04.30 - Pericardial Diseases (Nichols)

Question 1

Signs and Symptoms of Acute Pericarditis

Answer 1

Sharp, substernal pleuritic positional pain; Pericardial friction rub

Question 2

2 Forms of Post-MI Pericarditis

Answer 2

(1) Extension of visceral pericarditis to parietal over large transmural infarct, uncommon; (2) Dressler Syndrome 2-12 weeks after infarct, probably AI

Question 3

4 Features of Cardiac Tamponade

Answer 3

JVD, muffled heart sounds, Hypotension, Pulsus Paradoxus

Question 4

5 Causes of Fibrinous Pericarditis

Answer 4

Viral, Uremia, Acute MI, Mets, AI

Question 5

AI Pericarditis occurs with

Answer 5

Lupus (as part of polyserositis), and RA

Question 6

Causes of Fibrinous Pericarditis

Answer 6

Viral Myopericarditis, Uremia, Acute MI, Metastatic Malignancy, AI

Question 7

Causes of Serous Pericarditis

Answer 7

HF, Lymphatic Obstruction by Tumor, Hypoalbuminea

Question 8

Constrictive Pericarditis is commonly due to

Answer 8

Previous Purulent or TB pericarditis

Question 9

Diastolic Rumble and Holosystolic murmur with normal rate and BP

Answer 9

Myxoma likely

Question 10

Drug-Induced Pericarditis occurs with

Answer 10

Procainamide, and Hydralazine

Question 11

Echo findings for Cardiac Tamponade

Answer 11

Diastolic collapse of RA and RV

Question 12

Features of Fibrinous Pericarditis

Answer 12

Dry, roughened, shaggy, bread and butter surface; more neutrophils, lymphocytes, and macrophages; serofibrinous if with effusion

Question 13

Features of Purulent Exudate

Answer 13

Red Granular surface coated with pus, lots of subsurface neutrophils

Question 14

Features of Serous Pericarditis

Answer 14

Smooth surface, scant neutrophils, lymphocytes, and macrophages; thin fluid (protein <50%)

Question 15

Hemorrhagic Pericarditis is associated with what 3 things

Answer 15

(1) Metastatic Carcinoma; (2) Leukemia (t-penia); (3) TB

Question 16

How can Acute MI that leads to HF cause Mitral Regurg

Answer 16

Dilation of ventricle stretches out mitral ring too far for valve to close

Question 17

How old is Acute MI with numerous leukocytic infiltration?

Answer 17

2 days old

Question 18

How old is MI with well developed rim of red granulation tissue around it

Answer 18

About 2 weeks

Question 19

Important tests for unexplained pericarditis

Answer 19

Skin test for TB, chest X-ray

Question 20

JVD, Muffled Heart Sounds, Hypotension, Pulsus Paradoxus

Answer 20

Cardiac Tamponade

Question 21

Limit for slow increase in Pericardial Effusion

Answer 21

1 L

Question 22

Limit for sudden increase in Pericardial Effusion

Answer 22

250mL

Question 23

Most commonly etiology of Acute Pericarditis

Answer 23

Idiopathic (viral)

Question 24

Normal level of Pericardial Serous Fluid

Answer 24

15-50mL

Question 25

Pericarditis with smooth surface, scant neutrophils, lymphocytes and mac’s, effusion of thin fluid

Answer 25

Serous Pericarditis

Question 26

Purulent =

Answer 26

Suppurative

Question 27

Sharp, substernal pleuritic positional pain with Pericardial Friction Rub

Answer 27

Acute Pericarditis

Question 28

Swan-Ganz =

Answer 28

Equalization of pressures

Question 29

Tests for Hemorrhagic Pericarditis

Answer 29

Skin test for TB, chest X-ray

Question 30

Tx of Cardiac Tamponade

Answer 30

Pericardiocentesis

Question 31

Type of Pericarditis caused by Uremia, Acute MI, Mets, AI

Answer 31

Fibrinous

Question 32

Usual clinical course of Acute Pericarditis

Answer 32

Self-limited 1-3 weeks

Question 33

What causes Polyserositis

Answer 33

Lupus

Question 34

What is Constrictive Pericarditis

Answer 34

Encasement of heart in a dense fibrous or fibrocalcific scar, prevents cardiac hypertrophy or dilatation

Question 35

What is preferable in Transposition: VSD or PDA

Answer 35

VSD

Question 36

When does Rheumatic Valve Disease present

Answer 36

Children with ARF, or about 20 years later, with mitral stenosis