Cardiology #13 (Pericardial Effusion, Tamponade, Pericarditis, Ortho Hypo) Flashcards
What is a pericardial effusion?
accumulation of fluid in the pericardial space
Etiologies of pericardial effusion
-Idiopathic
-Viral
-Malignancy (lung cancer MC)
Symptoms of a pericardial effusion
-Chest pain
-Dyspnea
-Fatigue
-Decreased/Muffled heart sounds (due to fluid)
Diagnostic of choice for a pericardial effusion
Echocardiogram
What is seen on an ECG with a pericardial effusion?
-Electrical alternans (alternating amplitudes of QRS complexes)
-Low QRS voltage
Although a chest radiograph is normally NOT used in the diagnosis of pericardial effusion, what may be seen on the CXR?
Water bottle heart
Treatment for pericardial effusion
-Treat underlying cause
-Serial echocardiography if necessary
-Large effusions may need pericardiocentesis for symptomatic relief
What is a cardiac tamponade?
Pericardial effusion causing significant pressure on the heart, impeding cardiac filling, leading to decrease cardiac output and shock (medical emergency)
MC nontraumatic cause of cardiac tamponade
Malignancy
Symptoms of a cardiac tamponade
Beck’s Triad: muffled heart sounds, increased JVP, systemic hypotension
Pulsus Paradoxus: exaggerated (>10 mmHg) decrease in systolic BP with inspiration
Dyspnea, fatigue, peripheral edema, shock, tachycardia, cool extremities
What is seen on echocardiogram in a cardiac tamponade?
Pericardial effusion + diastolic collapse of cardiac chambers
Much like a pericardial effusion, what is seen on ECG with a cardiac tamponade?
Electrical alternans (low voltage QRS, alternating high and low QRS)
Definitive diagnostic for cardiac tamponade
Right heart catheterization
Treatment for cardiac tamponade
Immediate pericardiocentesis to remove the pressure
Volume resuscitation and pressor support if needed.
What treatment should be pursued for cardiac tamponade if the condition is recurrent?
Pericardial window
What is constrictive pericarditis?
Loss of pericardial elasticity (thickening, fibrosis, and calcification) leading to restriction of ventricular diastolic filling
Decreases stroke volume and cardiac output
In the US, _____ and ____ are the most common causes of constrictive pericarditis. Worldwide, ______ is the MCC
Idiopathic and viral illness
Tuberculosis
Symptoms of constrictive pericarditis
-Dyspnea (MC), Orthopnea, fatigue
-Right sided HF symptoms: Increased JVD, peripheral edema, nausea, vomiting, Kussmaul’s Sign (lack of inspiratory decline or increased in JVP with inspiration)
-Pericardial knock: high pitched diastolic sound similar to S3
What is seen on echocardiogram for constrictive pericarditis?
Pericardial thickening and/or calcification
Square root sign: early diastolic dip followed by a plateau of diastasis
What is a diagnostic that is MORE sensitive than an echocardiogram for constrictive pericarditis?
MRI or CT scan
Medical management for constrictive pericarditis
Diuretics for symptom relief as well as reduction of edema and pressure
What is the definitive treatment for constrictive pericarditis?
Pericardiectomy
What is postural (orthostatic) hypotension?
Hypotension within 2-5 minutes of standing (or 5 minutes of supine rest) defined by a least 20 mmHg fall in systolic pressure and/or at least 10 mmHg fall in diastolic pressure
Name 5 causes of orthostatic hypotension
-Impaired autonomic function
-Meds: Antihypertensives, Diuretics, Narcotics, Antidepressants
-EtOH
-Diabetic neuropathy
-Parkinson’s Disease
-Hypovolemia (Loop Diuretics, vomiting, hemorrhage)
Symptoms of orthostatic hypotension due to cerebral hypoperfusion
Dizziness, fatigue, lightheadedness, palpitations, blurry vision, syncope
What is included in the workup of a patient with orthostatic hypotension?
Blood pressure management
Tilt Table Test: blood pressure reduction at 60-degree angle
Labs (Electrolytes, BUN, creatinine, glucose) to evaluate for anemia or dehydration
Initial therapy and management for postural (orthostatic) hypotension
Conservative: increasing salt and fluid intake, gradual position changes, compression stockings, exercise, caffeine, discontinue offending medications
What is the first-line medical management of orthostatic hypotension?
Fludricortisone
If additional medical therapy is necessary, or if the patient cannot take Fludricortisone, what other two options for medications are out there?
Midodrine
Droxidopa
What are some other recommendations you can give to patients with orthostatic hypotension?
Avoid the flat position
Sleep with the head of the bed raised 30-45 degrees
