B4-062 Pericarditis and B4-070 Uremic Pericarditis Flashcards
1
Q
common presentation of pericarditis
A
sharp pain aggravated by inspiration
relieved by sitting up and leaning forward
friction rub
2
Q
acute pericarditis may be preceeded by a […] phase
A
prodromal
fever, malaise, fatigue, dyspnea
3
Q
tachycardia in pericarditis is due to
A
pain or fever
4
Q
velcro sound
leather rubbing
high pitched
A
pericardial rub
5
Q
what would you expect to see on ECG?
A
tachycardia
ST elevation
current of injury
low voltage=large effusion
6
Q
following acute pericarditis [ECG finding] may persist for weeks to months
A
T wave inversion
7
Q
the ST elevation in pericarditis is described as
A
concave
8
Q
typical electrocardiogram findings
A
small to trace effusion
9
Q
diagnostic criterion
A
- chest pain
- pericardial rub
- ECG changes
- some effusion
must have 2/4
10
Q
most common causes of pericarditis
A
- idiopathic
- iatrogenic
- trauma
11
Q
major predictors of severity
A
- fever
- subacute onset
- cardiac tamponade
- large effusion
- NSAIDS ineffective after 7 days
12
Q
if the patient does not have major risk factors, should they be admitted or treated as outpatient?
A
outpatient
13
Q
NSAIDs should be taken for
A
4-6 weeks
14
Q
second line treatment for refractory or rheumatologic etiology
A
corticosteroids
not first line
15
Q
first line treatment
A
- high dose NSAIDs
- cholchicine
16
Q
top reasons why pericarditis would recur
A
- non adherent to bedrest
- tapered NSAIDs too quickly
17
Q
DOC inflammatory recurrent pericarditis
A
anti IL-1 agents
18
Q
DOC non-inflammatory recurrent pericarditis
A
azathioprine, IV Ig
19
Q
trial drug resulting in rapid resolution of recurrent pericarditis
A
rilonacept
20
Q
complications of acute pericarditis
A
- cardiac tamponade
- constrictive pericarditis
21
Q
most common cause of pericarditis
A
idiopathic
22
Q
immunocompromised state indicates
A
more severe disease
23
Q
pain lasts for days, is knifelike, and intense
A
acute pericarditis
24
Q
scratchy superficial velcro rub or leathery rub on ausculatation
A
acute pericarditis
25
upward concave ST elevation with PR segment elevation
acute pericarditis
26
diminshed QRS complexes
cardiac tamponade
27
most patients with acute pericarditis have [...] effusion
trace
28
loculated pericardial effusion is most often seen in
recurrent pericarditis
29
first line treatment for acute uncomplicated pericarditis
ibuprofen 600 mg for 6 weeks
aspirin 650 mg for 6 weeks
30
high risk criteria for acute pericarditis
| 6
* troponin elevation
* large effusion
* high fever
* immunocompromised state
* subacute course
* poor response to NSAIDs
31
resolution of ECG changes in acute pericarditis
1. ST elevations resolve/normalize
2. intially upright T waves flatten and become inverted. may remain inverted for long period of time or indefinitely
32
for patients who have not responded to NSAIDs within the first few days, offer
colchicine
33
acts by concentrating in the neutrophils and prevents neutrophil migration
colchicine
34
last line therapy for acute pericarditis
prednisone
35
recurrent pericarditis is seen in [...]% of cases
30
36
associated with high risk of recurrence
shorter duration of NSAIDs
rapid taper of NSAIDs
non compliance with bedrest
37
prednisone therapy is associated with a higher rate of
recurrence
38
recurrence is more likely in individuals who are
immunocompromised
39
large volume pericardiocentesis can help
establish diagnosis and rule out infectious etiology
40
most patients with uremic pericardial effusion have [...] effusion
exudative
41
transudative effusion in uremic pericarditis may be associated with
| 2
* malnourishment
* nephrotic syndrome with low albumin
42
effusion is:
* high in protein
* high LDL
* high mononuclear cell count
* low pH
* high specific gravity
uremic pericarditis
43
treatment reserved only for constrictive pericarditis
pericardial resection
44
reaccumulation of a large pericardial effusion due to a clogged or ineffective drain should be treated with
emergency ultrasound-guided pericardial tap with repositioning of the drain
| if that doesnt work --> pericardial window
45
cardiac chamber that is first to compress
right atrium
| next is RV in diastole
46
chambers that show the earliest signs of cardiac tamponade
1. **right atrium**
2. right ventricle
47
cardiac tamponade physiology
intra-pericardial pressure becomes higher than diastolic intracardiac pressures
| causes decreased SV and CO
48
why does cardiac tamponade cause tachycardia?
