8. MTB Step 3 - Pericardial Disease Flashcards
Cards Complete:
PERICARDITIS
PRESENTATION
What are the (2) Most Common Presenting Symptoms of Pericarditis?
*SHARP & BRIEF* Chest Pain that is…
Pleuritic (changes w/ Respiration)
and
Positional (Relieved by Sitting Up and Leaning Forward)
PERICARDITIS
ETIOLOGY
What are the Vast Majority of Pericarditis cases Caused By?
VIRUS
PERICARDITIS
ETIOLOGY
What are (3) General Causes of Pericarditis that can be in the Patient’s History?
- ANY Infectious agent
- Collagen-Vascular Disease
- Trauma
PERICARDITIS
PHYSICAL EXAM
What is the ONLY pertinent Positive Finding on Physical Exam and what are it’s (3) Components?
Friction Rub
- Only present in 30% of patients with Pericarditis
- There is NO Pulsus Paradoxus, Tenderness, Edema, or Kussmaul sign
- BP is Normal, and there is NO Jugular Venous Distension (JVD) or Organomegaly
PERICARDITIS
DIAGNOSIS
What is the Best INITIAL Test for Pericarditis and what are (2) Findings this Test shows?
ECG
Shows:
- ST Elevation is ALL Leads (everywhere)
-
PR Depression in Lead II is PATHOGNOMONIC
- Not always present
PERICARDITIS
TREATMENT
What is the Best INITIAL Therapy for Pericarditis and what are (4) Examples?
NSAIDs
Examples:
- Indomethacin + Colchicine
- Naproxen + Colchicine
- Aspirin + Colchicine
- Ibuprofen + Colchicine
Colchicine adds Efficacy to NSAIDs and Prevents Recurrent episodes.
PERICARDITIS
TREATMENT
If the Chest Pain persists in a patient with Pericarditis AFTER 1 - 2 days of initial therapy, what Treatment should be Added Next?
Prednisone (PO)
PERICARDIAL TAMPONADE
PRESENTATION
What are (4) Common Presenting Signs/Symptoms of Pericardial Tamponade?
- Shortness of Breath (SOB)
- Hypotension
- Jugular Venous Distension
- CLEAR Lungs on Auscultation
PERICARDIAL TAMPONADE
PRESENTATION
What are (2) Unique Features of Pericardial Tamponade?
- Pulsus Paradoxus is a Decrease of BP > 10 mmHg on INHALATION.
- Electrical Alternans is Alterations of the Height (Axis) of the QRS Complex on ECG.
PERICARDIAL TAMPONADE
BASIC SCIENCE CORRELATE
What is the Mechanism of Pulsus Paradoxus?
MECHANISM:
- Inhalation INCREASES Venous Return
- Increased Venous Return EXPANDS the RIGHT Ventricle
- Expanded RIGHT Ventricle COMPRESSES the LEFT Ventricle
- Compressed LEFT Ventricle DECREASES Blood Pressure
Pericardial Tamponade COMPRESSES the Whole Heart
PERICARDIAL TAMPONADE
DIAGNOSIS
- What is the Best INITIAL Test for Pericardial Tamponade?
- What is the Most ACCURATE Diagnostic Test for Pericardial Tamponade?
-
ECG
- Shows Electrical Alternans - variation in the height of the QRS Complex from the heart moving backward and forward in the chest.
-
Echocardiography
- The earliest finding in Tamponade is Diastolic Collapse of the Right Arium and Right Ventricle
**NOTE: It is normal to have 50 mL or less of Pericardial Fluid, but there should be NO collapse of the cardiac structures at this amount.
PERICARDIAL TAMPONADE
DIAGNOSIS
What does Right Heart Catheterization show with Pericardial Tamponade?
“Equalization” of ALL the pressures in the Heart during Diastole (the wedge pressure will be the same as the RA and pulmonary artery diastolic pressure)
PERICARDIAL TAMPONADE
TREATMENT
- What is the Best INITIAL Therapy for Pericardial Tamponade?
- What is the Most EFFECTIVE Long-Term Therapy for Pericardial Tamponade?
- What is the Most DANGEROUS Therapy for Pericardial Tamponade?
- Pericardiocentesis
- Pericardial Window
- Diuretics
CONSTRICTIVE PERICARDITIS
PRESENTATION
Which (2) Signs/Symptoms does Constrictive Pericarditis present with?
- Shortness of Breath (SOB)
-
Signs of Chronic RIGHT Heart Failure:
- Edema
- Jugular Venous Distension (JVD)
- Hepatosplenomegaly
- Ascites
CONSTRICTIVE PERICARDITIS
PRESENTATION
What are (2) Unique Features of Constrictive Pericarditis?
- Kussmaul Sign is an Increase in JVD on INHALATION.
- Pericardial Knock is an Extra Diastolic sound from the Heart hitting a Calcified, thickened Pericardium.
