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CVPR > CV - pericardial disease > Flashcards

CV - pericardial disease Flashcards

1
Q

describe the pericardium

A

the pericardium is a fibroelastic sac with visceral (directly abutting the epicardium) and parietal layers, forming a sac containing a small quantity of pericardial fluid

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2
Q

what is the purpose of the pericardium?

A

to reduce the friction produced by the contraction and expansion of the heart

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3
Q

what are the four types of pericardial disease?

A

acute pericarditis
pericardial effusion without hemodynamic compromise
cardiac tamponade
constrictive pericarditis

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4
Q

what are the four commonest causes of acute pericarditis?

A

viral illness
connective tissue or autoimmune disease
uremia/advanced renal dysfunction
metastatic tumors

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5
Q

what is the commonest presentation of acute pericarditis?

A

sudden onset chest pain - often severe, varying with position and breathing

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6
Q

what are five diagnostic exam findings or study findings commonly associated with acute pericarditis?

A

chest pain varies with position or breathing
pericardial rub on cardiac exam
EKG - diffuse ST elevation
ECHO - pericardial fluid
response to anti-inflammatory agents (ibuprofen, aspirin, colchicine)

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7
Q

what are the typical drug therapies for acute pericarditis?

A

ibuprofen 300-800 mg po every 6 to 8 hours
aspirin 325-650 mg

hallmark of treatment now: aspirin and colchicine

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8
Q

what is the definition of acute pericarditis?

A

acute inflammation of the pericardium, most common pericardial disease

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9
Q

what is the definition of pericardial effusion?

A

abnormal accumulation of fluid in the pericardial cavity

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10
Q

what are the five commonest causes of pericardial effusion?

A 
viral or acute idiopathic pericarditis
metastatic malignancy
uremia
autoimmune disease
hypothyroidism
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11
Q

how does pericardial effusion present on chest X-ray?

A

enlarged heart

non-conjested lung fields

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12
Q

what are the diagnostic exam findings or study findings commonly associated with pericardial effusion?

A

small effusions without high intrapericardial pressure may be asymptomatic
large effusions with high intrapericardial pressures cause cardiac tamponade where myocardial compression impairs diastolic filling

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13
Q

what is the basic definition of pericardial or cardiac tamponade?

A

pressure on the heart due to a buildup of fluid, blood, pus or gas in the pericardial sac

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14
Q

what effect does pericardial tamponade have on heart function?

A

high intrapericardial pressure results in impaired filling of the right side of the heart, and decreased right ventricular output

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15
Q

what is the primary difference between pericardial tamponade and dilated cardiomyopathy?

A

in pericardial tamponade there is decreased right ventricular output and therefore the lungs are not congested
in dilated cardiomyopathy, the dilated heart is associated with pulmonary venous congestion in the lungs

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16
Q

what is the primary cause of constrictive pericarditis?

A

scarring and loss of elasticity of the pericardium

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17
Q

what are the four common etiologies of the scarring and loss of elasticity of the pericardium that cause constrictive pericarditis?

A

idiopathic
following cardiac surgery
radiation
infectious causes

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18
Q

what is the common presentation of constrictive pericarditis?

A 
elevated jugular venous pressure
hepatomegaly
edema
ascites
tachycardia
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19
Q

what are the diagnostic exam findings associated with constrictive pericarditis?

A

thickened or calcified pericardium on Xray
cardiac silhouette usually normal in size but encased by thickened pericardium
lungs not congested on Xray
in catheterization lab measure LV and RV pressures, observe dip and plateau during diastole, equalization of diastolic pressures between LV and RV

difficult to diagnose, often diagnosed by cardiac MRI

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20
Q

what is the distinguishing symptomatic feature that distinguishes pericardial pain from other causes of chest pain?

A

pericardial pain is “pleruitic” meaning it is aggrivated by deep breathing, and is “positional” meaning it is relieved by sitting up or other postural changes

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21
Q

pain from acute coronary syndromes is not altered by ____________, ____________ or ____________.

A

breathing
cough
positional changes

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22
Q

pain from acute pulmonary embolus may be pleuritic but lacks the ____________ and ____________ of pericarditis.

A

electrocardiographic changes

pericardial rub

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23
Q

how is pericardial tamponade distinguished from congestive heart failure (CHF)?

A

in tamponade, the major impairment is in the right heart filling during diastole and there is therefore no pulmonary congestion
in congestive heart failure there is usually no impairment in right heart filling but a generalized diminished myocardial function which causes both pulmonary and systemic congestion

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24
Q

in tamponade, the major impairment is with ____________ filling during ____________.

A

right heart

diastole

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25
Q

in congestive heart failure (CHF), there is usually no impairment in right heart filling but diminished ____________ function.

A

myocardial

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26
Q

what are four common features shared by tamponade and CHF?

A

distended neck veins
tachycardia
low blood pressure
large cardiac silhouette on xray

27
Q

what are the significant exam and X-ray findings that distinguish cardiac tamponade and CHF?

