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Foundations II (Cholley) > Diseases of pericardium > Flashcards

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

Foundations II (Cholley) (25 decks)

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