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Clinical Medicine III > Block I: myocardial/pericardial disease > Flashcards

Block I: myocardial/pericardial disease Flashcards

1
Q

most cases of myocarditis are []

A

infectious
-viral bacterial, rickettsial, spirochetal, fungal, parasitic
-

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2
Q

[] is the most common cause myocarditis

A

viral, exp. coxackie

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3
Q

how might myocarditis patients present?

A

with heart failure without any preceding symptom

pleural or pericardial chest pain, often sharp in nature

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4
Q

heart failure without preceding symptoms may indicate

A

myocarditis

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5
Q

when might myocarditis occur in patients?

A

several days to a few weeks after the onset of an acute febrile illness or respiratory tract infection (although can be longer)

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6
Q

PE exam reveals

  1. tachycardia
  2. gallop rhythm
  3. heart failure
  4. conduction defect

what do you suspect?

A

myocarditis

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7
Q

what might be revels on PE in a myocarditis pt.

A
  1. tachycardia
  2. gallop rhythm
  3. heart failure
  4. conduction defect
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8
Q

EKG in a myocarditis patient may reveal []

A

NOS ST-T changes and conduction disturbance

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9
Q

what may appear on a CXR of a myocarditis patient?

A

cardiomegaly, nos but likely present

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10
Q

[] provides the most convenient way of evaluating cardiac function

A

echo

-can be used to exclude other processes and view any dilation of ventricles

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11
Q

how are you treating a myocarditis patient?

A
  1. specific ABX when infecting agent ID

2. until agent det. treatment directed toward symptoms caused by heart failure and dysrhythmias

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12
Q

what is the prognosis of myocarditis

A
  1. most resolve spontaneously

2. others cardiac function deterioates progressively and may lead to dilated cardiomyopathy

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13
Q

dilated cardiomyopathy may represnt []

A

end stage viral myocarditis

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14
Q

why is rapid fluid expansion of 30 mL more detrimental than a slow fluid expansion of 1L (in terms if pericardial fluid)

A

pericardium cannot stretch rapidly, if fluid accumulates more quickly than it will affect hearts ability to pump

pericardium can stretch slowly over a period of time to acomodate slow increase in fluid

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15
Q

what is a major complication of rapid effusion of pericardium

A

tamponade

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16
Q

how much fluid is normally in the pericardium?

A

20-50mL

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17
Q

how much pericardial fluid can cause significant disturbances?

A

60 mL

(20-50mL) normally

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18
Q

[] results from inflammation of pericardium with subsequent accumulation of pericardial fluid (effusion)

A

acute pericarditis

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19
Q

what causes pericarditis?

A
  1. infectious

2. non- infectious (Ct disease, drug related, malignancy)

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20
Q

the cardinal symptom of pericarditis is []

A

chest pain

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21
Q

chest pain described as retrosternal, sharp, pleuritic pain is usually []

A

pericarditis

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22
Q

pain that frequently radiates to the left trapezius ridge, and is aggravated by swallowing, coughing, and lying flat is usually

A

pericarditis

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23
Q

pericardial pain may be alleviated by []

A

sitting upright and taking shallow breath

make sure its alleviated and not achieved

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24
Q

what is the most common cause pericarditis

A

viral

males under age 50 most commonly affected

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25
Q

pericardial involvement typically follows []

A

URI

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26
Q

how will you treat a pericarditis pt?

A
  1. sympotmatic
    - ASA
    - ibuprofen
    - indomethiacin
    - corticosteroids may be benificial in patients who do not respond to anti-inflammatory medication
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27
Q

[] anticoagulant is considered safe for pts. who need anticoagulation that may also need surgeyr

A

heparin

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28
Q

what patients should never be taken off of anticoagulants? even if surgery is sure?

A

patients with artificial valves

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29
Q

what is a major early complication of pericarditis

A

tamponade ( < 5%)

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30
Q

pericardial resection if indicated in []

A

constrictive pericarditis

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31
Q

once purulent pericarditis is dx, what is the next step?

A
  1. timely drainage of pericardial fluid & culture

2. Vanc + ceftriaxone or cefepime until culture comes back

32
Q

pericarditis may occur 2-5 days after [] and is due to []

A

MI, transmural myocardial necrosis

33
Q

[] may be heard in a post MI pericarditis pt.

A

rub

34
Q

[] change on EKG of post MI pericarditis pt

A

replarization changes,

may be confused with ischemia

35
Q

what can provide symptom releif to post MI pericarditis pt?

