Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AI flashcard > AI Flashcards > Flashcards

AI Flashcards

1
Q

What is the pericardium?

A

A sac that surrounds a closed potential space with reflections of pericardial tissue that create sinuses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two layers of the pericardium?

A
  • Visceral pericardium (continuous with the epicardium)
  • Parietal pericardium (thin, dense, fibrous structure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What structures do the reflections in the posterior region of the pericardium surround?

A
  • Venae cavae
  • Pulmonary veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the dead ended pocket behind the left atrium called?

A

The oblique sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does the pericardium do?

A
  • Provides mechanical restraint to the cardiac chambers
  • Limits ventricular filling
  • Protects against excessive incompetence of atrioventricular valves
  • Isolates the heart from the surrounding mediastinal structures
  • Facilitates normal myocardial rotation and translation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What biochemical substances does the pericardium secrete?

A

Prostacyclin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the fibrinolytic function of the pericardium?

A

Maintains accumulated blood in a liquid state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How are changes in intrathoracic pressures transmitted to the pericardial space?

A

Nearly equally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the true filling pressure of the heart?

A

The true filling pressure of the heart is determined by transmural pressure.

Transmural pressure is calculated by subtracting the pericardial pressure from the intracardiac pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do intrathoracic pressures during spontaneous inspiration affect left heart output?”
“A. Body”: “Intrathoracic pressures during spontaneous inspiration may contribute to a decrease in left heart output.

A

This is due to a decrease in left atrial (LA) pulmonary venous return.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do intrathoracic pressures during IPPV inspiration affect left heart output?

A

Intrathoracic pressures during IPPV inspiration favor an increase in left heart output.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What changes occur in transtricuspid and transmitral velocities during spontaneous respiration?

A
  • Transtricuspid velocities normally increase by approximately 20% during spontaneous inspiration.
  • Transmitral velocities normally decrease by approximately 10% during spontaneous inspiration.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What changes occur in transtricuspid and transmitral velocities during IPPV?

A
  • Transtricuspid velocities decrease during IPPV.
  • Transmitral velocities increase during IPPV.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What physiological variables affect the absolute values of transtricuspid and transmitral velocities?

A

The absolute values of these velocities are affected by age, heart rate, rhythm, preload, volume flow rate, ventricular systolic function, diastolic function, and atrial contractile function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are intrathoracic pressures affected by certain pericardial pathologies?

A

In patients with certain pericardial pathologies, intrathoracic pressures may be blunted and not effectively transmitted to the intrapericardial structures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What alternative profile of transmitral velocity has been observed under conditions of intravascular volume depletion?

A

Under conditions of intravascular volume depletion, some transmitral profiles may reveal a slight decrease in maximal amplitude during IPPV inspiration that further decreases during expiration and reaches a nadir during expiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the five basic categories of pericardial pathology?

A
  • Pericarditis
  • Pericardial effusions severe enough to elicit tamponade physiology
  • Other pericardial pathologies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the general categories of pericardial pathology?

A
  • Congenital Pericardial Defects
  • Pericarditis
  • Pericardial Effusion
  • Pericardial Tamponade
  • Pericardial Masses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the significance of pericardial absence?

A

Most patients with pericardial absence are clinically asymptomatic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common clinical presentation in patients with congenital absence of the pericardium?

A

Paroxysmal stabbing chest pain that mimics coronary ischemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the incidence of additional congenital abnormalities in individuals with congenital absence of the pericardium?

A

30% of these patients will have some additional congenital pathology.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What imaging modalities are useful in making the definitive diagnosis of congenital absence of the pericardium?

A
  • CXR
  • Cardiac MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the etiologies of pericarditis?

A
  • Infections
  • Neoplastic
  • Immune/Inflammatory
  • Intracardiac-pericardial communications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the classic clinical findings in a patient suspected of having pericarditis?

A
  • Chest pain
  • ECG evidence of pericarditis (e.g., diffuse ST segment elevations)
  • Pericardial rub on auscultation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the normal pericardial thickness?

A

Approximately 2-3 mm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What imaging techniques have higher sensitivity and specificity for detecting pericarditis compared to echocardiography?

A
  • Cardiac MRI
  • High resolution (64 slice) computed tomography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is a pericardial effusion?

A

A collection of fluid within the pericardial sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the different patterns of fluid distribution in a pericardial effusion?

A
  • Diffuse distribution within the pericardium
  • Localized distribution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does a pericardial effusion appear on an echocardiogram?

A

Echolucent signal adjacent to the epicardium

30
Q

What are the general guidelines for pericardial effusion size and fluid distribution patterns?

A

Refer to Table 3

31
Q

What must be ruled out when diagnosing a pericardial effusion?

A

Presence of epicardial fat

32
Q

What is the clinical significance of a pericardial effusion?