SV is reduced, the only way to maintain CO is too increase heart rate
49
classic ECG findings of cardiac tamponade
* low QRS voltage
* electrical alternans
50
the amplitude of every other ECG complex is lower than the preceding one
electrical alternans
51
is caused by heart swinging from beat to beat in sac of water
electrical alternans
52
greater than 10mmHg decrease in systolic pressure during inspiration
pulsus paradoxus
53
# pulsus paradoxus
as RV increases in volume, LV is compressed causing
* decreased LV stroke volume
* decreases in systolic blood pressure
54
best measured by careful and slow auscultation using a manual sphygmomanometer
pulsus paradoxus
55
pulsus paradoxus can be diagnosed via palpation of
radial pulses
56
pulses paradoxus is indicative of
cardiac tamponade
57
before any drain is removed, what should be done to confirm there is no more pericardial fluid left?
repeat echocardiogram
58
pericardial knock is associated with
constrictive pericarditis
59
slightly high pitched sound hear in early diastole caused by the abrupt cessation of diastolic filling
pericardial knock
| as ventricle hits stiffened pericardium
60
Kussmaul's sign
when patient breathes in JVP goes up from the mid neck level to the level of the mandible
61
positive Kussmaul's sign
constrictive pericarditis
62
increasing venous return fails to be accomodated in the heart causing increased JVP on respiration
Kussmaul's sign
constrictive pericarditis
63
if draining one chamber does not result in much resolution of effusion,
multiple localations
| consider pericardial window
64
what imaging can detect pericardial inflammation
ganolinium contrast enhanced cardiac MRI
65
chylous pericardial effusion is caused by
disruption of thoracic duct
66
lymph is rich in [...], giving its milky appearance
TGs
67
both constrictive pericarditis and cardiac tamponade result in decreases
cardic output
68
which etiology of constriction is associated with the worst prognosis following pericardial resection
radiation
69
activity guidelines following pericarditis
strict bedrest for a few days followed by gradual resumption of activity
70
normally, intra-pericadial pressue should be [...] intra-cardiac pressure
less than or equal to
| facilitates venticular filling
71
most common cause of acute pericarditis in the general population
idiopathic
72
superficial scratchy sound
pericardial rub
| acute pericarditis
73
acts by tubulin disruption and inhibiting microtubule polymerization
colchicine
74
failure of JVP to decrease on inspiration
Kussmaul's sign
| constrictive pericarditis
75
most effective treatment for uremia pericarditis with moderate effusion
dialysis
76
gold standard imaging modality for cardiac tamponade
echocardiography
77
worldwide, the leading cause of constricitive pericarditis is
tuberculosis
78
in the US, the leading cause of restrictive pericarditis is
trauma or post surgery
79
given in refractory cases that have failed NSAIDs and colchicine
prednisone
80
if patient continues to have discomfort after NSAIDs, start
colchicine
81
most patients with acute pericarditis have [...] effusion
trace
82
most cases of acute pericarditis are
idiopathic
83
most likely ECG finding in a patient with uneventful recovery from acute pericarditis
normalization of ST elevation with subtle T wave inversions
84
[...] indicates a more severe acute pericarditis is likely
immunocompromised
85
acute pericarditis can develop large effusions, resulting in
cardiac tamponade
86
cardiogenic shock may be caused by
cardiac tamponade
