102014 pericardial dis

Question 1

pericardium is composed of

Answer 1

two layers: visceral and parietal

Question 2

significance of pericardial pres volume curve

Answer 2

relatively flat, compliant segment will transition relatively abruptly to a non compliant section

means that once critical volume of effusion is reached, small additional amts will create large increase of intrapericardial pres

Question 3

causes of acute pericarditis

Answer 3

majority of cases are idiopathic, assumed to be viral

Question 4

symptoms of acute pericarditis

Answer 4

chest pain, almost always present-better sitting forward and worse when lying down. SHARP AND PLEURITIC LIKE.

can have dyspnea, cough, hiccups, fever

secondary forms are associated with disorder-specific symptoms

Question 5

PE findings for acute pericarditis

Answer 5

pericardial friction rub-best heard at left LSB with pt leaning forward. disappearing/returning over short periods of time.

Question 6

ECG findings for acute pericarditis

Answer 6

ST segment elevation (step 1)
PR depression (elevation in AVR)
PR depression may be only ECG finding

ECG changes are dynamic! like the friction rub

low voltage QRS (non specific for acute pericarditis)

Question 7

laboratory findings for acute pericarditis

Answer 7

for idiopathic pericarditis:
mild elev of WBC count w/ lymphocytosis
mild elev of ESR

consider secondary etiologies:
significant WBC elev
anemia, elev ESR

Question 8

CXR for acute pericarditis

Answer 8

usually normal in uncomplicated pericarditis

abnormal–would consider secondary disorders

Question 9

tx of acute pericarditis

Answer 9

uneventful recovery in 70-90% of pts with acute idiopathic pericarditis

tx with NSAIDs
colchicine (given with NSAIDs)
steroids

Question 10

noninflam causes of pericardial disease

Answer 10

hydropericardium

hemopericardium

Question 11

pulsus paradoxicus

Answer 11

larger than 30mmHg drop in systolic pressure with inspiration