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So now fast forward through 15 years of AFAST and TFAST. Using ultrasound as a first‐ line screening test, veterinarians (and physicians) are now capturing PCE cases that would have otherwise been missed (Lisciandro 2014a,b, 2016a). However, what we are finding with the paradigm change is that there are two subsets of PCE, acute and chronic, and they are remarkably different (Table 7.8).

In the past, a feline or canine patient may have had acute PCE and cardiac tamponade but with radiography dominating as first‐line imaging, the unremarkable or equivocal cardiac silhouette missed the PCE because many patients were never scheduled for echocardiography. The patient, with or without help from the attending clinician, often declared themselves survivors or nonsurvivors despite care. In those that survived, the patient likely compensated, stretched its pericardium over time before developing the classic globoid heart and ascites, representing as weak with abdominal distension from ascites and generally stable. Pericardiocentesis was more commonly an elective procedure with high success due to PCE chronicity. In this patient subset, the findings of electrical alternans, pulsus paradoxicus, muffled heart sounds, and a globoid heart on thoracic radiography were possible, although with variable reliability (Johnson et al. 2004).

Table 7.8. Most common causes of pericardial effusion in dogs and cats.

Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX.

Dogsa	Catsc
Neoplasiab (~70%)	Congestive heart failure (≥75%)
Idiopathic (~20%)	Idiopathic
Right‐sided congestive heart failure	Lymphoma
Left atrial tear/rupture	Feline infectious peritonitis (FIP)
Anticoagulant rodenticides	Hyperthyroidism
Foreign body (plant awn, porcupine quill, projectile, other)	Uremia
Infectious (bacterial, fungal)	Infectious (fungal, bacterial)
Peritoneopericardial diaphragmatic hernia	Peritoneopericardial diaphragmatic hernia
Pericardial cyst	Sepsis
Uremia
Trauma

^a Ascites is a more favorable diagnosis with median survival reported to be 605 days compared to 45 days in dogs without ascites (Johnson et al. 2004), thus Global FAST should be done first line.

^b ~50–60% have metastatic disease at time of diagnosis (MacDonald et al. 2009), thus Global FAST should be done first line.

^c Most common cause in cats is congestive heart failure and most common heart disease is hypertrophic cardiomyopathy (Hall et al. 2007).

Data from Hall et al. (2007); Davidson et al. (2008); Shaw and Rush (2007); MacDonald et al. (2009); Ward et al. (2018).