Gestion en urgence des effusions péricardiques et tamponnades cardiaques chez les animaux de compagnie

Abstract

Pericardial effusion is one of the most common cardiac emergencies in veterinary medicine. The aim of this study was to investigate and define the optimal management of an animal presented to emergency with pericardial effusion and cardiac tamponade through a methodical synthesis of the literature. Rapid and appropriate diagnosis is critical for the survival of the animal in the emergency room. Pericardial effusion is the abnormal accumulation of fluid in the pericardium. Cardiac tamponades are real emergencies that compromise the vital prognosis of the animal. They occur when the pericardial pressure exceeds the intracardiac pressure, causing the right atrium to collapse and obstructing blood flow. Animals with pericardial effusion and cardiac tamponade are presented to the emergency with intense lethargy, possible cough, or abdominal distension, inappetence, exercise intolerance, respiratory distress, and possible vomiting within 48 hours. A thorough general examination should be carried out, with particular attention paid to assessing cardiac auscultation, the quality of the pulse, the colour of the mucous membranes and the capillary refill time. Effective diagnosis is essential for rapid animal management. Thoracic Point-of-Care Ultrasound is the Gold Standard for detecting pericardial effusions. It also helps to perform pericardiocentesis. Radiography, Computed Tomography Scan, serum cardiac troponin assay and electrocardiogram are discussed in this work. These additional examinations have limitations (specificity, sensitivity, delay, etc.), that restrict their choice for the diagnosis of pericardial effusion in emergency. The electrocardiogram can however be an additional tool to monitor the condition of the animal, for example during pericardiocentesis. Pericardiocentesis is essential to stabilize the animal admitted to emergency. Its implementation, the equipment required and associated risks are also considered. In this work, the management of pericardial effusion in emergency will be illustrated with the clinical case of Peps, a 9-year-old male Golden Retriever, presented to the emergency room with difficulty moving, depression and polypnea. A diagnosis of pericardial effusion with the presence of cardiac tamponade was made using Thoracic Point-of-Care Ultrasound. Pericardiocentesis was successfully performed.