Brainscape's Knowledge GenomeTM

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


See full index

TOP SECRET > B P9 C86 Pericardial Diseases > Flashcards

B P9 C86 Pericardial Diseases Flashcards

1
Q

The pericardium is composed of two layers, the _____, a monolayer of mesothelial cells and collagen and elastin fibers adherent to the epicardial surface of the heart, and the _____, which is normally about 2 mm thick and surrounds most of the heart

A

Visceral pericardium

Fibrous parietal pericardium

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

The _____ pericardium is largely acellular and contains collagen and elastin fibers

A

Parietal

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

The _____ pericardium reflects back near the origins of the great vessels and is continuous with and forms the inner layer of the parietal pericardium.

A

Visceral

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

The pericardial space or sac is contained within these two layers, and normally contains up to _____ of serous fluid.

A

50 mL

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

While its removal has no obvious negative consequences, the pericardium does function:

A

(1) to maintain a relatively constant position of the heart in the thorax
(2) provides a barrier to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The best-characterized mechanical function of the pericardium is its _____. This reflects the mechanical properties of the parietal pericardium.

A

Restraining effect on cardiac volume

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

In developing regions where _____ is endemic, it is the most common cause of pericarditis and effusion.

A

TB

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

In developed countries, presumed _____ etiologies are most common

A

Viral and idiopathic

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

Idiopathic cases of acute pericarditis are presumed to be _____.

A

Viral

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

Cases of acute pericarditis with concomitant myocarditis with impaired function are labeled _____

A

Perimyocarditis

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

Cases of acute pericarditis with concomitant myocarditis with normal LV function are labeled _____

A

Myopericarditis

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

In greater than 90% of cases, the main symptom of acute pericarditis is _____, often quite severe

A

Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Classically, the pain of acute pericarditis radiates to the _____.

A

Trapezius ridge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The pathognomonic physical sign of acute pericarditis is the _____, reported in about one third of cases.

A

Friction rub

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

The classic rub consists of three components corresponding to _____, and can be likened to the sound made when walking on crunchy snow.

A

Ventricular systole
Early diastole
Atrial contraction

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

The _____ is a key test for diagnosing acute pericarditis

A

ECG

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

The classic finding in the ECG of patients with acute pericarditis is _____

A

Diffuse ST-segment elevation.

The ST-segment vector points leftward, anterior, and inferior, with ST-segment elevation in all leads except aVR and often V1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The distinction between acute pericarditis and transmural ischemia is usually not difficult because of _____.

A

(1) More extensive lead involvement
(2) Lack of evolution to pathologic Q waves in pericarditis
(3) More prominent reciprocal ST depression in ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

_____ is also common and considered the earliest ECG sign of acute pericarditis, reflecting pericardial involvement overlying the atria

A

PR-segment depression

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

Typical ECG evolution in acute pericarditis follows four stages: _____ The ECG often evolves without all four stages

A

(1) PR depression and/or diffuse ST segment elevation
(2) Normalization of ST segment
(3) T wave inversion with or without ST segment depression
(4) Normalization

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

In acute pericarditis, additional ECG changes that may constitute clues to the cause of pericarditis or associated findings include _____ in Lyme disease, _____signifying a previous, silent MI, and _____ pointing toward significant effusion.

A

Lyme disease: AV block
Previous /silent MI: Pathologic Q waves
Significant effusion: Low-voltage or electrical alternans

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

In acute pericarditis, CRP usually normalizes within _____

A

1 week and in almost all cases by 4 weeks after initial evaluation

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

In addition to aiding in diagnosis, ___ can be used to monitor disease activity and individualize duration of therapy

A

CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Because small to moderate effusions may not cause an abnormal cardiac silhouette, even modest cardiac enlargement is of concern and generally associated with an effusion greater than _____ mL.

A

300 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The echocardiographic-Doppler examination is completely normal in approximately __% of patients with acute pericarditis

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Semiquantitative echocardiographic measurements of pericardial effusions

A

<10mm: small
10-20mm: moderate
>20: large

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

An _____ in a patient with a history consistent with acute pericarditis is confirmatory of the diagnosis.

