What is pericarditis?
Inflammation of the pericardium around the heart, usually as a result of a virus or a bacteria, or blunt trauma. Inflammation increases capillary permeability, which causes the influx or more inflammatory chemicals to the area.
How would pericarditis present in my patient?
- decreased cardiac output
- pericardial friction rub–super painful!
- ECG changes
Explain the pain associated with pericarditis
- precordial, doesn’t radiate
- abrupt onset
- sharp pain
- scapula pain
- increased pain with deep breath and cough
- relief when leaning forward
What is Dressler Syndrome?
chest pain post heart-attack after hospital treatment
What is a pericardial effusion?
accumulation of fluid in the pericardial space, caused by inflammation of the pericardium, infection, neoplasms, cardiac surgery, and trauma
What is the worst case scenario of fluid building up in the pericardial sac?
Cardiac Tamponade. This occurs when enough blood or other fluid has built up in the pericardial sac that it compresses the heart, which may prevent it from pumping effectively.
What can cause Cardiac Tamponade?
- Blunt trauma (MVA)
- Myocardial rupture post MI
- Cardiac surgery
- Aortic dissection
If I suspect that my patient is experiencing cardiac tamponade, how might they present to me?
It depends on the amound and the rapidity, but ultimately the compression limits stroke volume and cardiac output, which leads to low systolic blood pressure. You would see:
- chest pain and tachycardia, muffled heart sounds
- dyspnea and tachypnea
- change in mentation.
- elevated jugular venous pressure
- circulatory shock
How is Cardiac Tamponade diagnosed?
- Pulsus paradoxus
- ECG (would indicate decreased conductivity)
- Echocardiogram
- CT, MRI
How is cardiac Tamponade treated?
immediate pericardiocentasis
What is pulsus paradoxus?
a drop in systemic arterial pressure of greater than 10 mmHg on inspiration
LOOK UP CORONARY ARTERY CHART IN NOTES
LOOK AT IT NOW!
What 3 things assist coronary artery flow?
- Endothelial cells lining the arteries
- Diastolic pressure in the aorta
- Time in Diastole
What can you teach your patients if they want to reduce their risk for CAD?
Teach them the modifiable risks for the disease:
- HTN
- Hyperlipidemia
- Tobacco use
- Diabetes
- Obesity
- sedentary lifestyle
- ability to cope with stress
What are the non-modifiable risks for CAD?
- post-menopausal women are more at risk
- age
- ethnicity
- genetics/family history
Your patient comes into the emergency room complaining of chest pain, afraid that he might be having a heart attack. It turns out that he is experiencing stable angina. How can you explain this condition to him? What are the common manifestations?
- benign chest pain d/t lack of oxygen, often with exercise, exertion, cold temperatures, or high emotions
- Often a FIXED coronary narrowing
- normally substernal pain, occasionally radiates
- may experience epigastric discomfort
If your patient experiences stable angina again in the future, how can he relieve the pain?
Rest and nitroglycerine (if prescribed by dr)
What is the difference between stable angina and variant angina?
stable angina occurs with fixed coronary narrowing, but variant angina occurs d/t spasms of the coronary artery
Why are silent MI’s more likely in the elderly?
- Less myocardium involved, which decreases intensity of pain
- neuropathy, which leads to decreased sensitivity
- hypotension, which leads to vauge discomfort, mild diaphoresis, occasional stroke-like symptoms
What are the potential causes of Acute Coronary Syndrome?
-Unstable plaque rupturing to form a clot
-coronary vasospasm
-atherosclerotic narrowing
-Inflammation/Infection
SECONDARY CAUSES
-anemia, fever, hypoxemia, surgery
What is unstable angina?
[NSTEMI]
- with pre-diagnosis of “stable angina”
- occurs at rest, which is different from stable angina, which occurs with exertion
I might suspect my patient may be having an ST Elevation MI if he is exhibiting what specific symptoms?
- crushing/constricting pain or pressure
- substernal with radiation to the L arm and jaw
- epigastric distress/nausea
- palpitations
- cool, clammy skin
- Shortness of breath
- Anxiety
How long does it take for cell death to occur in an MI?
15-20 mins– Early perfusion and revascularization can prevent necrosis! ACT QUICK!
Myocardial ischemia and necrosis result in…
- Decreased contractile force
- decreased CO
- decreased coronary artery perfusion
- increased pulmonary vasculature pressure - Interruption of conduction
- dysrhythmias
