Pericarditis, Endocarditis, Myocarditis

Veterinary Internal Medicine
Cardiology
Dr. Khaled M. Al-Qudah
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Pericarditis; Endocarditis; Myocarditis
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Pericarditis
Dr. Khaled M. Al-Qudah
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Inflammation of the pericardial sac,
characterized by:
Audible friction rub in early
stage
Muffling of the heart
sounds in advance stage
C.H.F
4
5
Etiology:
•
May be septic, nonseptic, neoplastic, or
idiopathic
•
Common bacteria are Streptococcus and
gram negatives in horses, plus anaerobes
and Actinomycosis in cattle
•
Horses with pleuropneumonia or EHV1
•
Cattle with hardware
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Etiology…
Pericardial disease causes diastolic cardiac
dysfunction with minimal alterations in systolic
function
Accumulation of fluid in pericardial sac and
thickened and inflamed pericardium cause
cardiac tamponade and restrictive pericarditis,
which restrict diastolic filling resulting in
cardiac insufficiency
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Pathogenesis
1. Early stage of inflammation hyperemia and
deposition of fibrinous exudate

Friction rub when the pericardium and epicardium
rub together during cardiac movements.
2. As effusion develops the inflamed surfaces
are separated, and the friction rub is replaced
by muffling of the heart sounds.
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fibrinous exudate
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3. The accumulation of the fluid will compress
the atria and
ventricles preventing their complete filling

C.H.F.
4. Toxemia is present in case of suppurative
pericarditis.
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Fibrinous Pericarditis
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5. In the recovery stage:
In case of non-suppurative pericarditis,
resorbtion of the fluid followed by adhesion
between the pericardium and the epicardium.
This kind of adhesion is not strong to impair
cardiac movement.
In suppurative pericarditis the adhesions are
more serious and may cause complete
attachment between the epicardium and the
pericardium, which restrict the cardiac
movement followed by C.H.F.
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Clinical signs and physical findings:
• Fever, depression, anorexia
Nonspecific signs:
• Pleurodynia (intercostal muscular pain)
• Colic in horses
• Cardiac tamponade
Most specific signs:
1) Jugular distention, edema
2) Pleural effusion
3) Splashy or muffled heart sounds and/or
pericardial friction rubs
• May also have arrhythmias
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• Pain
 The animal avoid to move
 Abduction of the elbows
 Arching of the back
 Shallow abdominal respiration
 The animal lies down carefully
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Diagnosis:
Most specific diagnostic test is an echocardiogram
demonstrating pericardial fluid and collapsed RA.
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Aspirate of pericardial fluid for cytology and
culture
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Other nonspecific findings:
Laboratory evidence of infection or inflammation:
 Leukocytosis
 Hyperfibrinogenemia
 hyperglobulinemia
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Treatment:
• Pericardial drainage and lavage is very
important
• Antimicrobial therapy based on cytology
and culture
• Anti-inflammatory and analgesic therapy
• Rumenotomy or pericardiotomy to remove
foreign body in cattle if present with
hardware disease
• Treat arrhythmias and cardiac failure if
present
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Endocarditis
DR. Khaled M. Al-Qudah
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Inflammation of the endocardium may
interfere with the ejection of blood from
the heart by causing insufficiency or
stenosis of the valves.
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Etiology
Cattle
Horses
[streptococcus spp
[corynebacterium pyogenes
[clostridium chauvoci (Black leg)
[ myoplasma mycoides
[actinobacillus equali
[streptococcus spp
[strongylus spp (larvae)
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Etiology….


Focus of infection anywhere in the body that
embolizes to the valves
1)Actinomyces and Streptococcus most
common in cattle
2) Pasturella, Actinobacillus, and
Streptococcus most common in horses
Pre-existing valve lesions may predispose to
bacterial colonization
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Pathogenesis:
Bacteremia

M.O. colonize the heart valves and
endocardium

Bacterial endocarditis

Vegetative and ulcerative lesions

1. this will interfere with normal
blood passage through the cardiac orfices

CHF
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Pathogenesis…..
Fragments of vegetative lesions may become
detached circulation.

 arteritis
 miliary pulmonary abscesses
 myocardial abscesses
 kidneys and joint abscesses
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Pathogenesis…..
Impaired valve function from bacterial
colonization can lead to heart failure
1) Signs depend on valve (s) affected
2) Aortic and mitral valves (LAV) more
common in horse
3) Tricuspid valve (RAV) more common in
cattle
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Clinical Findings:





Depend on valve (s) affected and severity
May be subclinical …Cattle !!
May cause heart failure
The clinical signs of right-sided C.H.F.
 Tachycardia
 Jugular and mammary vein distention with
palpable pulses.
 Ventral and submandibular edema
Systolic murmur  only 50% have
detectable murmurs.
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Clinical Findings...

Cyclic fever

Tachycardia
Anorexia
Reduced performance
Chest pain
Often younger animals (< 5 years)
50% of cattle also have shifting leg
lameness .