A

Effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

According to the guidelines, the clinical diagnosis of acute pericarditis requires at least two of the following:

A

(1) chest pain
(2) pericardial friction rub
(3) ECG changes consisting of typical ST elevation and/or PR depression
(4) pericardial effusion

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

In acute pericarditis, CT may show _____. CMR may show _____.

A

CT: thickening or hyperattenuation of the pericardium

CMR: pericardial edema based on fat-suppressed T2-weighted dark blood images, or delayed pericardial hyperenhancement indicative of ongoing inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Although usually considered a hallmark of pericarditis, typical ECG changes reflect concomitant involvement of the _____,because the pericardium is electrically silent.

A

Myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

In patients suspected of acute pericarditis, the recommended routine tests are the following:

A

ECG, CBC, serum creatinine, CRP (or hsCRP), cardiac troponin, chest radiograph, and echocardiogram.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

If laboratory data do not contradict the diagnosis of idiopathic pericarditis, symptomatic treatment with _____ is recommended

A

Nonsteroidal Antiinflammatory Drugs (NSAIDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

In patients with acute pericarditis, restriction of physical activity _____ is recommended.

A

Until resolution of symptoms and normalization of CRP occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

For athletes who had acute pericarditis, return to sports is recommended after an arbitrary term of ___ months and only after symptoms have fully resolved and CRP, ECG, and echocardiogram have normalized

A

3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

In the treatment of acute pericarditis, two alternative regimens with an excellent safety profile are recommended:

A

Ibuprofen 600 to 800 mg orally TID

ASA 750 to 1000 mg orally TID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Colchicine is recommended for ___ months as an adjunct to NSAIDs.

A

3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Colchicine is thought to exert an antiinflammatory effect by blocking microtubule assembly in WBCs and inhibiting the inflammasome. Weight-adjusted doses _____ are recommended

A

0.5 to 0.6 mg orally every 12 hours

or

0.5 to 0.6 mg once daily for patients <70 kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Predictors of poor prognosis in acute pericarditis:

A

Major
* Fever > 38 ̊C
* Subacute onset
* Large pericardial effusion
* Cardiac tamponade
* Lack of response to aspirin or NSAIDs
after at least 1 week of therapy

Minor
* Myopericarditis
* Immunosuppression
* Trauma
* Oral anticoagulant therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Corticosteroid use should be minimized in patients with acute pericarditis because they may impair the clearance of infectious agents and short, high-dose courses may increase the risk of recurrence. However, there are selected indications for their use:

A

(1) contraindications to or failure of NSAID/colchicine
(2) underlying conditions (e.g., autoimmune diseases) whose primary treatment is corticosteroids
(3) concomitant diseases (e.g., renal failure)
(4) pregnancy
(5) concomitant therapies constituting relative contraindications to NSAIDs and/or colchicine (e.g., oral anticoagulants)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When cortecosteroids are used, relatively low doses of corticosteroids are recommended _____ to minimize complications.

A

Prednisone 0.2 to 0.5 mg/kg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Recurrences occur in _____% of patients with idiopathic acute pericarditis

A

15-30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

A diagnosis of recurrent pericarditis requires new symptoms and signs of disease activity (friction rub, ECG changes, new or worsening pericardial effusion, elevation of CRP) after a symptom-free interval of at least _____ weeks.

A

4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

If NSAID + Colchicine therapy fails in recurrent pericarditis, _____ may replace NSAID or may be added as “triple therapy”.

A

Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Colchicine should be included for ____ for difficult cases of recurrent pericarditis.

A

At least 6 mo up to 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Potential alternative therapies for colchicine-resistant and corticosteroid -dependent recurrent pericarditis include:

A

(1) Azathioprine (1 mg/kg/day with gradual dose increases and monitoring of WBC, transaminases, and amylase)
(2) Human IVIg (400 to 500 mg/kg/day for 5 days with a possible repeat course after 1 month)
(3) Anakinra, a recombinant short-acting IL-1α and IL-1β cytokine receptor blocker, which is off-label, is one example (1 to 2 mg/kg/day up to 100 mg SC daily)
(4) Rilonacept (loading dose of 320 mg SC followed by 160 mg SC weekly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Effusions with a high likelihood of progression to tamponade include:

A

Bacterial
HIV-associated infections
Bleeding
Neoplastic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

The mechanical consequences of a high pressure acting on the surface of the heart mainly result from compression and collapse of the _____ heart.

