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CP Test 2 > B4-062 Pericarditis and B4-070 Uremic Pericarditis > Flashcards

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

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2
Q

acute pericarditis may be preceeded by a […] phase

A

prodromal

fever, malaise, fatigue, dyspnea

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3
Q

tachycardia in pericarditis is due to

A

pain or fever

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4
Q

velcro sound
leather rubbing
high pitched

A

pericardial rub

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5
Q

what would you expect to see on ECG?

A

tachycardia
ST elevation
current of injury

low voltage=large effusion

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6
Q

following acute pericarditis [ECG finding] may persist for weeks to months

A

T wave inversion

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7
Q

the ST elevation in pericarditis is described as

A

concave

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8
Q

typical electrocardiogram findings

A

small to trace effusion

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9
Q

diagnostic criterion

A
  • chest pain
  • pericardial rub
  • ECG changes
  • some effusion

must have 2/4

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10
Q

most common causes of pericarditis

A
  • idiopathic
  • iatrogenic
  • trauma
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11
Q

major predictors of severity

A
  • fever
  • subacute onset
  • cardiac tamponade
  • large effusion
  • NSAIDS ineffective after 7 days
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12
Q

if the patient does not have major risk factors, should they be admitted or treated as outpatient?

A

outpatient

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13
Q

NSAIDs should be taken for

A

4-6 weeks

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14
Q

second line treatment for refractory or rheumatologic etiology

A

corticosteroids

not first line

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15
Q

first line treatment

A
  • high dose NSAIDs
  • cholchicine
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16
Q

top reasons why pericarditis would recur

A
  • non adherent to bedrest
  • tapered NSAIDs too quickly
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17
Q

DOC inflammatory recurrent pericarditis

A

anti IL-1 agents

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18
Q

DOC non-inflammatory recurrent pericarditis

A

azathioprine, IV Ig

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19
Q

trial drug resulting in rapid resolution of recurrent pericarditis

A

rilonacept

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20
Q

complications of acute pericarditis

A
  • cardiac tamponade
  • constrictive pericarditis
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21
Q

most common cause of pericarditis

A

idiopathic

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22
Q

immunocompromised state indicates

A

more severe disease

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23
Q

pain lasts for days, is knifelike, and intense

A

acute pericarditis

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24
Q

scratchy superficial velcro rub or leathery rub on ausculatation

A

acute pericarditis

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25
Q

upward concave ST elevation with PR segment elevation

A

acute pericarditis

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26
Q

diminshed QRS complexes

A

cardiac tamponade

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27
Q

most patients with acute pericarditis have […] effusion

A

trace

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28
Q

loculated pericardial effusion is most often seen in

A

recurrent pericarditis

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29
Q

first line treatment for acute uncomplicated pericarditis

A

ibuprofen 600 mg for 6 weeks
aspirin 650 mg for 6 weeks

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30
Q

high risk criteria for acute pericarditis

6

A
  • troponin elevation
  • large effusion
  • high fever
  • immunocompromised state
  • subacute course
  • poor response to NSAIDs
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31
Q

resolution of ECG changes in acute pericarditis

A
  1. ST elevations resolve/normalize
  2. intially upright T waves flatten and become inverted. may remain inverted for long period of time or indefinitely
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32
Q

for patients who have not responded to NSAIDs within the first few days, offer

A

colchicine

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33
Q

acts by concentrating in the neutrophils and prevents neutrophil migration

A

colchicine

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34
Q

last line therapy for acute pericarditis

A

prednisone

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35
Q

recurrent pericarditis is seen in […]% of cases

A

30

36
Q

associated with high risk of recurrence

A

shorter duration of NSAIDs
rapid taper of NSAIDs
non compliance with bedrest

37
Q

prednisone therapy is associated with a higher rate of

A

recurrence

38
Q

recurrence is more likely in individuals who are

A

immunocompromised

39
Q

large volume pericardiocentesis can help

A

establish diagnosis and rule out infectious etiology

40
Q

most patients with uremic pericardial effusion have […] effusion

A

exudative

41
Q

transudative effusion in uremic pericarditis may be associated with

2

A
  • malnourishment
  • nephrotic syndrome with low albumin
42
Q

effusion is:
* high in protein
* high LDL
* high mononuclear cell count
* low pH
* high specific gravity

A

uremic pericarditis

43
Q

treatment reserved only for constrictive pericarditis

A

pericardial resection

44
Q

reaccumulation of a large pericardial effusion due to a clogged or ineffective drain should be treated with

A

emergency ultrasound-guided pericardial tap with repositioning of the drain

if that doesnt work –> pericardial window

45
Q

cardiac chamber that is first to compress

A

right atrium

next is RV in diastole

46
Q

chambers that show the earliest signs of cardiac tamponade

A
  1. right atrium
  2. right ventricle
47
Q

cardiac tamponade physiology

A

intra-pericardial pressure becomes higher than diastolic intracardiac pressures

causes decreased SV and CO

48
Q

why does cardiac tamponade cause tachycardia?

