Title: Cardiac Emergencies of the Dog and Cat Presented by: Agnieszka Kent, DVM, MS, DACVIM (Cardiology) Description: This course will discuss common cardiac emergencies and how to identify and determine the primary problem through effective history-taking, physical examination, and diagnostics. We will discuss how to approach each emergent condition with treatment strategies and monitoring to help you be as successful as possible in helping your patients through these life-threatening conditions.

1. DR. AGNIESZKA KENT, DVM, MS, DACVIM (CARDIOLOGY)
CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Congestive heart failure
 Dogs
 Cats
 Feline arterial thromboembolism
 Syncope
 Tachyarrhythmias
 Bradyarrhythmias
 Pericardial effusion with cardiac tamponade
OUTLINE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Left-sided
 Pulmonary edema +/- mild pericardial and
pleural effusion
 Cough and may be coughing up frothy,
blood-tinged fluid
 Dyspnea +/- orthopnea
 Inspiratory pulmonary crackles
 Cyanotic and/or pale mucous
membranes
 Positive hepatojugular reflux due to
increased water retention
 May have a gallop at the left apex
 Possibly hypokinetic pulses
 DCM
CONGESTIVE HEART FAILURE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Right-sided
 Distended and fluid filled abdomen with
fluid wave
 On US distended caudal vena cava
and hepatic veins
 Abdominal veins may be congested
 +/- Peripheral pitting edema
 Jugular distention and pulses
 +/- Pleural effusion
 May or may not be dyspneic
 May have right apical gallop
CONGESTIVE HEART FAILURE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Myxomatous mitral valve
disease
 Dilated cardiomyopathy
 Congenital heart disease
 Patent ductus arteriosus
 Severe subaortic stenosis
 Large ventricular septal
defect
 Mitral valve
CONGESTIVE HEART FAILURE IN DOGS
CAUSES
Left-sided Right-sided
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CARDIAC EMERGENCIES OF THE DOG AND CAT
5
 Myxomatous tricuspid valve
disease
 Severe pulmonary
hypertension
 Congenital
 Tricuspid valve dysplasia
 Severe pulmonic stenosis
 Double chamber right-ventricle

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 Thoracic radiographs
 Blood work for minimum database before furosemide
 Renal parameters
 Electrolytes
 ECG if an arrhythmia is detected
 FAST scan +/- brief echocardiogram
DIAGNOSTIC PLAN
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Cardiomegaly?
 Left, or right-sided?
 Pulmonary vasculature
 Distention of the pulmonary veins OR arteries OR both?
 Pulmonary parenchyma
 Pulmonary edema due to increased pulmonary venous and capillary pressures
 Interstitial pattern (pulmonary capillary pressures, PCP, ~15-20 mmHg)
 Alveolar pattern (PCP ~30-40mmHg)
 For dogs look in perihilar and caudodorsal lungs, usually right caudal lobe first
 Pleural effusion?
 Fissure lines, lung lobe retraction
THORACIC RADIOGRAPHS
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Left atrial enlargement
 Pulmonary vein distention
 Infiltrates consistent with
cardiogenic pulmonary
edema
 Perihilar and caudodorsal
 Generally right caudal lung
lobe is first and more affected
 If deep chested may also have
cranial ventral
LEFT CHF THORACIC RADIOGRAPHS
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Severe pulmonary hypertension can cause non-cardiogenic edema
 Can be anywhere, can be patchy interstitial or alveolar
 Heart murmur that is more prominent at the right apex
 Good improvement when supplemented with oxygen
 May have ascites
 Right-sided cardiomegaly on radiographs
 No left atrial enlargement unless has concurrent left heart disease
 Lobar pulmonary artery distention
 Bulge at the 1-2 o’clock position on the VD/DV projection due to main PA enlargement
 Needs and echocardiogram before aggressive treatment for L-CHF
DIFFERENTIATE FROM SEVERE PULMONARY HYPERTENSION
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CARDIAC EMERGENCIES OF THE DOG AND CAT
Severely elevated TR velocities