A

Right Heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

The limited pericardial reserve volume dictates that modest amounts of rapidly accumulating fluid (_____mL) can impair cardiac function.

A

150 to 200 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

The compensatory response to a hemodynamically significant effusion includes _____

A

Increased adrenergic tone and parasympathetic withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

As fluid accumulates, left- and right-sided atrial and ventricular diastolic pressures rise and in severe tamponade equalize at a pressure similar to that in the pericardial sac, typically _____ mm Hg

A

20-25 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Equalization of atrial and ventricular diastolic pressures is closest during ____.

A

Inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

The small ______ (decreased preload) mainly accounts for reduced stroke volume (SV).

A

End-diastolic ventricular volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Hemodynamic abnormalities characteristic of tamponade:

A

(1) Elevated and equal intra-cavitary filling pressures
(2) Low transmural filling pressures
(3) Small cardiac volumes
(4) Loss of y descent of RA or venous pressure wave
(5) Paradoxical pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Loss of the y descent has been explained based on the concept that _____ in severe tamponade

A

Total heart volume is fixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

The second characteristic finding in tamponade is the _____, an abnormally large drop (>10 mm Hg) in systolic arterial pressure during inspiration.

A

Paradoxical pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Other causes of pulsus paradoxus include:

A

CP
Pulmonary embolus
Pulmonary disease with large variations in intra-thoracic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

In tamponade, in contrast to constriction, the normal inspiratory increase in systemic venous return is present and the normal inspiratory decline in systemic venous pressure is retained (Kussmaul’s sign is _____).

A

Absent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

In tamponade, the interventricular septum shifts to the left in exaggerated fashion on _____, encroaching on the LV such that SV and pressure generation are further reduced.

A

Inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

When there are preexisting elevations in diastolic pressures and/or volume, tamponade can occur without a paradoxical pulse. Examples include:

A

Chronic LV dysfunction
Aortic regurgitation
Atrial septal defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

In patients with retrograde bleeding into the pericardial sac due to aortic dissection,4 tamponade may occur without a paradoxical pulse because of:

A

Aortic valve disruption and regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Although mean left- and right-sided filling pressures are typically 20 to 25 mm Hg, tamponade can occur at lower filling pressures, that is, _____.

A

Low-pressure tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Low-pressure tamponade often occurs when there is a decrease in _____ in the setting of a preexisting effusion which would not otherwise be significant.

A

Blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Low-pressure tamponade may be observed during:

A

(1) Hemodialysis
(2) in patients with blood loss and volume depletion
(3) when diuretics are administered to patients with effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Pericardial effusions can be loculated or localized, resulting in regional tamponade, most commonly after _____.

A

Cardiac surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

_____ should be considered whenever there is hypotension in a setting where a loculated effusion is present

A

Regional tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Patients with tamponade often complain of _____ (the mechanism is uncertain because there is no pulmonary congestion) and are more comfortable sitting forward

A

Dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Beck’s triad, _____ suggests severe tamponade.

A

Hypotension
Muffled heart sounds,
Elevated jugular venous pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

In tamponade, tachycardia is also the rule unless:

A

(1) heart rate lowering drugs have been administered
(2) conduction system disease coexists
(3) pre-terminal bradycardic reflex has supervened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Hemodynamics in cardiac tamponade:

A

Systemic venous wave morph.: Absent y descent
Inspiratory change in SVP: DECREASE
Square root sign: ABSENT
Paradoxical pulse: Usually present
Equal left/right filling: Present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Hemodynamics in constrictive pericarditis vs cardiac tamponade:

A

Systemic venous wave morph.: prominent y descent (M or W shaped)
Inspiratory change in SVP: Increase or no change (Kussmaul sign)
Square root sign: PRESENT
Paradoxical pulse: Present in 1/3
Equal left/right filling: Present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

This ECG finding in tamponade is nonspecific and can be caused by emphysema, infiltrative myocardial disease, and pneumothorax.

A

Reduced voltage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

This ECG finding in tamponade is specific but relatively insensitive and caused by anterior-posterior swinging of the heart with each contraction.

