Diseases of pericardium Flashcards

1
Q

What do pericardial diseases cause?

A
  • Increased pericardial fluid

- Inflammatory disease, effusive disease, or BOTH

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2
Q

The pericardium contains how much plasma ultrafiltrate?

A

15-50mL

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3
Q

What is the most common disorder of the pericardium?

A

Acute pericarditis

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4
Q

Acute pericarditis is found in how many hospitalized pts?

A

.1-.2%

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5
Q

Acute pericarditis is found in how many pts in the ED w/ non-ischemic chest pain?

A

5%

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6
Q

What causes acute pericarditis?

A

Idiopathic

- Undx viral infections: Coxsackie virus B, Influenza

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7
Q

How does acute pericarditis present?

A

As an isolated processes or 1st sign of underlying systemic disease

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8
Q

What is the presenting sx in acute pericarditis?

A

Chest pain (in > 95%)

  • Sudden onset
  • Sharp, pleuritic
  • Radiation to trapezius ridge
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9
Q

What improves & exacerbates chest pain?

A
  • Improves w/ leaning forward

- Exacerbated by coughing, inspiration, lying flat

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10
Q

What is seen on PE for acute pericarditis?

A

Pericardial friction rub

  • Scratchy, squeaky quality
  • Loudest over LSB
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11
Q

What causes pericardial friction rub?

A

Friction btwn the 2 layers of pericardium

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12
Q

What does acute pericarditis look like on ECG?

A
  • Changes correlate w/ epicardial inflammation
  • *Diffuse ST elevation (concave up)
  • PR segment depression
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13
Q

Stages of acute pericarditis

A
  • Stage 1: diffuse ST elevation w/ PR depression
  • Stage 2: normalization of ST & PR segments
  • Stage 3: diffuse, T wave inversion
  • Stage 4: normalization
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14
Q

Pericardiocentesis & pericardial biopsy

A
  • Low yield

- Can be dx & therapeutic

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15
Q

When might you perform a pericardiocentesis?

A
  • Refractory to med therapy
  • Hemodynamic compromise
  • High complication rates
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16
Q

When might you perform a pericardial biopsy?

A
  • Illness lasting > 3 wks w/out a definitive dx

- Recurrent pericarditis

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17
Q

Describe the procedure of pericardiocentesis

A
  • Supine w/ head of bed at 30-60 degree
  • Under u/s guidance
  • Insert needle at 5-6th ICS at LSB
18
Q

What are markers of acute pericarditis?

A
  • Cardiac: Elevated troponin

- Inflammatory: CRP, ESR, WBC

19
Q

Dx criteria for acute pericarditis

A

Need 2 of the following:

  1. Typical CP
  2. Pericardial friction rub
  3. Characteristic ECG changes
  4. New/worsening pericardial effusion
20
Q

What are the 3 overall goals of tx for acute pericarditis?

A
  1. Relief of pain
  2. Resolve inflammation
  3. Prevent reoccurrence
21
Q

How long is tx for acute pericarditis?

A

2 wks or less, unless sx persist

22
Q

When is pericardial effusion present?

A

When amt of fluid inside pericardium exceeds normal amt

23
Q

What causes pericardial effusion?

A

Secondary to injury or insult to pericardium

  • Idiopathic
  • Infectious
  • Malignancy
  • Autoimmune
  • Drugs
24
Q

Pericardial effusion sx

A
  • Asx (often discovered incidentally)

- CP, pressure, discomfort

25
Pulsus Paradoxus
Decrease in SBP > 10 w/ inspiration, signaling that CO is falling during inspiration - May present w/ pericardial effusion - Not specific to pericardial diseases
26
When is pericardial effusion considered chronic?
3 months or more
27
When is pericardiectomy performed?
If reaccumulation of fluid occurs despite repeat pericardiocentesis
28
Define: Hemorrhagic pericardial effusion
Blood fills in pericardial space
29
What is the main cause of hemorrhagic pericardial effusion?
Malignancy (26%)
30
What can pericardial effusion lead do?
Cardiac tamponade
31
Define: Cardiac tamponade
Compression of all cardiac chambers due to increased pericardial pressure
32
Features of cardiac tamponade
- Chambers become smaller, diastolic compliance reduced - Venous return to R. heart increases w/ inspiration ˚ LV filling falls --> CO & BP fall
33
When does cardiac tamponade become subacute?
Days to weeks
34
What is regional cardiac tamponade?
Localized hematoma, only selective chambers become compressed - Post-pericardiotomy or post MI
35
Cardiac tamponade: Beck's Triad
Hypotension JVD Muffled heart sounds
36
Constrictive pericarditis
Scarring & loss of normal elasticity of pericardial sac - Typically chronic - Restricts filling volume --> SV & CO become reduced
37
What is the most common presentation of constrictive pericarditis?
Sx of HF
38
What is a sensitive PE finding for constrictive pericarditis?
JVP (93%)
39
What is JVP a reflection of?
Central venous pressure (CVP)
40
What is specific for constrictive pericarditis on CXR?
Pericardial calcification
41
What is the only definitive tx for constrictive pericarditis?
Pericardiectomy