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 Diuresis - furosemide
 Dosing depends on severity - 2-4 mg/kg IV/IM (less ideal SC)
 Repeat q 30 minutes if necessary
 Determine q 12/8/6h dosing schedule depending on severity
 If you have to give repeated boluses with no or minimal improvement, then
consider CRI, OR that the diagnosis may not be correct
 CRI – determine total dose you want to give over 24h (e.g. 8 mg/kg/d) and
divide by 24
 Generally 0.25-0.4 mg/kg/h; if fulminant CHF can use 0.5-1 mg/kg/h for a few hours
 Can dilute with 0.45% NaCl and give at ~3 mL/h
 Light-sensitive so line and syringe need to be protected from light
TREATMENT PLAN
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Diuresis – torsemide
 Also a loop diuretic but ~10 x more potent than furosemide
 Consider for patient that has chronically been treated with furosemide and is on
high dose (~10 mg/kg/d or more) or showing signs of resistance
 Lack of clinical response to higher doses of furosemide, no hypochloremia
 Dosing – calculate total daily furosemide dose
 Divide the total furosemide dose by 10 and divide this by 2 for q 12h dosing
schedule
 E.g – dog receives furosemide 40 mg q 8h = 120mg/d ➗ 10 ➗ 2 = 6 mg PO q
12h
 5 mg tablets available so try 5 mg PO q 12h and monitor response
TREATMENT PLAN
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Oxygen
 Ideally in O2 cage with FiO2
40%
 Alternatively nasal prongs
 High flow nasal O2
 Patients needing additional
respiratory support
 Intubation for mechanical
ventilation
TREATMENT PLAN
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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• Allows flow rates of 40L/min at FiO2 ranging from 0.21-1.0
Administration of
medical-grade, vapor-
humidified, heated gas
• Non-invasive ventilation in patients with mild to moderate hypoxemic
and/or respiratory failure
• Hypoxemic respiratory failure (e.g. pneumonia, ARDS)
• Acute CHF
• COPD, pulmonary fibrosis, hypercapneic respiratory failure
Indications
HIGH FLOW NASAL O2
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Benefits
 Inspired gas is warmed and humidified to
relative humidity of 95-100%
 Improves mucociliary function, improved
patient comfort, decreased patient energy
expenditure, decreased
bronchoconstriction
 Improved purging of nasopharyngeal CO2 –
decreased rebreathing of retained CO2
 Provides positive end expiratory pressure
(PEEP) – prevents alveolar collapse and
recruits atelectatic areas of lungs
 Improved patient access (not in O2 cage)
 Available for patient use at UVS!
HIGH FLOW NASAL O2
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Nitroglycerin ointment (transdermal)
 Predominantly venodilation
 Preload reduction
 0.25-1” on inner pinna depending on size
 Leave on x 12h, then wipe off
 If severe CHF can reapply q 6h
 Potential to develop nitrate tolerance if on >8-12h
TREATMENT PLAN
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Consider sodium nitroprusside if available
 Aggressive afterload reduction, titrate based on BP (ideally
direct arterial)
 Light sensitive, line needs to be wrapped
 Starting 1-2 ug/kg/min, can titrate up to 10 ug/kg/min with a goal
blood pressure – 90-100 mmHg
 Do not use for more than 24-48h due to risk for cyanide toxicity
FULMINANT CHF
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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Pimobendan
• Avoid in obstructive disease
(e.g subaortic or pulmonic
stenosis)
• Positive inotrope
• 0.25-0.3 mg/kg PO q 8-12h
ACE inhibition
• Not indicated for acute CHF
• Generally, start next day as
long as kidneys okay
TREATMENT PLAN
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Blood pressure <90 mmHg, hypothermia
 Dobutamine – for rapid positive inotropic effects
 Beta1-agonist, mild beta2 and alpha1 effects also
 Start at 5 mcg/kg/min and increase by 1 mcg/kg/min every 15-30 min
until systolic BP is ~90-100 mmHg. Max 15 mcg/kg/min
 Monitor ECG and use caution if patient has ventricular arrhythmias or
any tachyarrhythmia
 Once patient is stable can decrease by 50% every 2-4 hours and
when reach 2 mck/kg/min can discontinue if BP is maintained
CARDIOGENIC SHOCK
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Abdominocentesis if significant ascites
 Ideally ultrasound guided
 Choose appropriate catheter
 Small patients – 18G OTN catheter
 Medium dogs – 16G Angiocath
 Large dogs – 14G Angiocath
 Extension set, 3-way stopcock, appropriate syringe, container for
collection
 These patients generally require higher furosemide dose for CHF
control
 Consider 3 mg/kg PO q 12h and monitor renal parameters and electrolytes
RIGHT-SIDED CONGESTIVE HEART FAILURE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Cough is possible but uncommon
 Dyspnea/orthopnea
 If has pleural effusion do
thoracocentesis ASAP, if have US
perform before radiographs
 Left atrial enlargement less evident
 Look for left auricular bulge on VD/DV
CATS WITH CONGESTIVE HEART FAILURE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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PULMONARY EDEMA
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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PULMONARY EDEMA
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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CARDIAC EMERGENCIES OF THE DOG AND CAT
PLEURAL EFFUSION

