Diseases of the Pericardium Flashcards
This is the layer of the pericardium that adheres to the outer wall of the heart
visceral pericardium
This is the outer layer of the pericardium that is very tough.
Parietal pericardium
This is the term that refers to the fact that the 2 ventricles share a fixed space limited by the rigid pericardium, so change in volume/pressure in 1 will result in a reciprocal change in the other.
Ventricular interdependence.
This is an exaggeration of the normal decline in systolic BP that occurs with insipration.
Pulsus paradoxus
How much must the decline in systolic BP be to be termed pulsus paradoxus?
> 10 mmHg
During inspiration, how does the negative pressure in the chest cause pulsus paradoxus?
increase in RV volume –> ventricular septum shift to L –> smaller LV filling –> small SV –> ↓ BP
Will BP increase or decrease in pericardial tamponade?
drop real big.
True or False: in constrictive pericarditis, there is the pulsus paradoxus effect as in tamponade because of the inability of the heart to expand and fill.
FALSE. in constrictive pericarditis, the negative intrathoracic pressure created during inspiuration is not easily transmitted through the rigid pericardial shell.
This is a signal of constrictive pericarditis because of increased blood in the thoracic and jugular veins from the inability of the RV to expand during breathing, thus, the jugulars distend during inspiration.
Kussmal sign
What are the 2 viruses to cause viral pericarditis?
echovirus and coxsackievirus group B
What is the bug to cause pericarditis in immunosuppressed patients?
TB
What are teh 2 bugs to cause non-TB bacterial pericarditis in immunocompromised pts, especially with severe burns and malignancies?
S. pneumo and Staph
Pericarditis can form a few days after what type of injury to the heart?
MI
What is the name of the syndrome where pericarditis forms 2 weeks to several months after an MI, and due to an autoimmune origin?
Dressler syndrome
Uremic pericarditis can from in pts with what type of problem?
Renal failure
What forms in the pericardium in neoplastic pericarditis?
Tumors
What are teh 3 things that can cause pericarditis assocaited with connective tissue diseases?
SLE, rheumatoid arthritis (RA) and progressive systemic sclerosis (PSS)
What are the 2 drugs to cause drug-induced pericarditis?
procainamide and hydralazine
This is the stage of pericarditis where there is local vasodilation with transduction of fluid into the pericardial space, increased vascular permeability, and leukocyte exudation.
Acute pericarditis
What is the type of pain felt by a pericarditis pt?
Sharp, pleuritic chest pain, that’s aggrivated by inspiration and coughing and is positional.
True or false: there is a fever in acute pericarditis.
True
Why is there a friction rub in pericarditis?
pericardial layers move against 1 another
What shows up on EKG in pericarditis?
ST ↑ with PR ↓
What are the 3 complications to pericarditis?
pericardial effusion, tamponade, constricitve pericarditis
Case: pt presents with muffled heart sounds, Ewart sign (dullness to percussion of the L lung), enlarged cardial silhouette, and electrical alternans. Dx?
Pericardial effusion
Case: pt presents with JVP, systemic hypotension, small & quiet heart, pulsus paradoxus, and sinus tachycardia. Dx?
Pericardial tamponade
Case: pt presents with reduced CO, elevated systemic venous pressures, and Kussmaul sign. Dx?
Constrictive pericarditis
What is the Tx of acute pericarditis?
Rest, NSAIDs, Colchicine, treat cause
What is the Tx of pericardial effusion?
pericardiocentesis
What is the Tx of pericardial tamponade?
pericardiocentesis
What is the Tx of constrictive pericarditis?
cut it out. ha. hahaha. hahahhahhsahahahahahahahahhahah
This is the form of pericarditis where noninfectious inflammatory diseases cause irritation of the parietal pericardium and serous effusion.
Serous pericarditis
These are the 2 most frequent types of pericarditis, caused by acute MI, Dressler syndrome, and others.
Fibrinous and Serofibrinous pericarditis
What is the morphology of the pericardium in fibrinous pericarditis?
dry, granular
What is the morphology of the pericardium in serofibrinous pericarditis?
yellow-to-brown turbid fluid from WBC’s and RBC’s and fibrin
What are the Sx to fibrinous and serofibrinous pericarditis?
friction rub and pain
This type of pericarditis is caused by invasion of the pericardial space by microbes, leading to the formation of pus within the pericardial sac.
Purulent or Suppurative pericarditis
What are the 2 manifestations of purulent pericarditis?
- spread to surrounding structures, leading to mediastinopericarditis
- scarring
This is the form of pericarditis where a malignant neoplasm causes exudate with blood and fibrinous or suppurative effusion.
Hemorrhagic pericarditis
This is the form of pericarditis where TB causes disabling, fibrocalcific, chronic constrictive pericarditis.
Caseous pericarditis
This is a manifestation of pericarditis where the pericardial sac adheres to surrounding structures, leading to cardiac hypertrophy.
Adhesive mediastinopericarditis
This is a manifestation of pericarditis where the heart is encased in a dense, fibrous or fibrocalcific scar that limits diastolic expansion and CO.
Constrictive pericarditis
Which bone disorder can cause fibrinous pericarditis in 20-40% of the pts?
Rheumatoid arthritis
