32_pericardial disease

Question 1

Etiologies of Acute pericarditis include:

Answer 1

Idiopathic, Viral, fungal, uremic, tuberculosis, trauma, radiation, drug reaction

Question 2

The 3 stages of Acute pericarditis are:

Answer 2

1. Local vasodilation
2. Increased vascular permeability
3. Leukocyte followed by mononuclear infiltration

Question 3

Scant infiltrate in acute pericarditis

Answer 3

Serous pericarditis

Question 4

Bread and butter infiltrate

Answer 4

Serofibrinous pericarditis

Question 5

Bloody effusion

Answer 5

Hemorrhage pericarditis

Question 6

Intense exudate in acute pericarditis

Answer 6

Purulent (suppurative) pericarditis

Question 7

Acute pericarditis is better with inhalation(T/F)

Answer 7

False

Question 8

Acute pericarditis is relieved when standing and leaning forward (t/f)

Answer 8

True

Question 9

Which has a sharp, stabbing angina? (MI or Pericarditis or both)

Answer 9

Pericarditis is associated with a sharp, stabbing chest pain while MI has more of heavy pressure-like squeezing

Question 10

When do you see convex ST elevations on an ECG? (MI or Pericarditis or both)

Answer 10

Myocardial infarction usually has a localized convex ST elevation. Pericarditis has a wide concave ST elevation.

Question 11

Therapy for acute pericarditis includes:

Answer 11

NSAIDS
Colchicine
Corticosteroids
Each etiology has some specific therapies i.e. uremic - dialysis, purulent - catheter drainage

Question 12

When would outpatient treatment NOT be enough for acute pericarditis cases?

Answer 12

High fever 
Trauma 
Immunocompromised
Tamponade
Myocarditis

Question 13

Characteristic etiology and pathophysiology of Pericardial Effusion

Answer 13

Any pericarditis
Non inflammatory serous effusion
Increased capillary permeability (hypothyroidism)
Increased capillary hydrostatic pressure (CHF)
Decreased plasma oncotic pressure (nephrotic syndrome)
Trauma

Question 14

Pericardiocentesis is the indicated in any pericardial effusion case (t/f)

Answer 14

False. Pericardiocentesis is only used in hemodynamically significant cases

Question 15

Characteristics of pericardial effusion on Diagnostic tests

Answer 15

ECG: Low voltage complexes, Electrical altercans (variation in QRS height)

CXR: if >200-250 cc = water bottle heart

Question 16

Patients with pericardial effusion can have the following symptoms:

Answer 16

Asymptomatic
Dull heart sounds
Compression of surrounding structures (trachea, esophagus, recurrent laryngeal nerve-voice,lung)
Ewart sign - dull percussion of left scapula inferior angle
Friction rub

Question 17

Cause of tamponade?

Answer 17

Any cause of effusion 
Acute hemorrhage (trauma, post MI wall rupture, cmplxn of aortic dissection)

Question 18

What happens in tamponade?

Answer 18

Each chamber diastolic pressure increases and equals the pericardial pressure.

This leads to reduced venous return–> lower stroke volume and lower cardiac output. With failed compensatory mechanisms fail (tachycardia, systemic vasoconstriction, etc.) cardiogenic shock can develop.

Beck’s Triad (systemic hypotension, distension of JV, quiet heart)

Inspiratory fall in systolic blood pressure

Question 19

Diagnosing tamponade?

Answer 19

Cardiac Cath is definitive hemodynamic marker of tamponade

Echo shows chamber collapse as well as inhalation variation in inflow

Question 20

Is the “y descent” blunted or rapid in tamponade?

Answer 20

Y descent should be blunted because the increased diastolic pressure in the chambers reduces the decline in pressure of the atria

Question 21

How do you distinguish restrictive cardiomyopathy from constricted pericarditis?

Answer 21

Biopsy- RCM will show abnormalities while constricted pericarditis will be normal

Question 22

Does constricted pericarditis have blunted or rapid y descent?

Answer 22

Its y descent is rapid in early diastole because the ventricles are able to expand to a certain point before the scarred pericardium prevents further expansion.

Question 23

What would the result of Kussmaul sign be if I have constricted pericarditis?

Answer 23

On inspiration, the jugular vein should be distended indicating dysfunction in the right heart. Normally inspiration decreases thoracic pressure , allowing more expansion during diastole, thus dropping JVP.

Question 24

What is the only treatment for severe constricted pericarditis?

Answer 24

Pericardiectomy