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CARDIAC EMERGENCIES OF THE DOG AND CAT
PLEURAL EFFUSION

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 #1 Minimize stress – consider sedation
 Butorphanol 0.2-0.25 mg/kg IV/IM
 Acute:
 Furosemide 1-2 mg/kg SC/IM*/IV*
 Repeat q 30-60 minutes depending on response
 If really severe dyspnea give 3-4 mg/kg IM/IV then subsequent doses would ideally be
lower
 If responding poorly consider furosemide CRI
 Monitor renal parameters very closely in older cats
 Do not start a beta-blocker due to negative inotropic effects
CAT TREATMENT
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Monitoring respiratory rate q 1h
 Recheck renal parameters and electrolytes every
12-24 hours
 Depends on whether there was azotemia on
presentation
 Monitor for hypokalemia, if starts to develop start
spironolactone in dogs
 Typical dose: 1 mg/kg PO q 12h OR 2 mg/kg q 24h
 Use some caution in cats due to potential risk for facial
excoriations
IN-HOSPITAL MONITORING
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Decreased auricular
function
 Endothelial injury exposes
subendothelial collagen,
platelet adhesion
 Platelet hypersensitivity,
decreased antithrombin
and protein C activities,
increases in factor VIII
activity and fibrinogen
ARTERIAL THROMBOEMBOLISM
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Which patients are at risk?
 Severe left atrial dilation
 Spontaneous echocardiographic contrast (“smoke”)
 Left atrial and/or auricular thrombus
 Reduced left auricular ejection velocities on echo
 Velocities <0.2 m/s were associated with smoke
 Cardiac disease is not the only cause
 Neoplasia
ARTERIAL THROMBOEMBOLISM
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CARDIAC EMERGENCIES OF THE DOG AND CAT
Left auricular ejection velocities

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 Acute paresis or paralysis of one or more limbs
 Lower motor neuron signs
 Generally intensely painful
 Affected musculature is firm and painful
 Paw pads of affected limbs are cyanotic
 Paw pads of affected limbs are cold
 Absent pulses in affected limb
 Can use Doppler to try to find pulse
 Chemistry ↑↑↑CK, ↑↑AST, ↑ALT
PRESENTATION/CLINICAL SIGNS
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CARDIAC EMERGENCIES OF THE DOG AND CAT
Compare nail beds

