Chapter 10: Pericardial Disease Flashcards
What are the LAYERS of the pericardium?
- visceral pericardium
- parietal pericardium
a. fibrous
b. serous
What are the FUNCTIONS of the pericardium?
- isolation
- barrier to infection
- reduced friction during contraction
- affects pressure distribution to the cardiac chambers
What causes pericardial disease?
- infection
- malignancy
- inflammatory
- trauma
- idiopathic
Define PERICARDITIS
inflammation of the pericardium
What are the ECHO FINDINGS for PERICARDITIS?
- increased echogenicity on 2D
- multiple parallel reflections posterior to LV on m mode
Define PERICARDIAL EFFUSION
build up of fluid around the heart. (pleura)
What are the CLINICAL SIGNS of PERICARDITIS?
- chest pain (typically worse when supine and with inspiration)
- widespread ST elevation on ECG
- pericardial friction rub on auscultation
- new or increasing pericardial effusion
What are the RATING SCALES for PERICARDIAL EFFUSION?
- quantification
- otto rating sale
- reynolds rating scale
Describe the QUANTIFICATION rating scale
- normal/very small = posterior echo free space in systole
- small = posterior echo free space
- mod to large = anterior and posterior echo free space
- large = anterior and posterior space and swinging motion
- tamponade = RA collapse and swinging motion
What is the OTTO RATING SCALE and what are the NORMS?
- based on the degree of separation between the parietal and visceral layer
small < .5 cm
mod .5 - 2 cm
severe > 2cm
What are the NORMS for REYNOLDS RATING SCALE?
Small -space systole/diastole posterior only < 1cm
Moderate -space systole/diastole poster/anterior < 1 cm
Large - space systole/diastole surrounds heart > 1cm
How can you distinguish pericardial effusion from pleural effusion?
-A left pleural effusion will extend posterolateral to the descending aorta
-A pericardial effusion will track anterior to the DA
What is PLEURAL EFFUSION?
build up of fluid in the space between your lungs and chest cavity
What are the 2 types of pleural effusion?
- transudative
- exudative
What is a TRANSUDATIVE EFFUSION?
high pressure pushes fluid out of vessels into interstitial (between cells), airways, pleural space
What is a EXUDATIVE EFFUSION?
inflammation of vessel walls allow fluid and proteins/large particles to leave vessel (infection, pneumonia, autoimmune, cancer, lung injury)
What is LOCULATED PE?
localized pocket(s) of fluid
What causes LOCULATED PE?
isolated areas of pericardial sac adhere and trap fluid
When is it common for LOCULATED PE to occur?
post op and recurrent pericardial disease so always check all windows
What is ATELECTASIS?
collapse area of lung
What is PNEUMONIA?
inflammation/infection of the air sacs
Name other PERICARDIAL MASSES
- epicardial fat pad
- right pleural effusion
- fibrinous stranding
- metastatic PE
- pericardial cysts
- hematoma
- pseudoaneurysm
What is CARDIAC TAMPONADE?
occurs when pericardial effusion causes pressure in pericardium to exceed pressure in chambers impairing cardiac filling
What is CONSTRICTIVE PERICARDITIS?
visceral and parietal layers become adhered, thickened, and fibrotic impairing diastolic filling “acting like a rigid box” leading to decreased cardiac output
What are the signs and symptoms of CARDIAC TAMPONADE?
- dyspnea and tachycardia(most common)
- hypotension
- cough
- JVD
- hoarseness, difficulty swallowing
What are the signs and symptoms of CONSTRICTIVE PERICARDITIS?
- diagnosis is often delayed bc symptoms occur late *
- fatigue
- malaise
- dyspnea
- JVD
- hepatomegaly
- ascites
7.peripheral edema
What types of AUSCULTATIONS are heard with CARDIAC TAMPONADE?
- distant heart sounds (Becks Triad if accompanied with hypotension and JVD
- pulsus paradoxus: systolic BP drops >10 mmHg when the patient inspires
What is EWARTS SIGN and when is it heard with?
- bronchial breathing and dullness to percussion at the lower angle of the left scapula due to the fluid collapsing the left lower lobe
- cardiac tamponade
What AUSCULTATIONS are heard with CONSTRICTIVE PERICARDITIS?
- distant heart sounds
- diastolic pericardial knock - as ventricular inflow is abruptly stopped
- pulsus paradoxus
What is KUSSMAUL’S SIGN and when is is it heard with?
- a rise in JVP on inspiration due to RV noncompliance pushing fluid back into the venous system
- constrictive pericarditis
What are the ECHO FINDINGS fo CARDIAC TAMPONADE?
- Large pleural effusion and swinging heart
- RA systolic collapse ( <⅓ of systole) - RA intracardiac pressure is lowest in systole
- RV diastolic collapse ( strong indicator for tamponade)- RV intracardiac pressure is lowest in early diastole
- LV may appear hyperkinetic as it seeks volume to circulate
- Reciprocal respiratory changes in ventricular volumes
- Enlarged nonpulsatile IVC
What are the treatments for CARDIAC TAMPONADE?
- treat etiology of tamponade
- volume expansion
- pericardiocentesis
- pericardial window
What is PERICARDIOCENTESIS?
needle aspiration of pericardial that is echo guided to reduce complications
What are the 2D FINDINGS for CONSTRICTIVE PERICARDITIS?
- Echogenic pericardial thickening may be evident, some suggest > 3mm
- Binded or bound appearance a the epicardial pericardial border with lack of pericardial slide
- Septal shift with inspiration (bouncing)
- Normal to dilated atria due to chronic atrial pressure elevation
- Dilated IVC and hepatic veins due to elevated atrial pressures
What are the M MODE FINDINGS for CONSTRICTIVE PERICARDITIS?
- LV: multiple dense linear reflections posterior to LV “railroad track sign”
- LV: diastolic septal or “Spanish” notch
- LV: PW shows early diastolic descent followed by flattening (aka square root sign)
- PV: exaggerated premature opening of PV
What are the DOPPLER FINDINGS for CONSTRICTIVE PERICARDITIS?
- Significant respiratory change at the TV and MV > 25% (like tamponade)
- Respiratory changes will be similar at other right and left heart locations
- MV and TV demonstrate prominent E wave with rapid deceleration slope, and small A wave
- May note diastolic flow reversal in hepatics
- IVRT demonstrates respiratory changes with ↑ time in inspiration