A

Electrical alternans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

The chest radiograph in patients with pericardial effusion reveals a normal cardiac silhouette until effusions are at least _____ in size.

A

Moderate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

A significant effusion appears as a lucent separation between parietal and visceral pericardium for the entire _____.

A

Cardiac cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Small effusions are usually first evident over the _____LV. With increasing effusions, the fluid spreads anteriorly, laterally, and behind the LA, where it is limited by the visceral pericardial reflection

A

Small: Posterobasal LV
Increaseing: anterior - lateral- behind LA

75
Q

Effusions are graded as:

A

Trivial (only seen in systole)
Small (echo free space in diastole <10 mm)
Moderate (10 to 20 mm)
Large (>20 mm)
Very large (>25 mm)

76
Q

Frond-like or shaggy appearing structures in the pericardial space on echocardiography suggest:

A

Clots
Chronic inflammation
Neoplastic processes

77
Q

Several echocardiographic findings indicate that an effusion is large enough to cause hemodynamic compromise. These include:

A

(1) Early diastolic collapse of RV
(2) Late diastolic indentation or collapse of RA
(3) Exaggerated respiratory variation in RV and LV size and interventricular septal shifting during inspiration (septal bulge or “bounce”)

78
Q

Isolated LV and LA chamber collapse can occur with pericardial hematomas after _____.

A

Cardiac surgery

79
Q

Doppler recordings in patients with tamponade demonstrate:

A

(1) exaggerated respiratory variation in right- and left-sided venous and valvular flow
(2) inspiratory increases on the right and decreases on the left

80
Q

_____ provide more detailed quantitation and regional localization of effusions than echocardiography and are useful with loculated and coexistent pleural effusions

A

CT and MRI

81
Q

CT Attenuation similar to water suggests _____; attenuation denser than water suggests _____ ;and attenuation less dense than water,a _____ effusion.

A

Water: Transudative effusion
Denser than water: Malignant, bloody or purulent
Less dense than water: Chylous

82
Q

Situations where tamponade is a near-term threat include:

A

(1) Suspected bacterial pericarditis
(2) Hemopericardium
(3) Any moderate to large effusion that is not thought to be chronic and/or is increasing in size

82
Q

Klein and colleagues propose a three-step scoring system for pericardial effusion that awards points based on _____to arrive at a cumulative score whose value dictates whether urgent drainage is warranted.

A

Etiology
Clinical presentation
Imaging

83
Q

Patients with _____ should be considered to have threatened tamponade because of the etiology.

A

(1) Suspected bacterial infections
(2) Hemopericardium with small effusions (<10 mm)

84
Q

Patients with acute, apparently idiopathic pericarditis with no more than mild tamponade can be treated for a brief period of time under careful monitoring with an _____ in an attempt to rapidly shrink the effusion.

A

NSAID and/ or a corticosteroid combined with colchicine

85
Q

Once actual or threatened tamponade is diagnosed, _____ should be instituted.

A

IV hydration with normal saline

86
Q

_____ increase the risk and difficulty of closed pericardiocentesis.

A

Loculated effusions or effusions containing clots or fibrinous material

87
Q

The danger of a closed approach pericardiocentesis in patients with hemopericardium is that _____ without affording an opportunity to correct its source

A

Lowering intra-pericardial pressure will allow more bleeding

In cases of trauma or post-MI LV rupture, closed pericardiocentesis should usually be avoided.

If bleeding is slower, closed pericardiocentesis is generally indicated because bleeding may stop spontaneously and/or the procedure can provide temporary relief before definitive repair.

88
Q

Closed pericardiocentesis in patients with hemopericardium due to _____ has been considered contraindicated.

A

Type A Aortic dissection

89
Q

The usual approach to closed pericardiocentesis is _____ needle insertion with echocardiographic guidance to minimize risks of myocardial puncture and assess completeness of fluid removal

A

Para-apical

90
Q

During pericardiocentesis, once the needle has entered the pericardial space, a modest amount of fluid is removed (perhaps _____ mL) in an effort to produce rapid improvement

A

50-100

91
Q

Echocardiographically guided pericardiocentesis has a greater than ___% success rate and less than ___% serious complication rate

A

95% Success rate
<2% Serious complication rate

92
Q

Rarely, patients suffer _____ following closed or open drainage, a poorly understood but life-threatening syndrome characterized by combinations of pulmonary edema and shock.