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 Low rectal temperature
 <99.0 oF (Smith et al); mean 96.8 oF in non-survivors (Borgeat et al)
 Congestive heart failure
 Affected long term prognosis (Smith et al, 2003)
 With CHF 77d; No CHF 254 d
 ≥ 2 limbs affected
 Bradycardia
 Hyperphosphatemia
NEGATIVE PROGNOSTIC INDICATORS
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 1st Analgesia!
 Fentanyl, hydromorphone, morphine, buprenorphine
 Butorphanol is not strong enough unless pain is mild
 24-48 hours post-event pain generally subsides
 Treatment to prevent further thrombus formation
 Clopidogrel**, low molecular weight heparin**
 Enoxaparin 1 mg/kg SC q 12h
 Clopidogrel 18.75 mg PO q 24h
 Tissue plasminogen activator for thrombolysis
 No statistical improvement in survival or complication rates
(Guillaumen J, et al; J Feline Med Surg, 2022, Dec;24(12):e535-e545
ACUTE TREATMENT
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Pain generally subsides within 48-72 hours
 Reperfusion injury
 Look for hyperkalemia
 Bradycardia, atrial standstill (monitor ECG)
 Many cats will regain function of the affected limb within 4-6
weeks
 Cats with one limb affected do better than true saddle
thrombus
 Some can develop rhabdomyolysis, limb contracture
 Requires amputation
FELINE ARTERIAL THROMBOEMBOLISM
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Clopidogrel PO + enoxaparin SC
 Clopidogrel PO + rivaroxaban PO(factor Xa inhibitor)
 Dual antithrombotic therapy with clopidogrel and rivaroxaban resulted in a low reported incidence of
adverse events. Cats placed on dual therapy for an ATE event experienced a low rate of recurrence
and effective thromboprophylaxis was achieved in cats with intracardiac thrombi or SEC.
 J Feline Med Surg. 2022 April ; 24(4): 277–283. Dual therapy with clopidogrel and rivaroxaban in cats with thromboembolic disease. Sara T Lo, et al.
 When prescribed due to an ATE event 16.7% (3/18) had recurrent ATE
 When prescribed for spontaneous echo contrast or intracardiac thrombi
(n:14) no cats experienced ATE
TREATMENT TO GO HOME
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Transient loss of consciousness secondary to inadequate cerebral blood flow
SYNCOPE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Neurocardiogenic (vasovagal)
 Triggered: activity/excitement, coughing, sudden rising from rest
 Sudden reduction in heart rate and/or blood pressure
 Generally due to significant cardiac disease, severe pulmonary hypertension
 Inadequate cardiac output
 Severe subaortic or pulmonic stenosis, dilated cardiomyopathy
 Transient tachyarrhythmia
 Ventricular tachycardia
 Less commonly supraventricular tachycardia
 Bradyarrhythmia
 Sick sinus syndrome
 High grade Mobitz 2 second degree or 3rd degree/complete atrioventricular block
SYNCOPE - CAUSES
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Syncope
 No pre-or post-ictal phase
 Question owners thoroughly
 Acute collapse
 Can paddle (but not aggressively) due to disorientation
 Opisthotonus possible
 May vocalize
 May urinate or defecate
 No jaw snapping or foaming
 Recover after a short time, may take a minute or 2 for full recovery and then are normal
 Note: syncopal dogs and especially cats may have some facial twitching
SYNCOPE VERSUS SEIZURE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Presence of greater than 3 ventricular premature
complexes in sequence
 HR >170 bpm
 Causes
 Structural heart disease (DCM) or electrical (ARVC),
myocarditis
 Drugs/toxins (e.g chocolate, asthma inhaler)
 “Usual suspects”: Splenic disease, GDV, severe anemia,
DIC, trauma
 Metabolic imbalance/endocrine diseases
 Hypokalemia, hypomagnesemia
 Hyperthyroidism
 Autoimmune imbalance (high sympathetic tone)
 pheochromocytoma
VENTRICULAR TACHYCARDIA
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CARDIAC EMERGENCIES OF THE DOG AND CAT
P-waves seen “marching through” but not associated with QRS complexes

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 Treatment Plan
 Place IV catheter
 Perform minimum baseline blood
work – ensure potassium is normal!
 To ensure lidocaine will be effective
 Give lidocaine – dose depends on
species
PATIENT WITH SUDDEN COLLAPSE AND PALE GUMS
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CARDIAC EMERGENCIES OF THE DOG AND CAT
25 mm/s
This is your ECG…EEEK!

