Ch 4 Pericardial Disease

Question 1

List 2 distinctive echo features when comparing constrictive pericarditis + restrictive cardiomyopathy?

Answer 1

Answer: A + C

-Respiratory ventricular septal shift in constrictive
-TDI lateral E’ < septal E’ in constrictive

(RV + LV filling pressures are not equal in restrictive)

Question 2

Differentiate the RV + LV filling pressures with constrictive pericarditis + restrictive cardiomyopathy?

Answer 2

Constrictive: equal
Restrictive: LV > RV

Question 3

What pulse is associated with cardiac tamponade?

Answer 3

Pulsus paradoxus

Question 4

List 3 clinical features of cardiac tamponade?

Answer 4

-Pulsus paradoxus (decrease in systolic BP more than 10 mmHg)
-Low CO
-Tachycardia

Question 5

Where does pleural effusion + pericardial effusion occur?

Answer 5

Pleural: below DTA
Pericardial: above DTA

(look in PLAX)

Question 6

Constrictive pericarditis will have a higher lateral E’ velocity than septal E’ velocity. True or False?

Answer 6

False

(it has a higher septal E’, think opposite of normal)

Question 7

What procedure is performed when there is an excess amount of fluid in the pericardial space that causes compression of the cardiac chambers?

Answer 7

Pericardiocentesis

Question 8

Swinging heart syndrome is associated with what?

Answer 8

Pericardial effusion

Question 9

In cardiac tamponade, what are the 3 main 2D echo findings are seen?

Answer 9

-RA systolic collapse
-RV diastolic collapse
-IVC plethora/dilation

(not pleural effusion, IVC collapse, LV diastolic collapse)

Question 10

Pericarditis that occurs weeks to months after an MI is known by what name?

Answer 10

Dressler’s syndrome

Question 11

PW doppler evidence of cardiac tamponade includes what?

Answer 11

-Inspiratory decrease in peak velocity across MV (small LV)
-Inspiratory increase in peak velocity across TV (dilated RV)

(this is ventricular interdependence)

Question 12

A thickened, inflamed, adherent or calcific pericardium is associated with?

Answer 12

Constrictive pericarditis

Question 13

What is the size of the pericardial effusion when the separation b/w the heart + parietal pericardium is 2.3cm?

Answer 13

Large PE (>2cm)

Question 14

When determining respiratory variation in cardiac tamponade, what would you expect to see in the MV + TV inflow spectral doppler traces?

Answer 14

-MV velocity decrease of >30% on INSPIRATION
-TV velocity decrease >60% on EXPIRATION

Question 15

In constrictive physiology during expiration on echo, what would you be looking for?

Answer 15

Expiratory flow reversal in hepatic veins

Question 16

Based on the 2D + m-mode images, what pathology is associated with the findings above?

Answer 16

Cardiac tamponade

(m-mode shows RV diastolic collapse of the RV free wall)

Question 17

In tamponade physiology, which cardiac structure is affected first from the increasing pericardial pressures?

Answer 17

RA