A

Pericardial decompression syndrome

93
Q

If a pulmonary artery catheter has been inserted,_____ should be monitored before, during, and after the procedure.

A

RA and pulmonary capillary wedge pressure and CO

94
Q

Intra-pericardial catheters should ideally be left in place for ____ days to allow continued drainage and minimize recurrence

A

2-3 days

95
Q

Cholesterol-rich (“gold paint”) effusions occur in _____.

A

Hypothyroidism

96
Q

Chylous effusions can occur after ____.

A

Traumatic or surgical injury to the thoracic duct

Or

Obstruction by neoplasms

97
Q

If TB pericarditis is suspected, several other tests are useful, including:

A

Unstimulated interferon-gamma (uIFN-γ)
Adenosine deaminase (ADA)
Lysozyme levels
Polymerase chain reaction (PCR)

98
Q

In a small study, _____ antibodies in pericardial fluid and serum were found to be predictive of recurrence in patients with chronic effusions

A

Anti-myolemmal

99
Q

_____ is the end stage of an inflammatory process involving the pericardium.

A

Constrictive pericarditis

100
Q

In the developed world common etiologies of CP are:

A

Idiopathic
Post-surgical
Radiation injury

101
Q

___ was very common before the advent of effective therapy and remains important as a cause of CP in developing countries.

A

TB

102
Q

In “pure” constriction, ventricular contractile function is _____, although ejection fraction (EF) can be reduced due to a small end-diastolic volume

A

Preserved

103
Q

This sign reflects loss of the normal increase in right heart venous return on inspiration, even though tricuspid flow increases.

A

Kussmaul sign

104
Q

The most notable cardiac physical finding in CP is the _____, an early diastolic sound best heard at the left sternal border and/or cardiac apex

A

Pericardial knock

105
Q

This sign in CP occurs slightly earlier and has a higher frequency content than a third heart sound and corresponds to early, abrupt cessation of ventricular filling.

A

Pericardial knock

106
Q

_____ is seen in a minority of patients with CP and suggests TB but is not diagnostic of constrictive physiology.

A

Pericardial calcification

107
Q

Major 2D echo findings in CP include:

A

(1) pericardial thickening and calcification (best appreciated with TEE)
(2) abrupt displacement of the interventricular septum during early diastole (septal “bounce”)
(3) systemic venous congestion (dilated hepatic veins, inferior vena caval distention with blunted respiratory variation)

108
Q

Typically, patients with CP demonstrate a ≥ __% increase in mitral E velocity during expiration versus inspiration and increased diastolic flow reversal with expiration in the hepatic veins. Mitral E wave deceleration time is usually less than ____ milliseconds.

A

Mitral E velocity: ≥ 25%

Mitral E wave DT: < 160 ms

109
Q

Tissue Doppler reveals increased e′ velocity of the medial mitral annulus and septal abnormalities corresponding to the “bounce.” Lateral mitral annular e’ is lower than medial annular e′, termed _____.

A

Annulus reversus

110
Q

In CP, regional variations in deformation and strain include reduced LV circumferential strain, torsion, and early diastolic untwisting, with _____ longitudinal strain.

A

Preserved

111
Q

In contrast, in restriction, circumferential strain and untwisting are preserved but _____ in the longitudinal direction.

A

Reduced

112
Q

Regional longitudinal strain ratios of lateral LV wall/septum and RV free wall/septum indicative of pericardial-myocardial tethering are useful in differentiating constriction from constriction and improve after pericardiectomy known as _____

A

Strain reversus

113
Q

In CP, RA, RV diastolic, pulmonary capillary wedge, and pre-a wave LV diastolic pressures are elevated and equal, or nearly so, at around _____ mm Hg

A

20-25 mm Hg

114
Q

In CP , the RA pressure tracing shows a _____. RV and LV pressures reveal an early, marked diastolic dip and plateau (“square root” sign)

A

Preserved x descent
Prominent y descent
Roughly equal a and v wave heights, with resultant M or W configuration

115
Q

This the ratio of RV to LV systolic pressure × time on inspiration versus expiration

A

Systolic area index

116
Q

A ratio greater than _____ strongly suggests constriction.