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 Frequent multiform/polymorphic VPCs, frequent couplets
or triplets or ventricular tachycardia, dogs: HR >170bpm,
cats >240 bpm, R-on-T phenomenon
VENTRICULAR ARRHYTHMIAS - WHEN TO TREAT
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Lidocaine
 Dogs: 2 mg/kg IV bolus, can repeat every 5-10 min until reach
cumulative dose of 8 mg/kg. Stop if start to develop GI signs
(nausea/vomiting) or neurologic signs
 Can start CRI if recurrent 40-80 mcg/kg/min
 Cats: 0.5 mg/kg IV SLOW bolus, can repeat once or maybe
twice
 Very sensitive to neurologic side effects
VENTRICULAR TACHYCARDIA TREATMENT
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Dogs
 If have it, give procainamide 5-10 mg/kg bolus over 5-10 min
 If responsive can start CRI 10-50 mcg/kg/min
 Sotalol 1-2 mg/kg PO q 12h (caution if has myocardial depression, ventricular systolic
dysfunction, or patient has CHF)
 Esmolol 0.5 mg/kg IV slow bolus (same precaution as for sotalol)
 Nexterone (amiodarone) infusion
 2 mg/kg bolus over 10 min, then CRI 0.8 mg/kg/hr x 6h, then 0.5 mg/kg/hr
 No polysorbate 80 or benzyl alcohol – associated with anaphylaxis in dogs
 If still not converted can try magnesium infusion
 Electrical cardioversion
WHEN LIDOCAINE IS NOT EFFECTIVE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Cats
 Can try esmolol 0.25-0.5
mg/kg IV bolus
 If effective can start atenolol
(0.5-1 mg/kg PO q 12h)
 Not if in CHF (“no beta-
blockers to wet patients”)
 Next step is oral sotalol 2
mg/kg PO q 12h
WHEN LIDOCAINE IS NOT EFFECTIVE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Common in post-splenectomy or GDV patients
 Slow regular ventricular arrhythmia (generally 130-150 bpm)
 Comes and goes and appears to compete with sinus rhythm
 Generally self-limiting and hemodynamically stable rhythm
ACCELERATED IDIOVENTRICULAR RHYTHM (AIVR)
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CARDIAC EMERGENCIES OF THE DOG AND CAT
www.vmth.ucdavis.edu/cardio/cases
Look for fusion beats

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 Narrow complex with P-waves
 Possible mild electrical alternans
 Rapid 240-300 bpm
 Cats can be higher
 Abrupt start and finish
 May not be able to see P-waves
 May be buried in preceding T-wave
SUPRAVENTRICULAR TACHYCARDIA
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CARDIAC EMERGENCIES OF THE DOG AND CAT
ECG courtesy of Dr. Brian Scansen, DVM, MS, DACVIM

