265-266 Pericardium/tumors

Question 1

Pericardial friction rub heard in___% of pericarditis, 3 components per cardiac cycle

Answer 1

Rasping, scratching , grating

Heard best end expiration

Question 2

Ecg Stages of pericarditis

Answer 2

Stage 1 (hours to days): diffuse st elevation and pr depression
Stage 2 (first wk): ste normalizes
Stage 3 (variable duration): t wave inversion
Stage 4: normal ecg

Question 3

Clinical classification pericarditis (duration)

Answer 3

Acute <6wka
Subacute 6wks-6mos
Chronic >6mos

Question 4

Familial pericarditis

Answer 4

Mulibrey nanism: growth failure, hypotonia, enlarged ventricles, chronic constrictive pericarditis, hepatomegaly

Question 5

Tx acute pericarditis

Answer 5

• aspirin 2-4g/day - 1-2wks then taper
• nsaids (indomethacin 25-50mg tid, ibuprofen 600-800mg tid): 1-2wks then taper
• ppi
• colchicine 0.5mg od (<70kg); 0.5mg bid (>70kg): enhance response to nsaids, reduce recurrence
• hold anticoagulants can cause hemopericardium
• • if cant tolerate nsaid, pred 1mg/kg x 2-4d then taper but may cause recurrence

Question 6

Indication for admission pericarditis

Answer 6

Fever >38, massive effusion, subacute course

Question 7

Pericardial fluid normal and capacity

Answer 7

Normal 50cc
Acute 200cc
Chronic 2000cc

Question 8

Pericarditis in ckd

Answer 8

• uremic pericarditis
• dialysis associated pericarditis
  Tx: nsaids, intensify hd
  May be sanguinous or fibrinous

Question 9

Square root sign found in

Answer 9

Constrictive pericarditis

Restrictive cardiomyopathy

Question 10

Clinical signs of cardiac tamponade

Answer 10

• becks triad

- pulsus paradoxus: decrease arterial pressure by>10mmhg during inspiration

Question 11

Constrictive pericarditis

Answer 11

• kussmaul sign: increase venous pressure with inspiration
• broadbent sign: apical pulse retracts during systole
• pericardial knock

Question 12

Constrictive pericarditis tx

Answer 12

• pericardial resection 5-10%operative mortality, do earlier better
• sodium restriction ad diuretics

Question 13

Tb pericarditis

Answer 13

• antitb meds, steroids

- if still with thickened pericardium at 2-4wks, pericardiectomy

Question 14

Tumors of the heart percentage benign and malignant

Answer 14

Benign 75%

Malignant 25%

Question 15

Myxoma % sporadic

Answer 15

90%

Question 16

Most common Familial myxoma

Answer 16

Carney complex - lentigines/pigmented nevi, atrial myxomas, endocrine overactivity
Subtypes:
1. LAMB - lentigines, atrial myxomas, blue nevi
2. NAME - nevi, atrial myxomas, myxoid neurfibromas, ephelides

Question 17

Gene mutation in 70% of carney complex

Answer 17

Pkar1A - protein kinase a subtype 1 alpha regulatory subunit

Question 18

Tx and recurrence myxoma

Answer 18

• surgical curative

- recurrence: 1-2% sporadic 12-22% familial

Question 19

Benign

Answer 19

1. lipomas
2. papillary fibroelastoma: most common tumor in valves, cmv, resect even if asymp
3. rhabdomyomas: mc in children and infants, ventricles, multiple in 90%, may regress
4. Fibromas: mc in children, ventricles, can cause arrhythmia, resect even if asymp
5. Paragangliomas: roof of left atrium, hormonally active
6. Hemangiomas and mesotheliomas: intramyocardial: sudden death from arrhythmia

Question 20

Primary malignancies of the heart

Answer 20

Angiosarcoma: most common adult
Rhabdomyosarcoma: most common children
Most are right sided

Question 21

Metastatic tumors mcc

Answer 21

Mc: breast and lung
High propensity to metastasize: malignant melanoma
Epicardium>myo>endo