A

1.1

117
Q

A ratio of RA pressure/ PCWP greater than ____ is an indicator of pericardial constraint that may distinguish pure constriction from constriction with myocardial involvement.

A

0.77

118
Q

This is the most accurate method for measuring thickness (normal <2 mm)

A

ECG synchronized CT and EMR

119
Q

The “normal” pericardium visualized by CMR is up to _____ mm in thickness.This most likely reflects the entire pericardial “complex,” with physiologic fluid representing a component of measured thickness.

A

CMR: 3-4 mm

120
Q

In patients suspected of CP, _____ on T2 STIR and _____ on CMR is more specific for active inflammation and may be useful in identifying patients who are candidates for management with antiinflammatory drugs

A

T2 STIR: Periardial edema
CMR: LGE

121
Q

In restriction, pulmonary venous systolic flow is _____ and diastolic flow is ______; this is not observed in constriction.

A

PV systolic flow: Blunted
PV diastolic flow: increased

122
Q

Enhanced respiratory variation in mitral inflow velocity (>__%) is seen in constriction but varies by less than 10% in restriction

A

Constriction: > 25%
Restriction: < 10%

123
Q

Recently proposed criteria (_____) distinguish constriction from restriction with sensitivity of 87% and specificity of 91%

A

(1) Respirophasic ventricular shift
(2) Preserved or increased medial mitral annulus e′ velocity [>9 cm/sec]
(3) Increased hepatic vein expiratory diastolic flow ratio [≥0.79]

124
Q

Brain natriuretic peptide (BNP) levels are _____ in restrictive cardiomyopathy but usually ____ in constriction.

A

Restrictive CMP: Elevated
Constrictive pericarditis: Normal

125
Q

In restriction, LV diastolic pressure is usually _____ than RV by at least 3 to 5 mm Hg, whereas in constriction LV and RV diastolic pressures _____ by more than 3 to 5 mm Hg.

A

LV diastolic pressures

Restriction: Higher than RV
Constriction:track closely and rarely differ

126
Q

The absolute level of atrial or ventricular diastolic pressure is also useful, with extremely high pressures (>___ mm Hg) more common in restriction

A

> 25 mm Hg

127
Q

Finally, the systolic area index is _____ in constriction than restriction and reported to have high sensitivity and specificity for distinguishing between them.

A

Greater

128
Q

CP has a progressive but variable course. _____ is the definitive treatment in most patients.

A

Radical surgical pericardiectomy

129
Q

Risk factors for poor results regarding pericardiectomy in CP include:

A

Radiation-induced disease
COPD
Renal insufficiency
Coronary artery disease and prior cardiac surgery
Reduced LV EF
Cardiopulmonary bypass
NYHA stage IV symptoms

130
Q

Because sinus tachycardia is compensatory in CP, drugs that slow the heart rate should be avoided. In patients with atrial fibrillation and a rapid ventricular response, _____ is recommended for rate control.

A

Digoxin

131
Q

A more aggressive approach of pericardiectomy in CP, with _____ of the pericardium has been advocated to facilitate access to the lateral, diaphragmatic, and posterior surfaces of the heart.

A

Complete removal

132
Q

_______ is an adjunct to conventional débridement or as the sole technique in patients with extensive, calcified adhesions.

A

Ultrasonic or laser débridement

133
Q

The ______ procedure in which multiple transverse and longitudinal incisions are made in the epicardial layer, is an alternative in patients with extensive epicardial involvement and can be done without cardiopulmonary bypass.

A

Waffle procedure

134
Q

Long-term results after pericardiectomy in CP are worst in patients with:

A

Radiation-induced disease
Impaired renal function
Reduced LV EF
Moderate or severe tricuspid regurgitation
Low serum sodium
Advanced age

135
Q

Poor responses to pericardiectomy have been attributed to:

A

(1) Myocardial atrophy or fibrosis
(2) Incomplete resection
(3) Development of recurrent cardiac compression by mediastinal inflammation and fibrosis

136
Q

Reversible constriction typically resolves in _____ months or longer.

A

3-6 months

137
Q

Intensity of enhancement as well as pericardial thickness ____ mm on late enhancement images is predictive of a response to antiinflammatory drugs with resolution of constriction

A

≥3 mm

138
Q

A proposed definition of underlying constriction in ECP is _____.

