Liz Bode

Hi Scott,

Yes, this paper is sometimes referred to for the management of pericardial effusions. I think it was the RVC if I remember correctly. To be honest I have never thought or needed to place a pericardial catheter in for a longer period of time than drainage takes. In my mind, if you drain them then only a handful will refill quickly and these tend to be the neoplasia cases. So given it is the minority of cases that refill quickly I think most PE cases don’t warrant the expense/ expertise/ nursing care that placing an in-dwelling catheter would need. Most of my PEs tend to go home after 24 hours. I guess you could consider an in-dwelling catheter in those cases that refill quickly whilst you are waiting for diagnostics to be returned.

Liz

Replying to Kathryn B. 26/10/2022 - 08:18

In that case it’s this one! Sorry I couldn’t spot where I’d mentioned it.

https://onlinelibrary.wiley.com/doi/10.1111/jvim.15854

Liz

Replying to Sybil Dryburgh 23/10/2022 - 23:14

Hi both

Yes, this group originally did a retrospective study on this (although I’m not sure how you do a retrospective study about applying pressure and the presence or absence of a murmur!). They then went on to prove the concept with this prospective study.

In some cats, usually older and thinner cats, it is possible to place your stethoscope on the right parasternum and cause a low grade systolic murmur. The same goes with echo in some cats. When looking at the right ventricular outflow tract from the right side you can cause a dynamic obstruction due to the pressure of the probe. Another study (before we knew that some of these could be iatrogenic) back in 2004 showed that cats with dynamic right ventricular outflow tract obstruction didn’t have associated pathology or heart disease that would cause it. So, putting two and two together (and hopefully making 4) I think it would be safe to say that these cats probably don’t have pathology but due to their chest conformation you can push the heart against the opposite wall of the chest and deform the right outflow tract resulting in a murmur. When you release the pressure the murmur should disappear. Obviously, if it doesn’t disappear then another cause of the murmur might be present and if you’re not sure then echo is indicated.

I don’t think we know about dogs but I think the majority of dogs have too big a chest for this to be an issue (think how narrow cat chests are compared to a chihuahua even!)

Hopefully this answers your question but let me know if there are any others.

Liz

Replying to Kathryn B. 17/10/2022 - 16:19

Hi Kathryn,
Ooh drainage of big dogs like this can take AGES!!! I’d use a Mila chest drain in these cases as you’ll find them much faster and should reach further into the chest cavity as it probably was the length of your needle that was the limiting factor. You can suture them in for a few days. However, if you’ve drained the chest and it keeps recurring for longer term management I’d use a pleural port ideally (depending on the source of the effusion). A haemorrhagic effusion in a golden retriever doesn’t sound great 🙁

Replying to Emma Holt 06/10/2022 - 15:49

Hi Emma,

The cut-off for myocarditis is unclear, but I would be more suspicious if the cTNI was >1. I think most cardiologists go by this too. Generally they are well above this in the acute stages. It is good to be mindful that chronic myocarditis (at least in people) may have normal or only mildly elevated cTnI, but they usually have a DCM phenotype.

Liz