Cardio

Question 1

Name tx : Pericarditis (2)

Answer 1

• NSAIDS + Colchicine
• Steroids are used in refractory cases, but associated with recurrence; they’re usually the wrong answer.

Question 2

Tx : Recurrent pericardal effusion

Answer 2

Pericardial Window

Question 3

Tx : Tamponade

Answer 3

• Do EMERGENT Péricardiocentèse.
• An echo facilitates the diagnosis but is neither necessary nor sufficient.

Question 4

Tx : Constrictive Pericarditis

Answer 4

Péricardiectomie

Question 5

Describe EKG : Pericarditis

Answer 5

• Diffuse ST segment elevation (caution MI)
• but what is pathognomonic is **PR segment Depression. **

Question 6

Describe imagery : Pericarditis (2)

Answer 6

• An Echo will show an effusion but not the inflammation…. Echo is the wrong answer.
• Theoretically, MRI is the best radiographic test, but is often not needed.

Question 7

Describe : Pericardial Effusion (sx, dx, tx)

Answer 7

• Sx will be those of CHF: dyspnea on exertion, orthopnea, and PND.
• Dx : Echocardiogram.
• Tx : Pericardial effusions are secondary to an underlying cause. Treat the effusion by treating the cause. Most often an effusion develops in the setting of pericarditis; treating the pericarditis treats it. But if the effusion is large, refractory, or recurrent a pericardial window (literally a hole in the pericardium) can be made so that the fluid drains into the chest rather than into the pericardial space.

Question 8

What produces Tamponade? (1)

Answer 8

• If the effusion is rapid (or there’s ventricular hemorrhage) the pericardium fills without time to compensate. = This produces tamponade.

Question 9

Describe sx : Tamponade

Answer 9

Beck’s triad
* Distension of the jugular veins
* Hypotension
* Distant Heart Sounds

Clear lungs
Pulsus paradoxus >10mmHg make the clinical diagnosis.

Question 10

Describe : Constrictive Pericarditis (3)

Answer 10

• If an inflammatory process is left untreated long enough, fibrosis will set in. The loose membrane of the pericardium becomes fixed and rigid. It causes no trouble with contractility, but the heart relaxes into a rigid box, limiting filling. As the heart expands into too-small-a-space, it strikes the walls of the box and causes a pericardial knock.
• Dx : Echocardiogram.
• Tx : By removing the rigid pericardium with a péricardiectomie.

Question 11

Describe : Neurocardiogenic (Vasovagal) Syncope

Answer 11

• The vagus nerve goes everywhere: visceral organs, blood vessels, and the brain. It’s both afferent and efferent. Its signal to the blood vessels causes them to dilate, reducing systemic vascular resistance. The signal given to the heart is bradycardia. If the Vagus nerve activates more than it should (for whatever reason), it can cause bradycardia (cardio-inhibitory) or hypotension (vasodepressor). In both cases blood pressure falls, blood to the brain falls, and the person passes out.
• Lots of things can cause the Vagus to fire: visceral stimulation, such as cough / defecation / micturition, an overactive carotid sinus as in turning the head or shaving, and, because the vagus nerve comes from the brain, psychotropic causes such as the sight of blood.
• Vasovagal is both situational and reproducible.
• Do a tilt-table test to confirm suspicions.