A

Failure of RA pressure to decline by at least 50% to a level below 10 mm Hg when pericardial pressure is reduced to almost 0 mm Hg by pericardiocentesis and/or all detectable fluid is removed

139
Q

The most common causes of ECP are:

A

Idiopathic
Malignancy
Radiation
Post-pericardiotomy
Connective tissue diseases

140
Q

In ECP, _____ can be useful to identify patients with active inflammation who are more likely to respond to an antiinflammatory regimen

A

CMR with gadolinium uptake and measurement of hsCRP

141
Q

_____ pericarditis is presumed to be the most common infection in countries with low TB prevalence

A

Viral

142
Q

In sub-Saharan Africa the most common bacterial cause of pericardial disease is _____.

A

TB

143
Q

A definitive diagnosis of TB pericarditis is based on _____.

A

Detection of tubercle bacilli in pericardial fluid or tissue

144
Q

A probable diagnosis of TB pericarditis is based on _____.

A

Evidence of disease elsewhere

and/or

Lymphocytic pericardial exudate with elevated IFN-γ, ADA or lysozyme levels.

145
Q

A presumptive diagnosis of TB pericarditis without evidence as outlined above is appropriate only in countries with high TB prevalence, followed by a _____.

A

Positive response to therapy

146
Q

______ should be avoided in HIV patients with TB pericarditis because they may increase HIV- associated malignancies

A

Corticosteroids

147
Q

Pericardiectomy is recommended in patients with TB pericarditis if the patient’s condition is not improving or is deteriorating after _____ weeks of therapy, and in appropriately selected patients with more long-standing constriction.

A

4-8 weeks

148
Q

______ are among the organisms implicated in Fungal pericarditis

A

Aspergillus and Candida spp

149
Q

HAART has reduced all forms of cardiac involvement except for _______ which are now the most common cardiac diseases in patients with HIV

A

Hypertensive Heart Disease and CAD

150
Q

_____remains the most common cause of larger effusions in African HIV-infected patients

A

TB

151
Q

There are three main presentations of pericardial disease in ESRD:

A

(1) Uremic pericarditis, often with moderate to large effusions, occurs before dialysis is initiated or within 8 weeks of initiation and is thought to be related to toxic metabolites

(2) “Dialysis” pericarditis, occurring more than 8 weeks after dialysis initiation

(3) CP, rarely

152
Q

_____ is effective in uremic pericarditis

A

Intensive dialysis

153
Q

In patients already receiving dialysis, ______ is less effective but remains a mainstay of treatment.

A

Intensification

154
Q

Current guidelines for the treatment of pericarditis in ESRD recommend NSAIDs, specifically _____ as first-line therapy.

A

1 to 2 weeks of:

(1) Aspirin (750 to 1000 mg every 8 hours)

or

(2) Indomethacin (600 mg every 8 hours)

155
Q

CP in autoimmune disease is rare, but most common in ____.

A

RA

156
Q

The most common auto-inflammatory periodic fevers are:

A

Familial Mediterranean fever (FMF)
TNF receptor-associated periodic syndrome

157
Q

Post-cardiac injury syndromes (PCISs) include:

A

Post-MI pericarditis
Post-pericardiotomy syndrome (PPS)
Posttraumatic pericarditis

158
Q

With the exception of _____ pericarditis, all are presumed to have an immune pathogenesis triggered by damage to pericardial tissue and/or blood in the pericardial sac associated with myocardial necrosis (late post-MI pericarditis), surgical trauma (PPS), or iatrogenic trauma (pericarditis after percutaneous procedures including coronary intervention [PCI], valve repair, arrhythmia ablation, device implantations, and left atrial isolation).

A

EARLY post-MI pericarditis

159
Q

According to proposed criteria diagnosis of PCIS (Post Cardiac Injury Syndrome) after cardiac injury requires at least two of the following:

A

(1) fever without an alternative cause
(2) pleuritic chest pain
(3) pericardial/pleural rubs
(4) pericardial effusion
(5) elevated CRP

160
Q

Early post-MI pericarditis occurs _____ days after MI. It is rare in the primary PCI era and is now seen after large, transmural MIs due to absent or late/failed reperfusion.

