04.30 - Pericardial Diseases (Nichols) Flashcards
Signs and Symptoms of Acute Pericarditis
Sharp, substernal pleuritic positional pain; Pericardial friction rub
2 Forms of Post-MI Pericarditis
(1) Extension of visceral pericarditis to parietal over large transmural infarct, uncommon; (2) Dressler Syndrome 2-12 weeks after infarct, probably AI
4 Features of Cardiac Tamponade
JVD, muffled heart sounds, Hypotension, Pulsus Paradoxus
5 Causes of Fibrinous Pericarditis
Viral, Uremia, Acute MI, Mets, AI
AI Pericarditis occurs with
Lupus (as part of polyserositis), and RA
Causes of Fibrinous Pericarditis
Viral Myopericarditis, Uremia, Acute MI, Metastatic Malignancy, AI
Causes of Serous Pericarditis
HF, Lymphatic Obstruction by Tumor, Hypoalbuminea
Constrictive Pericarditis is commonly due to
Previous Purulent or TB pericarditis
Diastolic Rumble and Holosystolic murmur with normal rate and BP
Myxoma likely
Drug-Induced Pericarditis occurs with
Procainamide, and Hydralazine
Echo findings for Cardiac Tamponade
Diastolic collapse of RA and RV
Features of Fibrinous Pericarditis
Dry, roughened, shaggy, bread and butter surface; more neutrophils, lymphocytes, and macrophages; serofibrinous if with effusion
Features of Purulent Exudate
Red Granular surface coated with pus, lots of subsurface neutrophils
Features of Serous Pericarditis
Smooth surface, scant neutrophils, lymphocytes, and macrophages; thin fluid (protein <50%)
Hemorrhagic Pericarditis is associated with what 3 things
(1) Metastatic Carcinoma; (2) Leukemia (t-penia); (3) TB
How can Acute MI that leads to HF cause Mitral Regurg
Dilation of ventricle stretches out mitral ring too far for valve to close
How old is Acute MI with numerous leukocytic infiltration?
2 days old
How old is MI with well developed rim of red granulation tissue around it
About 2 weeks
Important tests for unexplained pericarditis
Skin test for TB, chest X-ray
JVD, Muffled Heart Sounds, Hypotension, Pulsus Paradoxus
Cardiac Tamponade
Limit for slow increase in Pericardial Effusion
1 L
Limit for sudden increase in Pericardial Effusion
250mL
Most commonly etiology of Acute Pericarditis
Idiopathic (viral)
Normal level of Pericardial Serous Fluid
15-50mL
Pericarditis with smooth surface, scant neutrophils, lymphocytes and mac’s, effusion of thin fluid
Serous Pericarditis
Purulent =
Suppurative
Sharp, substernal pleuritic positional pain with Pericardial Friction Rub
Acute Pericarditis
Swan-Ganz =
Equalization of pressures
Tests for Hemorrhagic Pericarditis
Skin test for TB, chest X-ray
Tx of Cardiac Tamponade
Pericardiocentesis
Type of Pericarditis caused by Uremia, Acute MI, Mets, AI
Fibrinous
Usual clinical course of Acute Pericarditis
Self-limited 1-3 weeks
What causes Polyserositis
Lupus
What is Constrictive Pericarditis
Encasement of heart in a dense fibrous or fibrocalcific scar, prevents cardiac hypertrophy or dilatation
What is preferable in Transposition: VSD or PDA
VSD
When does Rheumatic Valve Disease present
Children with ARF, or about 20 years later, with mitral stenosis
