B4.062 Big Case Pericarditis Flashcards
list the layers of the pericardium
fibrous pericardium (outermost) parietal layer of serous pericardium pericardial fluid visceral layer of serous pericardium (innermost) myocardium
what structures attach to the fibrous pericardium to keep the heart in place
aorta
pulm artery and veins
IVC and SVC
how much pericardial fluid is normal
20-33 ccs
normal pericardial functions
attaches the heart to the thorax (prevents it from moving)
protective covering (shock absorber)
lubricant to decrease friction with heart beats
prevents excessive dilatation in situations of volume excess
helps with diastolic relaxation of the cardiac muscle
typical time span of MI or angina
30 min- 6 hours max
what are some identifying characteristics of GERD as a source of chest pain
association with food
worse when laying flat
symptoms of aortic dissection
severe chest, neck, or back pain can be ripping/tearing, but commonly sharp abrupt and maximal in onset nausea, vomiting, diaphoresis syncope (5-10%)
characterize the pain associated with pericarditis
mid sternal chest pain sharp/ knife like worse with deep inspiration/ cough better when sitting worse with laying supine unrelenting (longer lasting than MI or angina)
symptoms of acute pericarditis
pain prodromal phase fever malaise several days to weeks dyspnea fatigue
physical exam findings associated with acute pericarditis
tachycardia
increased temp
pericardial rub
discuss how to hear a pericardial rub
press stethoscope diaphragm firmly to the chest wall
may be exacerbated by deep inspiration
best heard when patient is sitting and leaning forward
what does a pericardial rub sound like
Velcro like
leather rubbing
scratchy/superficial
typical work up for acute pericarditis
blood work: troponins, CBC, ESR CXR: rule out pneumonia, rub fracture ECG echo other imaging: CT, MRI (usually not done)
ECG findings with acute pericarditis
tachycardia
diffuse concave upward ST elevations
PR depressions
low voltage if large effusion present
echo findings with acute pericarditis
cannot see inflamed pericardium
most have pericardial effusions (usually small, occasionally large)