A

Related to the amount of fluid and the time course of accumulation

33
Q

What ECG finding can be associated with pericardial effusions?

A

Electrical alternans

Regular occurrence of alternating heights of the QRS complex that may involve other waves and segments

34
Q

What is the relevance of a pericardial effusion in cardiac surgical patients?

A

Highly common in cardiac surgical patients, generally peaking by the 10th postoperative day

35
Q

What happens when intrapericardial pressure increases to the point that cardiac chamber filling is compromised?

A

Development of tamponade physiology

36
Q

What occurs when there is a significant increase in pericardial pressure?

A

Manifestation of ventricular interdependence

37
Q

What is the adaptive nature of the pericardium in slowly accumulating effusions?

A

Hypertrophy of mesothelial cells and increased accommodation of pericardial fluid

38
Q

What happens to the septum in pericardial tamponade?

A

The septum will shift towards the left

39
Q

What is characteristic of tamponade in the CVP tracing?

A

Loss of the y-descent

40
Q

What is tamponade physiology?

A

When the pericardial pressure exceeds cardiac chamber pressure

41
Q

What are the echocardiographic findings of pericardial effusions?

A
  • Echolucent signal adjacent to the pericardium
  • Fibrinous stranding within the pericardial fluid
  • Regional septal wall motion abnormalities
  • MV & TV prolapse
  • Systolic anterior motion (SAM) of the anterior mitral leaflet
  • Early systolic closure of the aortic valve
  • Mid-systolic notching of either the aortic valve or pulmonic valve
42
Q

What are the echocardiographic findings of pericardial tamponade?

A
  • RA systolic collapse, or inversion
  • RV diastolic collapse
  • Reciprocal respiratory changes in RV and LV volumes

Inversion for > 1/3 of systole has a 94% sensitivity and 100% specificity for tamponade. RV diastolic collapse has a sensitivity of 60-90% and specificity of 85-100% for tamponade.

43
Q

What is the pulsus paradoxus?

A

It is a phenomenon characterized by an exaggerated decrease in systemic blood pressure during inspiration

44
Q

What is the characteristic waveform observed during expiration in patients with pericardial tamponade?

A

Expiration-pulsus paradoxus

45
Q

What is an indicator of tamponade that can be observed on the arterial waveform?

A

Inferior vena cava (IVC) plethora (dilated IVC with < 50% inspiratory reduction in diameter near the IVC-RA junction)

46
Q

How does Doppler evaluation of tamponade physiology provide diagnostic information?

A

Decrease in transmitral velocity flow profiles during inspiration

Normal trans-atrioventricular valve Doppler profiles show a decrease in transmitral velocity flow during inspiration.

47
Q

What happens to transtricuspid valve velocities during spontaneous respiration in tamponade?

A

They increase by as much as 77%

48
Q

What is the mechanism for the exaggerated respirophasic variation in tamponade during spontaneous respiration?

A

Insulation of the heart from the intrathoracic pressure changes associated with the respiratory cycle

49
Q

How does Doppler interrogation of transmitral valve velocities during IPPV differ from spontaneous respiration?

A

The dynamics of the transmitral valvular velocities are opposite in direction and markedly attenuated

According to a study in a canine model, the dynamics in transmitral valvular velocities seen in pericardial tamponade are opposite in direction and markedly attenuated during IPPV.

50
Q

What is the overall change in amplitude of flow velocities observed during mechanical ventilation in tamponade?

A

There is a decrease in the amplitude of the flow velocities compared to individuals without tamponade

51
Q

In addition to trans-atrioventricular valve velocities, what other flow profiles can provide diagnostic information in patients with tamponade?

A

Hepatic vein flow profiles

52
Q

How do hepatic vein flow velocities change during inspiration in patients with tamponade?

A

The systolic and diastolic forward flow velocities increase

Under conditions of tamponade physiology, the systolic and diastolic forward flow velocities in the hepatic vein increase in magnitude during inspiration.

53
Q

What happens to hepatic vein flow velocities during expiration in patients with tamponade?

A

There is a marked reduction, or reversal, of both the S and D waves

In normal subjects, the forward flow during systole in the hepatic vein is equal to or greater than the forward flow during diastole throughout the respiratory cycle. However, in tamponade, there is a marked reduction or reversal of both the S and D waves during expiration.

54
Q

Is the evaluation of hepatic vein profiles with TEE useful in patients with tamponade physiology during positive IPPV?

A

No

Data on respirophasic changes in hepatic veins during IPPV is not available, so the evaluation of hepatic vein profiles with TEE during positive IPPV is not useful at present.

55
Q

What is an important quantitative method for assessing pericardial effusion and tamponade physiology?

