Chapter 11: Pericardial Disease

Question 1

True/false: Pericardial lesions are usually primary (and thus only reflect pathological processes of the pericard).

Answer 1

False! Pericardial lesions typically are associated with a pathologic process elsewhere in the heart or surrounding structures, or are secondary to a systemic disorder

Question 2

What is a pericardial effusion?

Answer 2

Pericardial effusion is the buildup of extra fluid in the space around the heart

Question 3

How much cc fluid is usually in the pericardial sac?

Answer 3

<50cc

Question 4

Under various circumstances, the pericardial sac may be distended by accumulations of serous fluid (i), blood (ii), or pus (iii). What are the names for i, ii and iii?

Answer 4

Pericardial effusion, hemopericardium and purulent pericarditis respectively

Question 5

Pericardial effusions can either be of three different causes. Name and explain

Answer 5

• Serous: Congestive heart failure, hypoalbuminemia of any cause
• Serosanguineous: Blunt chest trauma, malignancy, ruptured MI, or aortic dissection
• Chylous: Mediastinal lymphatic obstruction

Question 6

Chronic pericardial effusions can become quite large (<500 cc) without interfering with cardiac function. How? How can this be seen?

Answer 6

The pericaridum has time to dilate. The only clinical characteristic is globular enlargement of the heart on a chest radiograph

Question 7

Acute/rapidly developing fluid collection of 200-300 cc has consequences for the heart. What happens?

Answer 7

Devastating compression of the thin-walled atria and venae cavae, or the ventricles themselves; cardiac filling is thereby restricted, producing potentially fatal cardiac tamponade.

Question 8

Is primary pericarditis common?

Answer 8

No

Question 9

Is primary pericarditis often due to bacteria or a virus?

Answer 9

Virus, but bacteria, fungi or parasites may also be involved!

Question 10

What is pericarditis often associated with (which disease)?

Answer 10

concurrent myocarditis

Question 11

True/false: pericarditis can either be primary or secondary

Answer 11

True, but primary pericarditis (typically) due to viral infections is very uncommon. Secondary pericarditis is a lot more common.

Question 12

Pericarditis is often secondary, from what?

Answer 12

Acute MI or cardiac surgery (Dressler’s syndrome), radiation to the mediastinum, or processes involving other thoracic structures (pneumonia/pleuritis)

Question 13

What are the symptoms of pericarditis?

Answer 13

Pericarditis classically manifests with atypical chest pain (not related to exertion and worse in recumbency), and a prominent friction rub. When associated with significant fluid accumulation, acute pericarditis can cause cardiac tamponade, which leads to declining cardiac output and consequent shock. Chronic constrictive pericarditis produces a combination of right-sided venous distention and low cardiac output, similar to the clinical picture in restrictive cardiomyopathy.

Question 14

In extreme cases of chronic pericarditis, there is so much dense fibrosis that it cannot expand normally during diastole. How is this condition called?

Answer 14

Constrictive pericarditis