A

aspirin or NSAID

36
Q

[] occurs 1-12 weeks post MI or open heart surgery and is believed to be an autoimmune d/o that presents with pain, fever, malaise, leukocytosis

A

dressler’s syndrome

37
Q

rapid collection of [] mL in pericardial fluid can cause severe hemodynamic compromise

A

100-200

38
Q

enlarged cardiac silhouette with globular configuration may suggest

A

effusion

39
Q

[] are beat to beat changes in one or more portions of electrocardiogram and is pathognomonic in pericardial effusion

A

electrical alternans

40
Q

[] is the primary method for demonstrating pericardial effusion

A

echocardiogram

41
Q

[] discriminates effusion from heart failure

A

echocardiogram

42
Q

[] is a possible precursor to tamponade

A

cardiac effusion

43
Q

[] can lead to thickened, fibrotic, adherent pericardium that restricts diastolic filling and produced chronically elevates venous pressure

A

constrictive pericarditis

44
Q

constrictive pericarditis most commonly occurs after []

A
  1. radiation
  2. cardiac surgery
  3. viral pericarditis
    * histoplasmosis uncomoon
45
Q

[] is a paradoxical increase in JVD and pressure during inspiration

A

Kussmaul’s sign

46
Q

describe Kussmaul’s sign, when does this occur?

A
  1. paradoxical increase in JVD and pressure during inspiration
  2. occurs in constrictive pericarditis and restrictive cardiomyopathy
47
Q

an echocardiogram demonstrating thick pericardium and small chamber indicates

A

constrictive pericarditis

48
Q

how to treat constrictive pericarditis?

A

gentle diuresis and surgical removal of pericardium in symptomatic patients

49
Q

what d/o req. gentle diuresis?

A

constrictive pericarditis

50
Q

what is a rare but life threatening complication of pericardial effusion?

A

tamponade

51
Q

elevates intrapericardilal pressure of > 15mmHG that restricts venous reurn and ventricular filling is []

A

tamponade

52
Q

what is the characteristic of tamponde

A

elevated intrapericardial pressure of > 15 mmHG that restricts venous return and ventricular filling

53
Q

stroke volume and pulse pressure [] in tamponade

A

fall

54
Q

heart rate and venous pressure [] in tamponade

A

rise

55
Q

why might venous pressure rise in tamponade?

A

heart gets backs up in providing systemic circulatoin, veins cant deliver to backed up uheart

56
Q
  1. tachycardia
  2. tachypnea
  3. narrow pulse pressure
  4. preseved systolic P

characteristics of []

A

tamponade

57
Q

what is beck’s triad?

A
  1. distended jugular veins
  2. muffled heart tones
  3. hypotension with narrowing pulse pressure

*indicative of tamponade

58
Q

what is pulse pressure?

A

Systolic P - diastolic P =pulse pressure

small diff of the two may indicate tamponade

59
Q

what is > 10 mmHG decline in systolic P during inspiration as compared to expiration

A

pulses paradoxicus

60
Q

what is pulsis paradoxicus and what might it reveal

A

> 10 mmHG decline in systolic pressure during inspiration as compared to expiration

result of further impairment of ventricular fluid
may lead to tamponade dx,

61
Q

puslses paradoxicus is a classic finding in []

A

tamponade

62
Q

hemodynamic deterioation during tamponade requires emergent []

A

drainage of pericardial fluid (pericardiocentesis) or throracic surgery (pericardial window)

63
Q

temporizing measures can be used to treat tamponade by []

A

increased pre-load, i.e. amount of blood pouring into ventricle

64
Q

what are some temporizing agents that can be used in tamponade?

A

inotropic agents dopamine, NE, Epi

to expand volume

65
Q

what is a scratchy, triphasic, best heard along left sternal border during expiration when pt leands forward

A

rub

66
Q

when is a rub best heard?

A
  1. when patient leads forward and holds expiration

best heard over L sternal border

67
Q

what is a fundamental sign of pericarditis

A

pericardial friction rub

68
Q

distant/mufled heart sounds suggest []

A

pericardial effusion

69
Q

a chest x ray is usually [] in acute pericarditis

A

normal

70
Q

water bottle shaped heart on xray indicates []

A

chronic pericarditis, effusion of > 200 mL

71
Q

what are EKG changes assoc. with acute pericarditis

A
  1. diffuse ST segment elevation with
  2. upward concavity
  3. absence of recpircoal ST seg depression

in ALL LEADS

72
Q

pericarditis may have depression [] in EKG

A

PR interval

73
Q

low voltage QRS or electrical alternans may occur in []

A

effusion

74
Q

pericarditis may show ST elevation in [] leads

A

all

75
Q

MI may show elevation in [] leads

A

two

Clinical Medicine III (5 decks)

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