A

Measurement of the isovolemic relaxation time (IVRT)

The IVRT is normally < 100 msec in most age groups and significantly prolonged in tamponade patients

56
Q

What are the pathophysiologic features of constrictive pericarditis?

A
  • Fibrotic pericardium
  • Inflamed pericardium
  • Calcific thickening of the pericardium
  • Abnormal diastolic filling
  • Narrow RV pulse pressure
  • Prominent early diastolic RV pressure dip and later plateau
57
Q

What imaging modalities are considered to provide more accurate measurements of pericardial thickness in constrictive pericarditis?

A
  • Computed tomography
  • Magnetic resonance imaging
58
Q

What are some nonspecific echocardiographic findings associated with constrictive pericarditis?

A
  • Paradoxical ventricular septal motion
  • Ventricular septal “bounce”
  • Diastolic flattening of the posterior LV
  • Premature mid-diastolic pulmonary valve opening
  • Spontaneous inspiratory leftward shift of the atrial & ventricular septum
  • Enlarged hepatic veins
  • Dilated IVC without variation in size during respiration
  • Normal ventricular size
  • Normal or enlarged atria with reduced wall excursion
59
Q

What Doppler modalities are used to assess constrictive pericarditis?

A
  • Pulse wave Doppler transmitral tracings
  • Pulse wave Doppler pulmonary vein tracings
  • Tissue Doppler imaging of the mitral annulus
  • Color Doppler M-mode (flow propagation, Vp) of the transmitral inflow
60
Q

What is the mechanism behind the exaggerated respirophasic variation observed in constrictive pericarditis?

A

The thickened pericardium insulates the intracardiac chambers from the changes in intrathoracic pressure, increasing the gradient between the pulmonary veins and the left atrium during inspiration.

61
Q

What is the primary difference in decreased left ventricular compliance between constrictive pericarditis and restrictive cardiomyopathy?

A

In constrictive pericarditis, the decreased compliance is related to the restrictive nature of the thickened pericardium, while in restrictive cardiomyopathy, the restriction is related to pathology within the myocardium.

62
Q

How can constrictive pericarditis be differentiated from restrictive cardiomyopathy?

A
  • Assessment for exaggerated respiratory variation in transmitral Doppler flow velocity profiles
  • Echocardiographic or cardiac MRI/high resolution CT scan evidence of pericardial thickening
  • Color M-mode flow propagation velocities (Vp)
  • Doppler tissue imaging (DTI) at the level of the mitral annulus
  • Doppler myocardial velocity gradients (MVGs)
63
Q

What is Color M-mode used for in the assessment of patients with suspected CP?

A

Color M-mode provides excellent spatial and temporal resolution of diastolic mitral inflow.

64
Q

What will Color M-mode assessment generally demonstrate in patients with CP?

A

Color M-mode assessment will generally demonstrate high values of flow propagation toward the LV apex.

65
Q

What will Color M-mode assessment generally demonstrate in patients with RCM?

A

Color M-mode assessment in patients with RCM will have decreased Vp values.

66
Q

What does Transthoracic TDI of the lateral mitral annulus in a patient with CP show?

A

Transthoracic TDI of the lateral mitral annulus in a patient with CP shows high Em velocity.

67
Q

What does Transthoracic TDI of the lateral mitral annulus in a patient with restrictive physiology show?

A

Transthoracic TDI of the lateral mitral annulus in a patient with restrictive physiology shows diminished (Ea) or Em velocity.

68
Q

What are the relative sensitivities and specificities of each technique to distinguish CP from RCM?

A
  • E wave peak MV (resp. variation ≥ 10%): Sensitivity - 84%, Specificity - 91%
  • D wave peak (resp. variation ≥ 18%): Sensitivity - 79%, Specificity - 91%
  • Color M-mode Vp (slope ≥ 100 cm/s): Sensitivity - 74%, Specificity - 91%
  • Tissue Doppler (Em ≥ 8 cm/s): Sensitivity - 89%, Specificity - 100%
69
Q

What pericardial masses can be seen in patients?

A

Pericardial masses include benign pericardial cysts, pericardial neoplasms, and tumors that invade the pericardium from neighboring tissue.

Pericardial cysts are usually asymptomatic but can be associated with symptoms such as chest pain, dyspnea, cough, arrhythmias, and compression of the pulmonary vein, left atrium, or pulmonary vein(s).

70
Q

What is another type of pericardial mass that may lead to hemodynamic compromise?

A

Pericardial thrombus formation is another pericardial mass that may lead to hemodynamic compromise.

71
Q

What may cause hemopericardium?

A

Hemopericardium may result from aortic dissection with extravasation of blood into the transverse sinus, percutaneous catheter interventions, pacer wires, or post-infarction myocardial necrosis and rupture.

AI flashcard (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions