Dz of Pericardium, Cardiac Tumors, Cardiac Trauma

Question 1

acute pericarditis causes

Answer 1

-MC cause is VIRAL INFECTION (coxsackieviruses, echoviruses, influenza, EBV, varicella, mumps, COVID-19, HIV)

-Other causes: autoimmune syndromes, uremia, neoplasm, radiation, drug toxicity, post-cardiac surgery, bacterial infections

Question 2

layers of the heart

Answer 2

outer layer: fibrous pericardium
middle layer: pericardial sac w/ fluid
inner layer: myocardium

Question 3

Major clinical manifestations (hx, PE, dx tests) of acute pericarditis (must have 2/4 for dx)

Answer 3

• > 95% have sudden chest pain (sharp, worse w/ inspiration & lying down)
• scratchy/squeaky FRICTION RUB (listen w/ diaphragm of stethoscope over L sternal border)
• widespread ST elevation or PR depression on EKG (I, II, III, aVL, aVF, V2-V6)
• a new or worsening pericardial effusion (seen on US)

Question 4

Acute pericarditis: Dx tests

Answer 4

-EKG: diffuse ST elevation, PR depression
-CXR: may see enlarged cardiac silhouette
-ECHO: assess for pericardial effusion or tamponade; assess for wall motion which should be normal w/ pericarditis (abnormal with acute MI)

Question 5

Acute pericarditis: Tx

Answer 5

-admit to hospital if fever, tamponade, or immunosuppression
-Combo (2) of ibuprofen, ASA, colchicine (MC is ibuprofen + colchicine)
-Corticosteroids if pt can’t take NSAIDs
-Avoid strenuous activity until sx are gone and dx tests are normal (if not, may trigger recurrence)
-Prognosis is generally good, complications are rare

Question 6

pericardial effusion vs. tamponade

Answer 6

Pericardial effusion: excess fluid w/in pericardial space (>15-50mL)

Cardiac tamponade: when pericardial effusion impairs cardiac filling & reduces SV
*tampon = blockage of BF

Question 7

when does cardiac tamponade most often occur

Answer 7

suddenly after chest trauma, chest surgery, ruptured aorta, or ruptures ventricle after MI

Question 8

Clinical presentation of pericardial effusion vs. cardiac tamponade

Answer 8

Effusion:
-chest pain/fullness
-often asymptomatic, other than something d/t the underlying cause (ex. fever d/t infection)

Tamponade:
-chest pain, dyspnea
-signs: tachycardia, elevated JVP (too compressed, won’t let blood in); BECK’S TRIAD

Question 9

what is Beck’s triad and what condition is associated with this sign?

Answer 9

Beck’s triad: low BP, distention of jugular veins, & muffled heart sounds

associated with cardiac tamponade

Question 10

paradoxical pulse

Answer 10

during inspiration, clinician can detect beats w/ auscultation but cannot detect radial pulse

*may be present w/ pericardial effusion or tamponade

Question 11

Pericardial effusion vs. Tamponade: Dx tests

Answer 11

Pericardial effusion:
-ECHO most accurate

Cardiac tamponade:
-EKG often shows electrical alternans (alternating QRS sizes - big, then small, then big, etc)
-ECHO

Question 12

Pericardial effusion vs. Tamponade: Tx

Answer 12

Pericardial effusion:
-immediate drainage not necessary if no tamponade
-pericardial bx or fluid analysis may be needed

Cardiac tamponade:
-urgent pericardial effusion drainage; generally results in rapid and dramatic improvement

Question 13

constrictive pericarditis

Answer 13

-fibrous scarring & adhesion of both pericardial layers obliterating pericardial cavity

Question 14

what is the MC cause of constrictive pericarditis (worldwide and in the US)

Answer 14

Worldwide: TB
US: idiopathic or postop/post-radiation

Question 15

Constrictive pericarditis: S/S

Answer 15

-ELEVATED JVP is MC sign
-peripheral EDEMA or anasarca (fluid all over)
-may be a PERICARDIAL KNOCK (diastolic sound)

Question 16

Constrictive pericarditis: Dx tests

Answer 16

echo

Question 17

Constrictive pericarditis: Tx

Answer 17

-tx cause (TB, cancer, autoimmune dz)
-NSAID + colchicine
-Pericardiectomy is only tx for chronic cases

Question 18

With metastatic tumors what is a common condition that occurs with the heart

Answer 18

pericardial effusions are common w/ metastatic tumors

Question 19

What % of primary cardiac tumors are benign

Answer 19

80% of cardiac tumors are benign

Question 20

MC type of cardiac tumor and MC location of this tumor type

Answer 20

Myxoma
- 75% are in the L atrial wall

Question 21

Myxoma dx test

Answer 21

echo

Question 22

Myxoma sx

Answer 22

-may obstruct valve or cause regurgitation
-may embolize
-constitutional sx: fever, fatigue, erythematous rash, myalgias, wt loss

Question 23

Myxoma PE findings

Answer 23

-split S1 (S1 occurs when AV valves are closing - in cardiac tumors you may hear 2 S1’s bc the tricuspid valve and mitral valve may not close at the same time)
-early diastolic “plop”

Question 24

Myxoma/cardiac tumor tx

Answer 24

surgery

Question 25

Blunt cardiac trauma (usu d/t MVA): Myocardial contusion

Answer 25

-RV is most commonly involved
-can cause myocardial necrosis (sim to MI)

Question 26

What may occur if someone is struck directly over the heart during T wave

Answer 26

Ventricular fibrillation that can result in sudden arrhythmic death

“Commotio cordis”

Question 27

Myocardial contusion: Dx tests

Answer 27

echo - impaired wall motion

Question 28

Blunt cardiac trauma (usu d/t MVA): Aortic injury

Answer 28

-abrupt deceleration
-MC injury: tear in the wall of the aorta just distal to L subclavian a.

Question 29

Aortic injury d/t cardiac trauma: Dx test

Answer 29

CT, TEE