Cardiology: Pericardial Disease

Question 1

name causes of pericarditis use mnemonic:

CARDIAC RIND

Answer 1

Collagen vascular disease
Aortic dissection
Radiation
Drugs 
Infections
Acute renal failure (uremia)
Cardiac (MI)
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome

Question 2

how is pericarditis defined

Answer 2

inflammation of the pericardial sac

Question 3

name two ways pericardial disease can compromise cardiac output

Answer 3

tamponade or constrictive pericarditis

Question 4

how does pericarditis present? how does it change with position and breathing

Answer 4

• pleuritic chest pain, dyspnea, cough, and fever

- worsen in supine position and with inspiration

Question 5

what will be found in examination in a pt with pericarditis

Answer 5

pericardial friction rub
elevated paradoxus (a decrease in systolic BP> 10 mmHg on inspiration)
tampanode

Question 6

how should pericardial disease be diagnosed?

Answer 6

CXR, ECG, and ECHO to rule out MI and pneumonia

Question 7

what ECG changes would be expected

Answer 7

diffused ST segment elevation and PR segment depressions followed by T wave inversions

Question 8

what may ECHO show in pericardial disease

Answer 8

pericardial thickening or effusion may be evident

Question 9

A 20-yr old male presents with an initial BP of 150/85 mm Hg, and repeat measurement yields 147/85 mmHG. The pt’s potassium level is 3.2mg/dL What is the next step in diagnostic step?

Answer 9

a hyperaldosteronism workup with serum aldosterone and renin levels is an appropriate next step

Question 10

name treatment of pericarditis (3 steps)

Answer 10

• address the underlying cause or symptoms
• avoid corticosteroids within a few days after MI- to avoid risk of ventricular wall rupture
• monitor for pericardial effusions and use pericardiocentesis as needed

Question 11

define cardiac tampanode

Answer 11

excess fluid in the pericardial sac, leading to compromised ventricular filling and decreased CO

Question 12

what is more important in cardiac tampanode. the amt of fluid or the rate of fluid accumulation?

Answer 12

the rate of fluid accumulation

Question 13

name risk factors of cardiac tampanode

Answer 13

pericarditis, malignancy, SLE, TB, and trauma (stable wounds medical to left nipple)

Question 14

name triad of cardiac tampanode?

Answer 14

Beck’s triad (JVD, hypotension, distance heart sounds)

Question 15

how does cardiac tamponade present?

Answer 15

fatigue, dyspnea, anxiety, tachycardia, and tachypnea that can rapidly progress to shock and death

Question 16

aside from Beck’s triad what other 3 signs can be found in pt’s with cardiac tamponade

Answer 16

a narrow pulse pressure, pulsus paradoxus, and Kussmaul’s sign (JVD on inspirations)

Question 17

what is seen on ECHO in cardiac tamponade

Answer 17

shows right atrial and right ventricular diastolic collapse

Question 18

what is seen on CXR in cardiac tamponade?

Answer 18

enlarged, globular, water bottle shaped heart with a large effusion

Question 19

what is on ECG in cardiac tamponade?

Answer 19

electrical alternans- diagnostic of large pericardial effusion

Question 20

how is cardiac tamponade treated?

Answer 20

• aggressive volume expansion with IV fluids
• urgent pericardiocentesis (aspirate will be nonclotting blood)
• pericadial window if pt is decompensating