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