4.5: Pericardial disease

Question 0

Acute pericarditis- info

Answer 0

acute inflammation of pericardial cavity
Days to weeks
Virus- Cocksackie*, HIV, CMV, EBV, Flu
Bacteria- Pneumococcus, Staph, 
TB
Fungus- Histoplasmosis, Blastomycosis
Non-infectious: Post-MI* (immediate or Dressler's), Malignancy (mesothelioma), Mets, Uremia*, Radiation, Trauma
Hypersensitivity: SLE, Sarcoidosis, Procainamide, Hydralazin, INH&

Question 1

Timeline

Answer 1

Acute 6 month

Especially for Constrictive pericarditis

Question 2

Acute pericarditis- sx

Answer 2

Chest pain- Sharp
Ask the pts to hold breath and pain remains-> Pericardial pain
““pain goes away-> Pluritic pain
Moderate raise in myocardial biomarker and ST elevation*
Pain: Lying down makes it worse, sitting up makes it better*
“” pain does not change: MI
Scratchy sound on auscultation: sound stays with holding of breath
“”: sound goes away with Pluritic cause

Question 3

EKG AP/MI

Answer 3

ST elevation
AP: concave on all the LEADs
MI: convex on specific LEADs

PR segment depression: AP only

Question 4

Pericardial effusion- info

Answer 4

Excess fluid in pericardial cavity >200
Cause: Acute pericarditis
Amount and Rate is IMP
If its slow-> can accomodate up to 2L
If its fast-> even 200mL can cause it

Question 5

Pericardial effusion- sx

Answer 5

Compression on local structure

Question 6

Pericardial effusion- exam

Answer 6

Heart sound- quieter, muffled
Scratchy sound might go away
Ewart’s sign: area of dullness lower medial side of left scapula

Question 7

Pericardial effusion- dx

Answer 7

EKG (QRS complex: small. QRS alternants [big and small-> since the heart is floating in fluid and oscillates back and forth])
Ecocardiogram
Chest X-ray (enlarged heart shadow)*
Pericardial centesis: from xiphisternum up toward collar bone

Question 8

Pericardial effusion- tx

Answer 8

symptomatic
Pericardial centesis
Recurrent: Pericardiotomy

Question 9

Cardiac tamponade- info

Answer 9

Medical emergency
Outside pressure takes over inside pressure of heart due to too much blood or blood is filling up too fast in pericardial cavity.
The same pressure in all 4 chambers during diastole**
With Uremia, post-MI lateral free wall rupture, Malignancy

Question 10

Pericardial tamponade- exam

Answer 10

Dyspnea, syncope
JVD: dilated
Pulsus paradoxis: drop in systolic BP during inspiration >10mmHg* (LV is compressed even more by external pressure)
Normal on inspiration- more blood in the right side of the heart, RV compress LV-> slight dip in systemic BP <10mmHg*

Question 11

Cardiac tamponade- Atrial pressure

Answer 11

NO y wave (the filling of ventricle by pressure difference of A/V, since there is no pressure difference in all 4 chambers during diastole

Question 12

Cardiac tamponade- tx

Answer 12

Immediate pericardial centesis

Question 13

Constrictive pericarditis- info

Answer 13

Subacute or chronic

Concrete layer/ calcification around the heart

Question 14

Constrictive pericarditis- sx

Answer 14

Back up of blood since heart cannot be filled-> distention
Kussumaul sign: on inspiration, JVD increases (normal: decrease)
Pericardial knock: when heart expands on diastole, makes a knocking sound
Fredrick’s sign/ Square root sign: sudden drop of intracardial pressure during filling until the heart hits the wall

Question 15

Constrictive pericarditis- tx

Answer 15

Pericardial stripping