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CV II Exam 3 > Diseases of Pericardium > Flashcards

Diseases of Pericardium Flashcards

1
Q

Sharp chest pain which was of sudden onset some 10 days ago. The pain has been less intense over the past week, but worse with inspiration. Two months ago she had a tick bite while hiking in New England. There is a biphasic high pitched squeaky sound at the left sternal border, louder with expiration and leaning forward.

A

Chronic pericarditis

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2
Q

EKG of pericarditis

A

Inverted T waves

PR interval depression (more concave) -> goes direction opposite of P wave

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3
Q

What do inverted T waves mean?

A

Nonspecific

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4
Q

What do symmetrical T waves mean?

A

More likely to be ischemia

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5
Q

What position causes the pain to be aggravated in patient with pericarditis?

A

Worse supine

Relieved by sitting up

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6
Q

Pericardial pain is:

A

Pleuritic and postural

Tends to be substernal

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7
Q

Pericardial pain may be associated with:

A

Fever, dyspnea, and rub

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8
Q

Common causes of pericarditis

A 
Viral
TB
Bacterial
Uremia 
Neoplastic
Inflammatory reaction/Dresslers 
Radiation
Drugs
Myxedema
Autoimmune
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9
Q

Viral causes of pericarditis

A

Coxsackie or echo

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10
Q

TB related pericarditis

A

Subacute

Night sweats

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11
Q

Pericarditis due to uremia described as

A

Shaggy, hemorrhagic, and exudative

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12
Q

Neoplastic pericarditis leads to

A

Tamponade

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13
Q

Inflammatory reaction pericarditis

A

Increased SR

Days to several months after MI or surgery

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14
Q

When do you see radiation pericarditis

A

Within first year

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15
Q

Drugs causing pericarditis

A

Clozapine

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16
Q

Myxedema pericarditis

A

Cholesterol crystals

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17
Q

Autoimmune pericarditis

A

SLE

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18
Q

Exertional dyspnea and orthopnea. PE reveals basilar crackles and an occasional rubbing sound over the precordium. EKG shows heart block.

A

Myocarditis

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19
Q

Can pericarditis produce heart block?

A

No

Need involvement of myocardium

20
Q

Chronic pericarditis can lead to

A

Myocarditis

21
Q

Pericarditis with myocardial involvement will be characterized by

A

Troponin elevations, heart block, wall motion abnormalities, and CHF (pulmonary edema)

22
Q

Early disseminated lyme disease

A

Meningitis, cranial neuropathy (bilateral nerve palsy), and motor or sensory radiculoneuropathy
Heart block and myopericarditis

23
Q

Late lyme disease

A

Oligoarthritis

24
Q

Other causes of bilateral nerve palsy

A

TB, sarcoid and trauma

25
Q

A 55 y/o male with diabetic renal failure has a BUN of 120 mg/dL and creatinine of 6.2 mg/dL. He presents with dyspnea, fatigue, neck vein distention, muffled heart sounds and BP of 90/70.

A

Cardiac tamponade

Uremic pericardial tamponade

26
Q

Beck’s triad

A

Increase JVP
Decrease BP
Muffled heart sounds

Tamponade!

27
Q

Pulsus paradoxus

A

Greater than 10 mm drop in systolic blood pressure with inspiration
Decreased LV ejection during inspiration due to the high CVP leading to increased RV filling with septal motion toward the LV, thus limiting LV filling and LVEF
Inflow across the mitral valve will decrease by 25%

28
Q

When do you seen pulsus paradoxus

A

Tamponade

Constrictive pericarditis, asthma and COPD

29
Q

What does JVP tracing look like with cardiac tamponade

A

Slow decrease and plateau in Y (atrial emptying)

30
Q

What causes dulled Y decent of cardiac tamponade

A

Intrapericardial pressures of > 15 mmHg restricts venous return and ventricular filling

Seen in LA via wedge pressure

31
Q

Left vs Right pressure with cardiac tamponade

A

Equal

32
Q

Cardiac ECHO in pericardial tamponade

A

May reveal that during diastole the thinner walled RV collapses

33
Q

“Please, Dr Beck, you PAY for the CT”

A 
Beck’s triad
Pulsus paradoxus
electrical Alterans
slowed Y descent
Cardiac Tamponade
34
Q

Treatment for Cardiac Tamponade

A

Pericardiocentesis

35
Q

A 55 year old female with a remote history of chest trauma presents with fatigue, weakness, elevated JVP, edema, and hepatomegaly with ascites. Kussmaul sign is present.

A

Constrictive pericarditis

**Elevated JVP, edema, and hepatomegaly with ascites

36
Q

Chest trauma can lead to

A

Contusion that calcifies -> constrictive pericarditis

37
Q

Kussmaul sign

A

Jugular engorges with inspiration

38
Q

When do you see Kussmaul sign?

A

Constrictive pericarditis
Severe COPD, pulmonary hypertension with RV failure
More rarely in cardiac tamponade

39
Q

JVP tracing of constrictive pericarditis

A

Short and sharp - M or W configuration

Early and abrupt diastolic filling

40
Q

Diastolic pericardial knock

A

Auscultation sounds like an S3
“Septal bounce” on ECHO due to rapid early filling in diastole
Also shows decreased mitral inflow

41
Q

“Square root” sign on heart cath

A

Rapid ventricular filling followed by a plateau phase during the rest of diastole
Rigid pericardium impairs mid and late diastolic filling resulting in decreased and equal diastolic filling pressures in all the cardiac chambers
Seen on left and right ventricular tracing

42
Q

Diastolic pericardial know and “square root” sign seen with

A

Constrictive pericarditis

43
Q

Cause of constrictive pericarditis

A 
TB
Post radiation
Cardiac surgery
Viruses
Trauma
44
Q

What simulates constrictive pericarditis

A

Restrictive cardiomyopathies (amyloidosis, endomyocardial fibrosis, hemochromatosis, sarcoidosis) -> decreased ventricular filling

LV diastolic dysfunction

45
Q

How do you differentiate constrictive pericarditis from restrictive cardiomyopathy

A

Via cardiac catheterization
LV end diastolic pressure is unequal (5 mmHg or higher) to the RV diastolic pressure in restrictive cardiomyopathy, whereas they are equal in constrictive pericarditis (square root sign)
**Pulmonary pressure is high in restrictive cardiomyopathy
BNP elevated in RC
Chest xray – calcification in CP and LA enlargement in RC
EKG – BBB, hypertrophy, q waves, and AV block in RC

46
Q

Treatment for Constrictive Pericarditis

A

Torsemide, thiazides, aldosterone antagonist

Pericardiectomy

CV II Exam 3 (13 decks)

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