Cardiac Pathologies: -itises - Lecture #2 Flashcards
What are the presenting sx in the patient hx?
- onset of progression, nature, any aggravating or alleviating sx
- chest pain with SOB and heart palpatations
- Overall fatigue
- syncope and dizziness
- hx of smoking, alcohol and drug use
- risk factors for CVD
What are we looking for in the chart review?
- diagnostic tests, imaging, procedures
- any lab values and ABGs (arterial blood gas)
- PMH/PSH and hospital course
- any medications and diet
- social hx, any cognitive and language ability and learning ability
What should we be checking for examinations?
- General observation: patient posture, how they breath and are they able to cough
- skin = blueish, are they pale, somewhat washed out and sweaty (within limits)
- pulses = are they off and how do they feel
- vitals
- heart and lung sounds
- Chest wall motion and palpation
- How is the rhythm (EKG)
- Checking circulation and lympathic system (which includes the peripheral vascular system)
What is pericarditis?
Inflammation of the pericardium (usually serous pericardium) or the pericardial fluid
What is the most common causes of pericarditis?
viral infection
- other infection: bacterial, uremia, acute MI and pericardiotomy (has to do with cardiac surgery, TB, malignancy, drug and toxin induced)
What are the other causes of pericarditis?
Systemic disease:
- autoimmune disorders (CT diseases)
- other inflammatory disorders (eg. sarcoidosis, amyloidosis, inflammatory bowel disease)
- drug toxicity
- chest irradiation
- hypothyroidism
Trauma
Can pericarditis have sx?
May not present with any signs or sx
What are the sx of acute pericarditis?
- retrosternal chest pain that is sharp, stabbing right behind the breastbone on the left side of the chest (or can be dull and achy)
- that pain can go to the back and left middle trap area
- dyspnea (with no exercise), cough and hoarseness
- general fatigue and fever
What makes acute pericarditis worse?
gets worse by coughing
deep breathing
supine
What makes acute pericarditis better?
helps when they sit up or lean forward
What is the EKG results of acute pericarditis?
abnormalities not common
- if there is = it will diffuse ST segment elevation
What populations do we see acute pericarditis?
seen in young and healthy because of a viral and idiopathic causes
- COVID 19 vaccinations
What do we hear when we’re auscultating?
Theres usually a friction rub because of the inflammed pericardial layers rubbing against one another
Usually best heard when the patient is leaning forward during an exhale
What do the labs say for acute pericarditis?
The labs will show acute inflammation
- increased levels of WBCs
- erythricyte sedimentation rate (sed rate)
- C-reactive protein
- May have mild elevated troponins indicating that myocardium is inflammed (will not continue to increase so might be MI)
how do we evaluate for acute pericardial effusion?
echocardiography
What the usualy timeline for acute pericarditis?
A self-limited disease around 1-3 weeks
How is acute pericarditis managed?
through rest, pain relief usually via anti-inflammatory drugs or sometimes steroids
Since it can be highly infectious or bacterial
- high dose of antibiotics through IV
- or pericardial drainage
What is constrictive pericarditis?
its a form of chronic pericarditis or pericardial effusion which ends up with thickening and scarring of the pericardium
What are the sx of constrictive pericarditis?
- dyspnea and fatigue because of decreased cardiac output
- LE and abdominal swelling
- Dizziness or syncope
- Vague retrosternal chest pain
- Jugular venous distention
How much fluid is in the pericardial effusion?
15-50 mL of fluid
What is the medical workup for constritive pericarditis?
chest x-ray
echo
CT
cardiac catherization
What is pericardial effusion?
accumulation of fluid within that pericardial space
What can lead to pericardial effusion?
pericarditis or other pathologies or even trauma
What is the mechanism of the pericardium which can be affected by effusion?
Since the pericardium is already stiff - it doesn’t tolerate well to large changes of fluid in a short time period
What are sx of pericardial effusion?
A very serious condition which can result in death
- feeling of fullness in chest
- has a cough
- hoarseness
- dysphagia (hard time swallowing)
- but can be asymptomatic
What is the medical work up for pericardial effusion?
- muffled heart and lung sounds
- dullness to percussion of the left lung at the angle of the scapula
- chest radiograoh can show big cardiac silhouette
- echo
What is the treatment for pericardial effusion?
Pericardiocentesis to drain the fluid
What is cardiac tamponade?
over accumulation of fluid in the pericardial space which increases the pressure on the heart - **a medical emergency **
- any pericarditis can progress
What is the most common progression towards cardiac tamponade?
- neoplastic
- post viral
- blunt or penetrating chest trauma
- dissecting aortic aneurysm
What are the sx of cadiac tamponade?
Poor filiing of the heart = decreased BP
Hypotension, shock and possibly death
Decreased CO signs: dyspnea, fatigue, syncope or dizziness
- theres also coughing, tachycardia and tachypnea
Jugular vein distentionw/ pulsus paradoxus (abdnormal drop in systolic BP during inspiration)
Decreased heart sounds (Beck’s triad)
What is the medical work up and treatment?
- echo
- when its an emergency, treated with pericardial (or cardiac) window = cutting a hole in the fibrous pericardium to let fluid drain or relieve pressure
- pericardiocentesis = inserting a fluid to draw out the fluid
What is endocarditis?
infection of the endocardium from a bacteria or fungi
What is the cause of endocarditis?
Usually travels from one part of the body (usually from dental work or GI/urinary procedures)
- caths, tattoos, IV drug use
- Rheumatic fever
How is endocarditis treated?
With long term antibiotic since if left untreated can lead to destructive of valves and is often fatal
cardiac supportive measures
possible valve replacement
What are the sx of endocarditis?
Flu like sx
pain with breathing
SOB
swelling
fever
- quick onset of flu sx
- can possibly hear the mitral valve regurgitation on auscultation
How are at most at risk with endocarditis?
artificial heart valves reservoir for germs
damaged valves or congenital heart defect
What are the complications of endocarditis?
bacterial vegetation can travel to other areas of the body
- heart valve damage
- abscesses
- PE
- kidney and spleen
What is the medical workup for endocarditis?
labs:
- sed rate
- C-reactive proteins
- WBCs
- blood cultures to isolate organism
EKG
Echo/TEE
What is the prevention of endocarditis?
- prophylactic antibiotic before dental work
- Upper respiratory procedures that has to do with incisions or biopsies
- GI/GU procedures if an effection is there
What is myocarditis?
Otherwise known as inflammatory cardiomyopathy
It’s an infection or inflammation of the heart wall/muscle
Generally viral or bacterial infection; rare: drug induced
- streptococcal which is the most common
- rheymatic fever
affects both pump and electrical conduction
What is the sx of myocarditis?
- diffuse chest pain
- fatigue
- SOB
- edema
- arrhythmias
- fever
- general weakness
What does myocarditis do for the pump?
Weakens pump action (diffusion chest pain, fatigue, SOB, edema) and arrhythmias
What does a decreased pump action result in?
Heart failure because of damaged cardiac muscle
If left untreated, what can myocarditis lead to?
Heart failure
MI or CVA because of the poor pump action which leads to pooling in the ventricles
Arrythmias (sudden cardiac death) because of the decreased electrical effienciency
