Cardiac 2

Question 1

Disorders of the heart wall: pericardium

Answer 1

Acute pericarditis
Pericardial effusion
Tamponade
Constrictive pericarditis

Question 2

Disorders of the heart wall: myocardium

Answer 2

Cardiomyopathies:

• dilated
• hypertrophic
• obstructive
• restrictive

Question 3

Disorders of the heart wall: endocardium

Answer 3

Valvular dysfunction: stenosis/regurgitation/prolapse
-aortic, mitral, tricuspid
-mitral valve prolapse
Rheumatic fever/Heart disease

Question 4

Heart wall layers

Answer 4

Pericardium (epicardium): double walled heart sac
Myocardium: muscle layer
Endocardium: inner lining

Question 5

Acute pericarditis

Causes

Answer 5

Acute inflammation of the pericardial membranes, fibrotic process - roughened 
Causes: MULTIPLE, idiopathic
-infectious (bacterial, viral, HIV, TB)
-trauma
-MI
-uremia
-SLE/RA

Question 6

Acute pericarditis
signs
symptoms
diagnosis

Answer 6

Signs: fever, tachycardia, cardiac friction rub at apex and left sternal border, ECG changes
Symptoms: precipitating fever, sudden onset, severe, retrosternal chest pain; worsens with breathing and lying down
Diagnosis: US, CT, MRI

Question 7

Acute pericarditis
treatment
complications

Answer 7

Treatment: tx of underlying cause, anti-inflammatory meds (salicylates/NSAIDS), colchicine
Comp: pericardial effusion, tamponade, constrictive pericarditis

Question 8

Pericardial effusion

causes

Answer 8

Fluid in pericardial sac, can occur with pericarditis
-exudate (inflammatory): acute pericarditis, autoimmune disorders, infections
transudate (serous): HF, hypoproteinemia, overhydration
-serosanguineous/ sanguineous: trauma ruptured myocardium, coag defect
Causes: 20% idiopathic, neoplasm, infection

Question 9

Pericardial effusion
signs
sx
dx

Answer 9

signs: muffled heart sounds, xray (water bottle)
sx: DOE, dull chest pain
dx: ECG can detect 20 mL

Question 10

Pericardial effusion
tx
complications

Answer 10

tx: pericardiocentesis (aspiration) or pericardial window (drain), analgesics, antiinflammatories, steroids
complications: fluid increases rapidly (50-100mL), tamponade typically preceded by pulsus paradoxus (BP during expiration >10 mmHg higher than inspiration)

Question 11

Cardiac tamponade

lead to?

Answer 11

when pressure exerted by pericardial fluid equals/exceeds diastolic pressure within the heart

interferes with atrial filling, increased venous pressure/congestion, S&S of RHF, decreased ventricular filling

can lead to circulatory collapse