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Pericardial effusions 心包积液 Haemorrhagic 血性的 Transudates 漏出液 Exudates 渗出液Constrictive pericarditis 缩窄性心包炎Pericardial neoplasia 心包肿瘤PPDH 腹膜心包疝Pericardial cyst 心包囊肿Tough sac in which the heartsits 在heartsits时碰到心包Small amount of pericardial fluid 有少量心包液Attached to diaphragm by ligament 以韧带与横膈相连Restricted filling preload important 充盈受限制前期负荷很重要Disease caused by compression of right side of heart由压迫右侧心脏导致的疾病Collapse of right atrium 右心房塌陷 Cardiac tamponade 心脏填塞Right ventricle may also collapse右心室也有可能塌陷Systemic venous pressures rise全身性静脉压上升Speed of development important发展的速度很重要Cats often incidental finding猫通常是偶然发现的Haemorrhagic 血性的 Idiopathic pericardial haemorrhage 自发性心包出血 Neoplasia 肿瘤 Trauma, coagulopathy 外伤，凝血障碍 Rupture of LA 右心房破裂Transudates 漏出液 RHF 右心衰竭 Hypoproteinaemia 低蛋白血症 PPDH, renal failure 腹膜心包疝，肾衰Exudates 渗出液 FIP 猫传染性腹膜炎 Infection 感染 Foreign body 异物Jugular distension 颈静脉驽张Ascites 腹水Hepatomegaly 肝肿大Weakness and lethargy 虚弱和嗜睡Muffled heart sounds 心音低沉Weak rapid pulses 脉搏弱而快Pulsus paradoxus ventricular interdependence 奇脉心室相互依赖Large round cardiac silhouette 心脏轮廓大而圆 Large heart DCM and TVD 心脏大扩张性心肌病和三尖瓣疾病 Pericardial effusion 心包积液 Peritoneopericardial diaphragmatic hernia 腹膜心包疝Ascites 腹水 Numerous! 量多！Small complexes 小的复合波Electrical alternans 电交换Large cardiac silhouetteGloboid no individual chamber enlargementStill outlineDistended caudal vena cavaPneumopericardium not used nowDiagnostic test 诊断测试Look for underlying cause neoplasia寻找潜在的病因肿瘤Cardiac tamponade can be visualised心脏填塞可见Check: 检查 Right auricular appendage 右心耳 Heart base tumours 心基瘤Rarely helpful 很少能有帮助Occasional lymphoma 偶见淋巴瘤Difficult to differentiate mesothelioma from reactive mesothelial cells 很难区别间皮瘤和反应性间皮细胞pH not helpful pH值没什么帮助Troponin assay 肌钙蛋白测定Do NOT give diuretics or vasodilators 不要用利尿药或血管扩张药May give intravenous fluids in short term 可短期输液Sedate ACP and opiate 镇静ACP和阿片制剂Drain pericardium 心包穿刺14 or 16 g OTN catheter 14-16号OTN导管Cut extra ports 去除其余部分Use ultrasound to guide needle 用超声引导Three way tap 三通管Attach suction and advance needle连通吸引器并进针When hit fluid stop and advance catheter碰到液体即停止进针并推入导管Wait while spin down / wait for clot等离心/等凝结Idiopathic pericardial effusion自发性心包积液 ? reactive blood vessels 血管反应？ ? immune mediated 免疫介导？Neoplasia 肿瘤 Right atrial haemangiosarcoma 右心房血管肉瘤 Chemodectoma 化学感受器瘤 Lymphoma 淋巴瘤Left atrial rupture 左心房破裂Younger dogs 幼小的犬Golden retrievers 金毛巡回猎犬50% chance will recur 50的可能性再发If recurs can drain 2nd time 如再发可再次排液Risk of developing constrictive pericarditis 有发生缩窄性心包炎的可能 RA haemangiosarcoma hopelessChemodectoma allow fluid to drain into pleural cavity thoracotomy balloon dilation of windowAdvanced DMVD ？Very poor prognosis 预后不良Try draining small volumes to keep out of tamponade but not enough to encourage bleed 试着排出少量液体，以解除心包填塞，但不要排出太多，以免继续流血Dont buy any large bags of dog food 不要买大包狗粮Transudates 漏出液 Secondary to right heart failure 继发于右心衰竭 FIP in cats high SG and protein 猫传染性腹膜炎比重和蛋白质均高 renal failure small volumes 肾衰少量Purulent pericardial effusion 化脓性心包积液 Cattle, cats rarely 牛，猫少见 drain and antibiotics 排出并用抗生素 surgery for FB 手术取出异物Congenital 先天性Incidental finding 偶然发现Vague discomfort, rapid breathing GI signs 隐约感觉不舒服，呼吸快，有胃肠道症状Long haired cats and Weimaraners 长毛猫和德国魏犬Muffled displaced heart sounds 心音低沉，不在其原来的位置Large cardiac silhouette 心脏轮廓大Surgery? 手术？Large cyst in pericardium 心包内有大的囊Remnant of omentum from PPDH PPDH后遗留的网膜Can give signs of RHS failure 可表现为右心衰竭Surgery 手术Usually straight forward 通常直接进行Rare 很少见Difficult to differentiate from restrictive cardiomyopathy 很难与限制性心肌病进行鉴别Based on variations of mitral inflow velocities on echocardiography 要以超声心动上二尖瓣流进时的流速为基础Surgery can be difficult! 手术很困难
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