Collapse – Syncope

Sudden death

Pericarditis
 Sincopa - Lipotimia
The term „collapse” is used to describe signs of varying
severity and duration where animals falls and become
recumbent with or without a loss of consciousness.

The term “syncope” describes a transient and abrupt loss

of consciousness and postural tone associated with
inadequate cerebral blood flow often due to a
cardiovascular anomaly; either a sudden reduction in
cardiac output or a loss of vasomotor tone resulting in
peripheral vasodilatation.
 Pathogenesis

Decreased cerebral blood flow

Heart causes
Metabolic imbalances
Diseases of the Central Nervous System
 Cardiovascular causes

• High frequency arrhythmias or extreme

bradycardia
• Cardiac obstruction (eg aortic stenosis,
severe subaortic stenosis)
• ↓ cardiac output
• ↓ peripheral resistance → blood stagnation
at the “periphery”
 Symptoms

Type of installation (sudden or slow), duration and

depth of loss of consciousness = variables.

Clinical: dizziness, nausea, instability, movement

disorders, decubitus, pedaling, urinary and fecal
incontinence.
Physical examination (when possible):

Pale skin, sometimes damp and cold

Accelerated and weak pulse versus rare pulse.
Low blood pressure
Mydriasis.
Skeletal muscles - relaxed, sometimes spasms
occur and rarely generalized tonic contractions.
 Diagnosis
Most often based on the anamnesis.
The Etiological diagnosis is difficult and is based
on:
duration of the crisis (subjective assessment)
functional and physical examination of the
cardiovascular system
blood pressure assessment
blood biochemical examination
 Differential diagnosis

Neurogenic syncope

The long duration of the crisis followed by a

long-term depressive state
Existence of signs of neurological focus
(paresis, paralysis, nystagmus, etc.)
 Prognosis, Prophylaxis and Treatment is
performed depending on the cause of syncope
 Sudden death

Sudden death is a natural, rapid and

UNEXPECTED death that occurs in the first
hour after the onset of a heart disease, in
individuals with known or unknown heart
disease.
 Death of apparent healthy individuals
This syndrome does not include deaths that have
occurred in the evolution of a severe disease with a
predictable end (cancer, liver cirrhosis).
Violent deaths are not included - accidents,
intoxications, traumas, etc.
Nothing special is observed on physical
examination (animals examined before sudden death)
Isolated or coupled premature ventricular bets
were observed; Ventricular tachycardia.
 Etiology

Heart diseases, especially hypertrophic

cardiomyopathy or myocarditis caused by
various viruses.
 Causes of Sudden
Cardiovascular Death
-Horses –
Collin C. Schwarzwald, 2018
 Diagnosis

Determined by ECG or Holter ECG in high-

risk individuals (family history)
 Treatment

(At animals with a family history)

Cardiac pacemaker
Treatment of ventricular arrhythmias
Administration of vitamin E, selenium,
carnitine.
 Pericarditis

Accumulation of pericardial fluid in varying

amounts and time in the pericardial sac.
 Etiology
 biotic: viral (Equine herpes, Influenza virus),
bacterial (Streptococcus, Actinobacillus, Pseudo-
monas, Pasteurella, Staphylococcus), parasitic, fungi
 trauma
 metabolic causes: uremia
 Idiopathic ! differential diagnosis from
leptospirosis
 neoplasms.
 Pathogenesis
Liquids can be:
Transudate: clear, low-cellular liquids,
Rivalta negative (protein less than 1 g / dl), low
density
Modified transudates - opaque pink liquids.

In congestive heart failure, diaphragmatic

hernia, hypo-albuminemia, acute toxemia.
Exsudates
- cloudy or opaque liquid, sero-fibrinous or
serosanguinolent, ihoros.
- rich and specific cellularity, increased
specific density, positive Rivalta (+ 3 g / dl).

In: primary or secondary infections.

Hemorrhagic
- increased cellularity (red blood cells)
- quantity ↑ protein and density.

In: neoplasms, idiopathic pericarditis,

atrial rupture, coagulopathies, warfarin
poisoning, uremic pericarditis, iatrogenic,
trauma (pericardocentesis)
1. Quantity: low, medium, large.
2. Accumulation speed

Cardiac tamponade - accumulation of medium or

large amount in a short time with specific clinical
picture - Cardiogenic shock.
Accumulation of a quantity ↑ in a long time →
Shock does not appear → “pericarditis” but NOT
cardiac tamponade.
 Symptoms

It depends on the amount and speed of

accumulation.

May be associated with pleurisy (common)

and ascites.

Severe - Cardiac tamponade: shock and death.

 Chronic pericarditis

Dyspnoea - orthopnea.
Abdominal breathing
Decreased vesicular murmur until it disappears.
Attenuation of heart sounds.
Signs of hypodiastolic heart failure:
hepatomegaly, jugular turgor.
Fever - Infectious pericarditis.
 Abdominal breathing
Differential diagnosis
Massive pericardial effusions accumulated
over time.
Massive pleurisy accumulated over time.
Pulmonary neoplasms - crackles
Chronic bronchitis - "Pulmonary
emphysema"
DIAGNOSIS
 Pericarditis is suspected on the basis of
symptoms and is confirmed by imaging
diagnostic methods:

Eco - anechoic areas around the heart

Rx. - "spherical" cardiomegaly

ECG - Severe reduction of ECG wave

amplitude
 Echocardiography

Anechoic (black) areas

around the heart.
Differential diagnosis of
pleurisy.
 Radiographic diagnosis
Acute pericarditis - fluid
accumulation in a short time -
Spherical shape

Chronic pericarditis - deformed image

- bizarre.
 ECG
Microvoltages

Normal amplitude in pericarditis + Left Ventricular

Hypertrophy
Treatment

Acute Pericarditis –
Pericardiocentesis

Chronic Pericarditis -
Etiological and
symptomatic treatment:
prednisone, furosemide.
Not Phlebotomy !