A

in tamponade the lungs are typically clear on physical exam and X-ray
in CHF the lungs are congested with the presence of rales on exam and redistribution of blood flow to the upper lobes, along with other X-ray findings

28
Q

____________, ____________ and ____________ are expected in tamponade and rare in CHF.

A

pulsus paradoxus
low voltage
pulsus alternans

29
Q

define pulsus paradoxus

A

abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration

with inspiration there is increased venous return to the right ventricle and the right ventricle expands more quickly. if there is a decrease in the pericardial expandability or an increase in pericardial pressure (pericardial tamponade), the expansion of the right ventricle causes a compression on the left ventricle and a resultant decrease in systolic blood pressure

30
Q

define pulsus alternans

A

physical finding with arterial pulse waveform showing alternating strong and weak beats, indicated of left ventricular systolic impairment

31
Q

what are three distinctive echocardiogram findings associated with cardiac tamponade?

A

large pericardial effusion
right atrial collapse
lack of normal decrease in inferior vena cava diameter

32
Q

what are three common features shared by pericardial tamponade and constrictive pericarditis?

A

reduced diastolic function with preserved systolic function
jugular venous distension
tachycardia and tendency to low blood pressure

33
Q

what are the distinguishing differences between pericardial tamponade and constrictive pericarditis?

A

tamponade has a very large cardiac silhouette on X-ray, whereas the silhouette apparent in constrictive pericarditis is typically normal with pericardial calcification
pulsus paradoxus is present in tamponade and uncommon in constrictive pericarditis
tamponade tents to exhibit a more rapid onset than constrictive pericarditis
echocardiogram findings of pericardial fluid, right atrial collapse with inspiration are typical of tamponade but absent in constrictive pericarditis

34
Q

tamponade has a ____________ on X-ray.

A

large cardiac silhouette

35
Q

constrictive pericarditis xray findings are often ____________ and may have ____________.

A

normal cardiac silhouette

pericardial calcification

36
Q

____________ is present in tamponade and uncommon in constrictive pericarditis.

A

pulsus paradoxus

37
Q

constrictive pericarditis typically develops ____________ and is often accompanied by ____________, ____________ and ____________.

A

very slowly
hepatic congestion
ascites
marked pedal edema

38
Q

the echocardiogram findings commonly found in tamponade are ____________ and ____________.

A

large pericardial effusion

right atrial collapse with inspiration

39
Q

what is the most common of the four pericardial diseases?

A

acute pericarditis

40
Q

what minimal amount of fluid may be present to cause an acute pathological state?

A

100-200ml fluid

41
Q

visceral pericardium comes into contact with the ____________ layer of the parietal pericardium.

A

fibrous

42
Q

T/F the pericardium may be damaged by inflammation or damage to the lungs.

A

true

43
Q

T/F you cannot see the normal pericardium on ECHO or Xray.

A

true

44
Q

what is the most common cause of acute pericarditis?

A

viral illness

45
Q

in most cases, acute pericarditis involves both ____________ and ____________.

A

pericardium

myocardium

46
Q

T/F in most cases, acute pericarditis affects the pericardium exclusively.

A

false

47
Q

describe ST segment elevation

A

an elevation of the ST segment from the baseline - the ST segment is higher/deviated than the PR segment baseline

48
Q

because it may present similar to an MI or blockage, oftentimes pericarditis is a diagnosis of ____________.

A

exclusion

49
Q

what is the most common cause of pericardial effusion?

A

metastatic malignancy

50
Q

T/F many pericardial effusions resolve without treatment.

A

true

51
Q

pericardial effusions are defined as mild, moderate or severe based on what measurement?

A

thickness of effusion

52
Q

what structures are the first to be affected by increased intrapericardial pressures, and how are they affected?

A

left and right atria

collapse during diastole

53
Q

how is the heart rate affected by progressing pericardial effusion?

A

heart rate increases, tachycardia

54
Q

how is stroke volume affected by progressing pericardial effusion?

A

stroke volume decreases

55
Q

how is cardiac output affected by progressing pericardial effusion?

A

stroke volume decreases and heart rate increases to compensate, cardiac output it initially unaffected

56
Q

in severe cases, pericardial effusions may be associated with ____________.

A

tamponade

57
Q

what is the cause of pericardial effusion associated with tamponade?

A

rapidly accumulating moderate or large effusions

58
Q

what is the presentation of pericardial effusion with tamponade?

A

decreased RV diastolic filling during inspiration
distended neck veins
inspiratory decrease in arterial pressure (paradoxical pulse or pulsus paradoxus) - respiratory variations in blood pressure

59
Q

what is the likely diagnosis if X-ray findings show an enlarged heart with clear/protected lung fields?

A

pericardial tamponade

60
Q

what is the likely diagnosis if X-ray findings indicate an enlarged heart with congested lungs?

A

cardiomyopathy

61
Q

what is the effect of cardiac tamponade on the IVC

A

IVC is dilated and does not compress

62
Q

constrictive pericarditis causes ____________ in diastolic pressures leading to ____________-sided heart failure.

A

increase

right

63
Q

does symptomatic constrictive pericarditis develop rapidly or slowly?

A

slowly - takes years to develop

64
Q

how is chronic constrictive pericarditis typically treated?

A

surgical shaving of the pericardium

CVPR (14 decks)

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