A

SV is reduced, the only way to maintain CO is too increase heart rate

49
Q

classic ECG findings of cardiac tamponade

A
  • low QRS voltage
  • electrical alternans
50
Q

the amplitude of every other ECG complex is lower than the preceding one

A

electrical alternans

51
Q

is caused by heart swinging from beat to beat in sac of water

A

electrical alternans

52
Q

greater than 10mmHg decrease in systolic pressure during inspiration

A

pulsus paradoxus

53
Q

pulsus paradoxus

as RV increases in volume, LV is compressed causing

A
  • decreased LV stroke volume
  • decreases in systolic blood pressure
54
Q

best measured by careful and slow auscultation using a manual sphygmomanometer

A

pulsus paradoxus

55
Q

pulsus paradoxus can be diagnosed via palpation of

A

radial pulses

56
Q

pulses paradoxus is indicative of

A

cardiac tamponade

57
Q

before any drain is removed, what should be done to confirm there is no more pericardial fluid left?

A

repeat echocardiogram

58
Q

pericardial knock is associated with

A

constrictive pericarditis

59
Q

slightly high pitched sound hear in early diastole caused by the abrupt cessation of diastolic filling

A

pericardial knock

as ventricle hits stiffened pericardium

60
Q

Kussmaul’s sign

A

when patient breathes in JVP goes up from the mid neck level to the level of the mandible

61
Q

positive Kussmaul’s sign

A

constrictive pericarditis

62
Q

increasing venous return fails to be accomodated in the heart causing increased JVP on respiration

A

Kussmaul’s sign
constrictive pericarditis

63
Q

if draining one chamber does not result in much resolution of effusion,

A

multiple localations

consider pericardial window

64
Q

what imaging can detect pericardial inflammation

A

ganolinium contrast enhanced cardiac MRI

65
Q

chylous pericardial effusion is caused by

A

disruption of thoracic duct

66
Q

lymph is rich in […], giving its milky appearance

A

TGs

67
Q

both constrictive pericarditis and cardiac tamponade result in decreases

A

cardic output

68
Q

which etiology of constriction is associated with the worst prognosis following pericardial resection

A

radiation

69
Q

activity guidelines following pericarditis

A

strict bedrest for a few days followed by gradual resumption of activity

70
Q

normally, intra-pericadial pressue should be […] intra-cardiac pressure

A

less than or equal to

facilitates venticular filling

71
Q

most common cause of acute pericarditis in the general population

A

idiopathic

72
Q

superficial scratchy sound

A

pericardial rub

acute pericarditis

73
Q

acts by tubulin disruption and inhibiting microtubule polymerization

A

colchicine

74
Q

failure of JVP to decrease on inspiration

A

Kussmaul’s sign

constrictive pericarditis

75
Q

most effective treatment for uremia pericarditis with moderate effusion

A

dialysis

76
Q

gold standard imaging modality for cardiac tamponade

A

echocardiography

77
Q

worldwide, the leading cause of constricitive pericarditis is

A

tuberculosis

78
Q

in the US, the leading cause of restrictive pericarditis is

A

trauma or post surgery

79
Q

given in refractory cases that have failed NSAIDs and colchicine

A

prednisone

80
Q

if patient continues to have discomfort after NSAIDs, start

A

colchicine

81
Q

most patients with acute pericarditis have […] effusion

A

trace

82
Q

most cases of acute pericarditis are

A

idiopathic

83
Q

most likely ECG finding in a patient with uneventful recovery from acute pericarditis

A

normalization of ST elevation with subtle T wave inversions

84
Q

[…] indicates a more severe acute pericarditis is likely

A

immunocompromised

85
Q

acute pericarditis can develop large effusions, resulting in

A

cardiac tamponade

86
Q

cardiogenic shock may be caused by

A

cardiac tamponade

CP Test 2 (16 decks)

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