Arthur was one of Karl’s first cases to see when he joined the team at Bridge Referrals. It quickly became a very memorable one. Arthur’s case was a great example of the power of a multidisciplinary team working together to give the patient the best outcome.
Arthur came to us with a history of seizure like activity and suspected pericardial effusion. He was a lovely old Labrador but when he arrived he had definitely lost his usual bounce, but could still manage a tail wag. Arthur had all the signs of pericardial effusion with muffled heart sounds, increased capillary refill time and poor femoral pulses. He was not a happy chap at all. He also had quite a painful abdomen when palpated but it did not feel ascitic which is certainly something we can see with Pericardial effusion.
On Ultrasound, there was an obvious pericardial effusion and cardiac tamponade was seen in both the right atrium and ventricle. This occurs when the pressure of the fluid in the pericardial sac becomes greater than right sided intra cardiac pressure during diastole so you will see the wall actually collapse inwards. As we removed the 200ml of fluid from Arthur’s pericardial sac he started to develop a ventricular tachycardia. Again, this is not uncommon with pericardiocentesis, although it usually settles when the the fluid is removed. His cardiac function was good when we re-scanned it.
With Arthur however, the rhythm didn’t stop. His bloods came back with changes consistent with pancreatitis and his abdomen was still very sore but clear of fluid on scan. At this point Arthur became a joint patient of both medicine and cardiology, one of the great advantages of working in a multidisciplinary team. He was started on a Lidocaine drip for his arrhythmia and symptomatic relief for his pancreatitis and admitted for hospital care for the next few days. It was touch and go for the first 2 days, but then Arthurs heart stabilised and he then started to eat and became a lot more comfortable. 5 days after Karl first saw him, he went back home to very happy owners with a lot of his bounce back and a very waggy tail.
Pericardial effusion has a number of possible causes, idiopathic; neoplasia and trauma being the most common. In Arthur’s case, there was no evidence or history of trauma and no clear neoplasia was seen on any of his scans. A diagnosis of Idiopathic Pericardial Effusion was made in Arthurs case. This condition can be a one off occurrence or may recur on a regular basis, unfortunately there is no way to predict. Regular pericardiocentesis can be carried out as long as it does not impact the welfare of the dog and quality of life is good in between procedures. In this case it seems like the stress of the effusion brought on an acute attack of pancreatitis which confused the issue. The ventricular tachycardia was likely triggered by the procedure but then sustained by the pancreatitis.
This case shows how what can start off needing one discipline can quickly develop to needing more.