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Diagnosis:
1. The history and physical examination.
2. Blood culture is the single most useful
procedure for the diagnosis of BE.
Three venous blood samples should be
collected aseptically during one or two hour
period.
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Necropsy photograph of the heart of the above calf.
Note the large vegetation on the TV (arrow)
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Most specific would be visualization of abnormal
valves on an echocardiogram
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Endocarditis Left AV valve
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Vegetative Endocarditis
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Vegetative Endocarditis
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Nodular Endocarditis
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Endocarditis in a calf about 6 months old
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Treatment
 Not
highly successful
 Antimicrobial therapy (4-6 wks) based on
culture
 The thickness of the lesions prevents
adequate penetration of the drugs.
 It is hard to treat before the isolation of the
M.O. and the selection of the drug should be
based on the sensitivity.
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Treatment
In case of negative culture:
Penicillin with gentamicin
or
Potentiated sulfonamide for long period...
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Prognosis



Fair to good if treated early before significant
valve lesions
Poor to grave if significant valve lesions
causing failure
80% of horses with aortic or mitral valve
endocarditis, die
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Myocardial disease
Dr. Khaled M. Al-Qudah
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Etiology

Inflammation of cardiac muscle caused by
1) Endotoxemia
2) Viral infection, EIA, EVA, FMD, AHS
3) Parasitic migration (Strongylosis, Neospora canium,
sarcocystis, cysticercosis infection)
4) Bacterial endocarditis (Clostridium chauvoei, Strep
spp, Mycobacterium spp, Staph aureus, Borelia
burgdorferi and Spirochete)
5) Idiopathic cardiomyopathy
6) Fungal. Blastomycosis (very rare)
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Etiology…

Electrolyte abnormalities
1) GI disease, esp. colic or colitis
2) K, Mg, Ca important
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Etiology…
Nutritional:
1.
Vitamin E or selenium deficiencies (horse
and ruminants)
2.
hypervitaminosis D
3.
Cu deficiency
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Etiology…
 Myocardial
infarcts or fibrosis
 Cardiac inflammation, degeneration or myocyte
electrolyte changes cause:
1) Altered conduction and arrhythmia
2) Reduced myocardial function, chamber
dilation, insufficient AV valves and failure
3) Can lead to arrhythmias and murmurs
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Etiology…
Neoplasia:

Aortic or carotid body tumor, may invade
atrium or ventricle.

Lymphosarcoma (cow, cat) and
Angiosarcoma (dog). Usually involves right
atrium.
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Etiology…
Toxic cardiomyopathy:






Bacterial toxins (e.g. clostridia).
Myocardial depressant factors of shock.
Chronic renal failure-induced myocardial depression
External toxins, (e.g. furazolidone, cobalt, alcohol).
Electrolyte abnormalities especially hypocalcemia,
hypophosphatemia, and hyperkalemia.
Drugs, e.g. doxorubicin, sodium iodide (causes dilated
cardiomyopathy in cat)
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Etiology…
Vascular disease and ischemia:



Atherosclerosis of coronary arteries
secondary to severe hypothyroidism in
dogs.
Ischemic myocardial necrosis and fibrosis in
the horse, possibly secondary to
arteriosclerosis.
Ischemia caused by hypotension.
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Etiology…
Trauma:

penetrating (e.g. bullet)

Non-penetrating ( blunt) very common.
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Clinical signs and physical findings
 Variable,
depending on severity and underlying
cause
 Exercise intolerance, Syncope and collapse
 Persistent tachycardia common, but
bradycardia may also occur
 Murmurs, especially systolic over AV valves
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Clinical signs
 Myalgia
- if generalized muscle pain
 Arrhythmias,
especially ventricular
tachycardia, and premature atrial or
ventricular contractions, and atrial
fibrillation
 Congestive heart failure - edema
and/or jugular venous distention
 Sudden
death
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Myocarditis, or inflammation of the muscular walls of
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the heart, is a common sign of FMD.
Focal Myocarditis
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Death is the usual result of Myocarditis among
newborn calves that contract FMD
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Diagnosis
 Can
be difficult
 Increased
serum cardiac Troponin
 Identify
underlying cause
1) Always check serum electrolytes
2) Endotoxemia-neutropenia
3) Endocarditis-inflammatory leukogram
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Diagnosis….
Blood concentrations of Vitamin
E/selenium and CK
. Feed analysis for Monensin:
•
Monensin concentration in cattle feed, Recommended
level 12 mg/kg BW
BLV serology in cattle
ECG - arrhythmias
•
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Treatment
1.
Treat underlying disease
2. Rest, avoid stress
3. Nonsteroidal anti-inflammatory drugs for
myocarditis
(Flunixin 1.1 mg/kg)
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Treatment…
4. Control cardiac arrhythmias:
 in
heart failure from myocarditis digoxine or
dopamine are indicated:
Digoxin: Horse: 12-14 g/ kg/24 hours
Cattle: 11 g/ kg tid
5. In case of Oedema, diuretics mast be given, as:
Furosemide: 0.5 - 1 mg/kg/day
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