B4.070 Prework 3: Pericardial Constriction

Question 1

what is pericardial constriction

Answer 1

thickened, fibrotic pericardium which constricts the heart and prevents diastolic filling
constrains the cardiac volume in a rind

Question 2

what is the pathophysiology of pericardial constriction

Answer 2

pericardium so thick that it prevent the normal inspiratory decrease in the intra-thoracic pressures from being transmitted to the intracardiac chambers
usual inspiratory atrial pressure drop does not happen and venous return to heart is compromised

Question 3

what can be present in pericardial constriction from a gross perspective

Answer 3

calcification

Question 4

what would you see on LV and RV pressure tracings in constriction?

Answer 4

abnormal ventricular interdependence
opposing changes in the two ventricles during inspiration and expiration (should go up and down together)
expiration: LV goes up, RV goes down
inspiration: RV goes up, LV goes down

Question 5

what is kussmaul’s sign?

Answer 5

increase (or absence of normal decrease) in JVP on inspiration

Question 6

signs and symptoms of constriction

Answer 6

systemic venous congestion due to impaired drainage of venacaval blood into the heart

• edema
• ascites
• SOB
• elevated JVP
• reduced CO
• Kussmauls sign
• pericardial knock

Question 7

where is a pericardial knock heard

Answer 7

apex or just medial to it

Question 8

what does a pericardial knock sound like

Answer 8

sharp
high pitched
diastolic
closer to S2 = worse constriction

Question 9

what is the cause of the pericardial knock/

Answer 9

blood flow into LV reverberating due to volume limitation

Question 10

common clinical features of pericardial constriction

Answer 10

elevated JVP 93%
pulsus paradoxus 20%
Kussmauls 13-21%
pericardial knock 47%
pleural effusion, edema, hepatomegaly, cachexia

Question 11

CXR/CT finding of constriction

Answer 11

calcification

Question 12

management of constriction

Answer 12

pericardial resection only definitive treatment

not easy

Question 13

similarities between tamponade and constriction

Answer 13

low CO state

elevated JVP

Question 14

unique features of tamponade

Answer 14

can cause shock
pulsus paradoxus
muffled heart sounds
low voltage ECG/electrical alternans

Question 15

unique features of constriction

Answer 15

prominent peripheral edema
kussmauls sign
pericardial knock