The Haunted Heart

The HAUNTED HEART

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Introduction

You are trapped inside the chambers of a haunted heart. The ghost that guards it cannot rest until its memories of pericardial disease are restored. To escape, you must navigate the pericardium’s dark secrets. Answer carefully: a wrong choice may trigger cardiac arrest, and only knowledge will bring you out alive…

01

While exploring the pericardial hallway, you notice two thin shimmering membranes. Which best describes them?

Parietal and visceral layers of the serous pericardium

Fibrous pericardium and visceral epicardium

Endocardium and myocardium

02

A cracked vial labeled “pericardial fluid” glows faintly in the hallway. Only a trace remains inside. How much fluid normally exists in a healthy dog or cat’s pericardial cavity?

Trace volume (microliters–few mL)

10-20 mL

50 mL

03

The pericardial hallway begins to flood. A ghost warns: “A few drops arrive quickly, and the chambers collapse. A whole bucket seeps in slowly, and the heart endures for weeks. Why?”

Fast effusion causes RAAS activation, while slow effusion does not

Slow accumulation is always benign, regardless of volume

Rapid accumulation raises intrapericardial pressure sharply, causing tamponade at low volumes

04

The walls suddenly constrict, making diastolic filling nearly impossible. The ghost laughs: “When my pressure exceeds that of the right atrium, collapse follows.” What condition has occurred?

Cardiac Tamponade

Chronic effusion

Constrictive pericarditis

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01

A Golden Retriever slams the piano keys and collapses. Echo shows effusion with a right atrial mass. What is the most likely cause?

Hemangiosarcoma

Chemodectoma

Idiopathic pericarditis

Mesothelioma

02

A low, rumbling chord echoes. A brachycephalic dog presents with recurrent pericardial effusion and a mass at the heart base. Which cause is most consistent?

Ectopic thyroid carcinoma

Chemodectoma

Brachycephalicoma

Hemangiosarcoma

03

A piercing high note rings out. A 14-year-old cat gasps with dyspnea and tachypnea. Echocardiography shows a small pericardial effusion with marked LA dilation. What is the most likely cause?

A witch

Lymphoma

FIP

CHF

04

The piano lid crashes shut. A toy breed dog with severe left atrial enlargement collapses suddenly. The ghost warns: “Tap me and I bleed.” What rare but deadly cause must you consider?

Left atrial tear

Coagulopathy (DIC)

The haunting of a Beverly Hills Chihuahua

Infectious pericarditis (fungal)

You found a secret message

♪♬ø

Remember these notes and play them on the piano in the correct order

01

...Keep playing

02

...One more

03

Start over...

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♪♬ø

You found a new item for your inventory

Use the magnifying glass to search for the code on the cardiac wall and then insert it into the typewriter

224

Enter the secret code

Code

The cardiologist’s ghost blocks your path. A dog lies weak, hypotensive, muffled heart sounds, jugular distension. What is the lifesaving treatment?

01

Thoracocentesis

Pericardiocentesis

Furosemide

The cardiologist’s ghost drags in a cat with a small pericardial effusion secondary to CHF. He hisses: “What is the best treatment for this patient?”

02

Subtotal pericardiectomy

Manage underlying CHF (diuretics/ACEI)

Pericardiocentesis

The surgeon’s ghost towers over you. A spectral dog lies before him — weak, tachycardic, jugular veins distended, pulses faint. The ghost growls: “What is the most common clinical finding of tamponade in dogs?”

03

Muffled heart sounds

Ascites

Dyspnea

The cardiologist’s ghost towers over you. A spectral dog lies before him — weak, tachycardic, jugular veins distended, pulses faint. The ghost growls: “What is the most common clinical finding of tamponade in dogs?”

03

Muffled heart sounds

Ascites

Dyspnea

A briefcase has appeared...

It's locked...look in the inventory for something to open it

Congratulations

You survived cardiac tamponade! Your knowledge was the pericardiocentesis. The ghost is free… and you escaped the Haunted Heart.

Oh, no. You failed...

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