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 Syncope less common
 Exercise intolerance, weakness
 May have structural heart disease
 Primary or secondary (tachycardia induced cardiomyopathy)
 May have unusual clinical signs like intermittent nausea or
inappropriate panting/restlessness
SUPRAVENTRICULAR TACHYCARDIA
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 16 yo cat with severe HCM
 Intermittent hypersalivation
 HR: 400 bpm!
SUPRAVENTRICULAR TACHYCARDIA - EXAMPLE
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Can try vagal maneuver (before and/or after injectable meds)
 Manual ocular pressure
 Carotid sinus massage
 1st choice: Diltiazem 0.25 mg/kg IV over ~2 min. Can repeat in 5-10 min
 Can use CRI as transitioning to oral (2-5 mcg/kg/min)
 Standard 1-2 mg/kg PO q 8h, or XR 2-4 mg/kg PO q 12h
 2nd choice: Esmolol 0.5 mg/kg IV bolus, can be repeated once
 3rd choice: Procainamide Dog: 5-10 mg/kg slow over 5-10 min, Cat: 1-2
mg/kg slow IV over 5-10 min
 Start oral sotalol (1-2 mg/kg PO q 12h) or oral diltiazem
SUPRAVENTRICULAR TACHYCARDIA TREATMENT
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Rapid
 Irregularly irregular
 No P-waves
 “sneakers in a clothes dryer” on auscultation
 Most commonly due to structural heart disease
 “ Lone atrial fibrillation”
 Large breed dogs (ex Irish Wolfhound), HR not as fast
 Anesthesia induced – in dogs, due to high vagal
tone
 Can give lidocaine 2 mg/kg IV
ATRIAL FIBRILLATION
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CARDIAC EMERGENCIES OF THE DOG AND CAT
www.vetgo.com

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 Patients generally present in congestive heart failure
 Syncope infrequent
 I rarely use IV diltiazem or diltiazem CRI for this
 I aim for gradual reduction in heart rate
 Diltiazem 1 mg/kg PO q 8h, uptitrate until inhospital heart rate ~120 bpm
 OR diltiazem XR starting at 2 mg/kg PO q 12h
 Add digoxin 0.003-0.006 mg/kg PO q 12h
 Need therapeutic blood monitoring
 Caution if ventricular arrhythmias or hypokalemia present
 Renally excreted so lower dose if renal dysfunction
ATRIAL FIBRILLATION
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Abnormal function of the
sinus node and conduction
system
 Periods of asystole (“flat-
line”)
 Intermittent syncope
 Random, no triggers
SICK SINUS SYNDROME
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Mobitz 2 second degree AV
block
 Consistent PR intervals
when there is conduction
 Complete (3rd degree) AV
block
ATRIOVENTRICULAR BLOCK
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CARDIAC EMERGENCIES OF THE DOG AND CAT
Cat

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 Atropine response test
 0.04 mg/kg IM – recheck ECG in 20-30 min
 0.04 mg/kg IV – recheck ECG in 15-20 min
 If AV block or sinus node dysfunction resolve, then is vagally
mediated
 No or inadequate response then patient needs a pacemaker
ATRIOVENTRICULAR BLOCK
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Some patients with AV block can also have ventricular arrhythmias
(ventricular tachycardia)
 Do not give lidocaine!
 You can inhibit the ventricular escape rhythm
 Pacemaker first
 Then begin antiarrhythmic treatment
 Patient may be in congestive heart failure (left or right-sided)
**PLEASE NOTE**
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Acute or progressive increase in intrapericardial pressure
 Cardiac tamponade – Compression of right atrium and
ventricle
 Resulting in poor cardiac output and shock
 Needs pericardiocentesis
 Do not administer furosemide even if patient has ascites
 Will worsen cardiac output
 Can give IV fluids to support BP
PERICARDIAL EFFUSION
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Jugular distention and pulses
 Pulses paradoxus
 Reduced or absent pulse during inspiration
 Left-sided heart filling is reduced due to increase in right-sided filling
 Ventricular interdependence
 ECG may show electrical alternans
 Pendulous movement of the heart within the fluid filled
pericardium
SEVERE PERICARDIAL EFFUSION
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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 Place peripheral IV catheter
 Need IV access for patient stabilization
 Sedation needed unless patient is in shock and weak
 Butorphanol
 Patient placed in left lateral recumbency and perform on right
 Avoid lacerating coronary vessels, easier to avoid lung
 I like to place patient at a 45o angle
 Use US guidance and approach the pericardium at a perpendicular
angle
 Monitor ECG during the procedure for ventricular arrhythmias
PERICARDIOCENTESIS
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CARDIAC EMERGENCIES OF THE DOG AND CAT

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THANK YOU!! QUESTIONS?
9/26/2023
CARDIAC EMERGENCIES OF THE DOG AND CAT