Diseases of the Pericardium

Question 1

2 layered sac which encircles the heart, separated by a thin film of fluid

Answer 1

Pericardium

Question 2

Name the two layers of the pericardium

Answer 2

Inner layer - Visceral pericardium
Outer layer – parietal pericardium

Question 3

The normal pericardial space contains how much fluid

Answer 3

15-50mL

Question 4

What is the most common affliction of pericardium?

Answer 4

Pericarditis

Question 5

What is the number one cause of pericarditis?

Answer 5

idiopathic

Question 6

Inflammation of the layers

Answer 6

Pericarditis

Question 7

What condition can be a complication of pericarditis?

Answer 7

Pericardial effusion

Question 8

What is the most common infectious cause of acute pericarditis?

Answer 8

Viral/idiopathic

Question 9

What is the most common pathogen of acute pericarditis?

Answer 9

Coxsackie virus

Question 10

What type of pericarditis is described below?

Characterized by scant polymorphonuclear leukocytes, lymphocytes, and histiocytes

Exudate is thin fluid secreted by mesothelial cells lining the serosal surface of the pericardium

Likely represents early inflammatory response common to all types of acute pericarditis

Answer 10

Serous pericarditis

Question 11

What type of pericarditis is described below?

Portions of visceral and parietal pericardium may become thickened and fused

Contains plasma proteins

Answer 11

Serofibrinous pericarditis

Question 12

What type of pericarditis is described below?

Intense inflammatory response associated with bacterial infection

Serosal surfaces are erythematous and coated with purulent exudate

Answer 12

Suppurative (purulent) pericarditis

Question 13

What type of pericarditis is described below?

Grossly blood form

Most often caused by TB or malignancy

Answer 13

Hemorrhage pericarditis

Question 14

What is the most common type of pericarditis?

Answer 14

Serofibrinous pericarditis

Question 15

Hemorrhage pericarditis is most often caused by?

Answer 15

TB or malignancy

Question 16

What are the two most frequent symptoms in pericarditis?

Answer 16

Chest pain

Fever

Question 17

Classic presentation of pericarditis - Triad

Answer 17

Pleuritic chest pain
Friction rub
EKG changes

Question 18

What condition’s chest pain features is described below?

Chest pain - Sharp, pleuritic

Worse lying flat

Better with sitting up/leaning forward

Answer 18

pericarditis

Question 19

What is abnormal in 90% of pericarditis cases?

Answer 19

EKG

Question 20

What are the characteristic EKG findings in pericarditis?

Answer 20

Diffuse ST segment elevation

PR segment depression

Question 21

Why should corticosteroids not be giving in pericarditis cases unless severe or complicated?

Answer 21

potentially severe side effects and because even gradual withdrawal of this form of therapy often leads to recurrent symptoms of pericarditis

Question 22

Which type of pericarditis has a high mortality rate?

Answer 22

Purulent pericarditis

Question 23

What are some complications of pericarditis?

Answer 23

Constrictive pericarditis
Pericardial effusion
Cardiac tamponade
Chronic pericarditis

Question 24

Results from pericardium becoming fibrosed and thickened

Restriction results in low-output failure – mimics restrictive
cardiomyopathy

Answer 24

Constrictive Pericarditis

Question 25

Constrictive Pericarditis most often follows what?

Answer 25

cardiac surgery

Question 26

What is diagnostic in Constrictive Pericarditis?

Answer 26

Cardiac catheterization

Question 27

Accumulation of excessive fluid in the pericardial space

Answer 27

Pericardial Effusion

Question 28

What is the pathophysiology of pericardial effusions?

Answer 28

When intrapericardial volume expands beyond a critical level a dramatic increase in pressure is incited by nondistendable sac

Question 29

Why would you expect to hear soft heart sounds in a pericardial effusion?

Answer 29

Large pericardial fluid “insulates” heart from chest wall – trying to hear through fluid

Question 30

What CXR findings would you expect to see in a pericardial effusion?

Answer 30

Enlarged cardiac silhouette - “water bottle heart”

Question 31

What characteristic EKG finding will you see in a pericardial effusion and also in cardiac tamponade?

Answer 31

Electrical alternams

Question 32

Pericardial fluid accumulates under high pressure, compresses cardiac chambers, and severely limits filling of the heart Can no longer accommodate normal venous return Ventricular stroke volume and cardiac output decline, resulting in: Hypotension Shock Death

Answer 32

Cardiac Tamponade

Question 33

What is the progression of cardiac tamponade if not identified and treated?

Answer 33

If not evacuated, effusion leads to inadequate perfusion of vital organs 🡪 shock 🡪 and ultimately death

Question 34

What are the etiologies of cardiac tamponade?

Answer 34

Neoplastic Post-viral Uremic pericarditis Acute hemorrhage (Trauma -penetrating) Rupture of LV free wall following MI Complication of dissection aortic aneurysm

Question 35

What is the most common etiology of cardiac tamponade?

Answer 35

Neoplastic

Question 36

What are the component's of Beck’s triad?

Answer 36

Hypotension JVD Muffled heart tones

Question 37

What triad is seen in 10-20% of cardiac tamponade cases?

Answer 37

Beck’s triad

Question 38

What characteristic finding in cardiac tamponade is described below? Can be recognized at bedside Refers to a decrease of SBP (>10mm) during normal inspiration Exaggeration of normal cardiac physiology

Answer 38

Pulsus paradoxus

Question 39

What procedure provides a definitive diagnostic of cardiac tamponade?

Answer 39

Cardiac catheterization

Question 40

Treatment for cardiac tamponade?

Answer 40

Pericardiocentesis