Interesting Cases:

admin — Thu, 16 Dec 2010 18:22:33 +0000

Hearts are inside a sac (the pericardium), which protects the heart from being rubbed by the lungs
while breathing. Normally, there is only a small amount of fluid in the sac, but sometimes the fluid
can accumulate to a dangerous amount. There is only so much room in the pericardial sac—and
accumulating fluid can keep the heart from beating normally. Abnormal heart beats (in particular
ventricular premature contractions) can lead to cardiac arrest and death if not stopped. Fluid can build
up from genetic defects, tumors, or for unknown reasons (idiopathic). It can be a single episode that
does not recur after treatment, or it can be a chronic problem that requires treatment many times. It
can be life threatening, especially if a tumor is the cause of the fluid.

At Animal Medical Clinic we had a recent case where our patient, Betty (a 10 year old female Great
Dane) , was acting lethargic and her owners had noticed that she was having trouble walking. One
evening when she went outside, she stumbled and was unable to get up. Her owners took her to the
Emergency Clinic of Northwest Arkansas that night for an exam. Her physical exam was normal except
for arthritis in her rear legs. Although her blood chemistries were okay, she did have an abnormal EKG.
Her heart was beating with an arrhythmia called ventricular premature contractions (VPC’s), a serious
heart issue. She was hospitalized and started on intrvenous fluids and lidocaine (a medication to stop
the VPCs) while she awaited transfer to our hospital in the morning.

The next morning she was transferred to Animal Medical Clinic where she was seen by Dr. Mohler.
Although she was feeling a little better and now able to walk, she was still not normal. Another EKG
at Animal Medical Clinic showed that the VPC’s were continuing to occur despite the medication she
had been started on. Dr. Mohler took chest x-rays and found that Betty had enlarged,round heart
silhouette—it looked more like a basketball! Dr. Smith was called in to get more information by
performing a heart ultrasound. Still images as well as videos of the heart were obtained with the
ultrasound and then tele-medicined ( via the internet) for a cardiologist to review. On the ultrasound
Drs. Smith and Mohler could see that the pericardial sac was full of fluid, and compromising the heart’s
ability to beat normally. Dr Smith was able to use the ultrasound to guide a needle into the pericardial
sac (but not into the heart!) and drain some of the fluid away. Betty showed immediate improvement
and her abnormal heart beats resolved. She was easily able to walk about the clinic. The cardiologist
confirmed the pericardial effusion (the fluid around the heart) but was unable to find a cause.

Betty did well for 3 days but then started to become lethargic . Repeat ultrasound of her chest
confirmed a re-accumulation of the pericardial fluid. Betty let Dr. Smith perform another
pericardiocentisis to drain the fluid away from the heart. 3.5 oz of fluid were removed and Betty once
again perked up. Three days later Betty began to relapse. Betty was not a good candidate for surgery,
and her owners opted for humane euthanasia. Upon autopsy, a one centimeter (1/2 inch) mass was
noted within her heart wall. The tumor was the cause of the pericardial effusion. Betty’s owners
thanked AMC for all of their hard work and said “I feel like you taking the fluid off her heart (meant) we
got to have her for a few more days—that I would not trade for anything.” We’ll all miss Betty.

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admin — Mon, 18 Oct 2010 17:54:39 +0000

Stay tuned for many updates to come from Animal Medical Clinic. Thanks for stopping by and have a Merry Christmas!

Fayetteville AR Veterinarians | Animal Medical Clinic

Interesting Cases:

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