A

1-3 days

161
Q

Late post-MI pericarditis (_____ syndrome) is also rare (<1% of MIs in the modern era) and also most common after large MIs.

A

Dressler Syndrome

162
Q

Because of its association with large MIs, early post-MI pericarditis should alert the clinician to possible _____, especially if an effusion is present

A

Rupture

163
Q

ECG finding which appears to be sensitive for early post-MI pericarditis

A

Atypical T wave evolution (persistent upright T waves or early normalization of inverted T waves)

164
Q

Late post-MI pericarditis occurs from _____ after MI.

A

1 week to a few months

165
Q

Most pericardial involvement in cancer occurs in the setting of _____ disease, and may present as acute pericarditis, isolated effusion, ECP, or CP

A

Metastatic disease

166
Q

Malignant effusions are often moderate to large and frequently cause tamponade. They are usually caused by direct pericardial implants resulting from ______ and less commonly by lymphatic involvement.

A

Hematogenous spread

167
Q

Most common cancers that cause pericardial disease

A

Lung and breast carcinomas

168
Q

The diagnosis of metastatic pericardial disease is based on confirmation of malignant infiltration of the pericardium by _____.

A

Pericardial fluid cytology or biopsy

169
Q

General principles in the management of pericardial disease due to malignancy

A
  1. Appropriate antineoplastic therapy.
  2. Therapeutic and diagnostic pericardiocentesis for tamponade and as
    a diagnostic tool for moderate to large, suspicious effusions. Pro-longed drainage is recommended to reduce the high recurrence rate (>40% to 50%). Additional interventions for recurrent effusions include surgical pericardial window and percutaneous balloon pericardiotomy.
  3. Intrapericardial instillation of cytostatic/sclerosing agents is sometimes effective in preventing recurrences. The agent should be tailored to the type of cancer.
  4. Radiation for controlling effusions in patients with radiosensitive cancers such as lymphomas and leukemias. Management is often palliative in patients with advanced disease and aimed at symptom relief rather than aggressive treatment of the underlying cancer.
170
Q

Various adverse cardiovascular effects have been ascribed to kinase targeted drugs.99 The main offender is _____, used to treat leukemias.

A

Dasatinib

171
Q

Pericarditis occurring as an adverse response to cancer treatment is treated with _____ and otherwise similarly to idiopathic pericarditis, that is, NSAIDs and colchicine, with corticosteroids used in poorly responsive patients.

A

Discontinuation of the offending agent

172
Q

Pericardial effusions develop in _____% of patients with severe hypothyroidism

A

25-35%

173
Q

In the treatment of pericarditis during pregnancy, NSAIDs may be prescribed during the _____ trimester.

A

First and early second trimester

174
Q

After gestational week 20, all NSAIDs (except _____) can cause constriction of the ductus arteriosus and should either not be started or withdrawn.

A

Aspirin ≤100 mg/day)

175
Q

Pericardial cysts are rare, benign congenital malformations, typically located at the _____.

A

Right or left cardiophrenic angle

176
Q

On CT imaging, cysts appear as round or elliptical masses with the same density as _____

A

Water

177
Q

Surgery is not ordinarily recommended for pericardial cysts unless _____

A

Symptomatic

178
Q

Congenital absence of the pericardium is very rare. Usually part or all of the ______ pericardium is absent.

A

Left parietal pericardium

179
Q

Partial absence of left pericardium is associated with:

A

ASD
BAV
Pulmonary malformations

180
Q

In patients with congenital absence of the pericardium (usually partial absence of the left pericardium), the ECG typically reveals:

A

ICRBBB

181
Q

Absence of all or most of the left pericardium results in a chest radiograph with a _____ shift of the cardiac silhouette and an _____ left heart border.

A

Leftward shift

Elongated

182
Q

Echocardiography in congenital absence of the pericardium reveals:

A

Paradoxical septal motion
RV enlargement

183
Q

_____ ameliorates symptoms and prevents herniation in patients with congenital absence of the pericardium

A

Pericardiectomy

184
Q

Lethal primary pericardial tumors

A

Mesothelioma
Fibrosarcoma

185
Q
A

TOP SECRET (85 decks)

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