Cardiology 3, Heart Disease Flashcards
Pericarditis symptoms
movement of the trunk, ionspiration, coughing. Pain is relieved by sitting up. Low-grade fever and malaise may also be present.
Diagnosing Pericarditis
friction rub variable. CXR is usually normal unless effusion is large. occasionally pulmonary infiltrate or small plerual efusion.L>R
EKG shows acute concave ST elevation in all ventricular leads. PR is depressed
Causes of pericarditis
viral, idiopathic, autoimmune and collagen diseases, also post myocardial infarction or cardiac surgery.radiation and neoplasm (Hodgkin, leukemia, lymphona, breast thyroid, lung tumors, melanoma) uremia, TB.
Post Cardiotomy Sydrome
after open heart procedures: pyrexia, increased ESR,, pleural or pericardial chest pain. Weeks ot months after operation. incidence decreases with age. Usually responds to antiinflammatory agents.
Features of tamponade
typically rapid fluid accumulation. Causes a decrease in ventricular volume, increased intrapericardial pressure increases the ventricular end diastolic pressure and mean atrial pressure and increased atrial pressure increases the venous pressure. Cardiac output diminishes. Think of ruptured myocardium after infarction, aortic dissection, ruptured aortic aneurysm and post open heart or catheterization.
More features of tamponade
BP is low and tending toward =sys/diastolic. Heart is small and quiet but tachycardia may be present. Jugular venous pressure is increased and pulsus paradoxus develops. (increased flow of blood into the right heart during inspiration) There may be an increase in inspiratory distention of the neck.(Kussmaul sign)
Features of constrictive pericarditis
dissociation of respiratory induced changes in intrathroacic and intracardiac pressures (pulsus paradoxus) Diasolic filling of ventricles is limited which leads ot smaller ventricular volume and higher end diastolic pressures.
Common causes of constrictive pericarditis
recurrent viral pericarditis, irradiation, previous open heart, TB and neoplasm
Symptoms of contrictive pericarditis
right-sided failure, peripheral edema, ascites and dyspnea and fatigue.
Clinical features of constrictive pericarditis
JVP is increased, inspiratory distention of neck veins (Kussmaul sign) JVP may show rapid descents and pericarrdial knock in <50%. Ascites and peripheral edema art etypical. CXR may show pericardial calcification and cardiac enlargement.
Diagnosing constrictive pericarditis
may be difficult. Keep suspicion high. check Doppler. CT may be helpful to identify thick myocardium. MRI can show inflammation. Hardest DDX restrictive cardiomyopathy.
Ventricular pressure curve with “square root sign”
a and v waves are equal and x and y descents are rapid.
Treatment for constrictive pericarditis
Thoracotomy to remove the pericardium.
Types of Bioprosthetic valves
homograft (aortic of pulmonary); heterograft (porcine); pericardial (bovine) = non as thrombogenic. No anticoag needed for most
Tissue valves degenerate and calcify and patients will need reoperation. In young patients this may happen rapidly.
Mechanical Valves
ball in cage, tilting disk, St Jude. All need anticoagulation and may cause hemolysis. Minor hemorrhage rate is only 2-4%/year and major 1-2%. Will need antibiotic for endocarditis.
Tumors of the heart
Metastatic tumors are 40 times more likely than primary. Typically melanoma (50% of malignant melanoma have cardiac mets), lymphoma, breast lung and esophageal.
