsed with profoundly low blood pressure, intravenous fluids may be indicated for resuscitation. Furosemide or other medications designed to reduce fluid accumulation in the pericardium have not been shown to be effective.
Surgery may be necessary for successful management of pericardial disease. Removal of the pericardial sac may be needed in recurrent hemorrhagic effusion of unknown cause, especially in younger dogs. The treatment for infective pericardial disease involves catheter drainage of the pericardium, subsequent surgical removal and drainage of the pericardial space (to prevent constriction), and specific antibiotic therapy based on culture.
Surgery is also indicated if constrictive pericardial disease is diagnosed or highly suspected. If a tumor is suspected but not confirmed on ultrasound, surgery may be needed to determine whether the tumor is present and, if present, to facilitate its removal. In some cases of hemorrhagic pericardial effusion caused by tumors, a small window may be cut into the pericardium to allow the blood to leak out of the sac and into the chest cavity, where it can be absorbed.