ECHO - Pericardial disease Flashcards
What is the pericardium?
- doulble-layered membrane with visceral and parietal components
- visceral: serosal monolayer that adheres firmly to the epicardium, reflects over the origin of the great vessels
- parietal: tough, fibrous layer
- pericardial space between the two serosal layers contains up to 50 mL of plasma ultrafiltrate (the pericardial fluid)
When do pericardial pressures rise and restraint becomes clinically important?
pericardial reserve volume is exceeded
What is the pericardial reserve volume?
equal to the difference between the unstressed pericardial volume and the cardiac volume
What are the clinicopathologic processes involving the pericardium?
- acute pericarditis
- and complications of pericardial inflammation (which arise when pericardial fluid accumulates)
- Pericardial scarring and inelasticity / Compressive syndromes
- tamponade, constrictive pericarditis, effusive-constrictive pericarditis
- Tumors
- primary and metastatic (especially)
- Congenital pericardial lesions
Why is Echo evaluation essential in suspected acute pericarditis?
- Helps identify:
- pericardial effusion (one of the diagnostic criteria for pericarditis)
- high-risk patient who warrants hospitalization
- Excludes other etiologies of chest pain
How is size of the pericardium measured on Echo?
- semi-quantitatively described by the end-diastolic distance of the echo-free space between parietal and visceral pericardium
- Small ( < 10 mm) or 50-100 mL
- Moderate ( 10-20 mm) or 100-500 mL
- Large ( > 20 mm) or > 500 mL
Define cardiac tamponade
life-threatening condition caused by fluid accumulation in the pericardial sac
- characterized by:
- elevation and equalizatin of cardiac diastolic and pericardial pressures
- reduced CO
- Pulsus paradoxus
- exaggerated inspiratory decrease in arterial systolic pressure ( > 10 mmHg)
What are the key echocardiographic signs of cardiac tamponade (visually)?
- pericardial effusion
- small cardiac chambers
- plethoric IVC
- supportive signs
- increased pericardial pressure
- right sided chamber collapse
- increased ventricular interdepdendence
- respiratory variation of ventricular dimensions and transvalvular velocities
- increased pericardial pressure
What are the Echocardiographic findings of cardiac tamponade?
What are common etiologies of pericarditis?
- Idiopathic
- Infectious (viral, myocobacterial, fungal, purulent)
- Autoimmune disease (SLE, Rheumatic fever)
- Acute myocardial infarction (acute, delayed)
- Postcardiotomy syndrome (cardiac surgery, trauma)
- Post-radiation therapy
- Drug-induced (Isoniazid, cyclosporin)
- Uremia
- Neoplastic disease
Describe the findings
- PW doppler with respirometer recording of mitral inflow - Cardiac tamponade
- peak velocities are low because of reduced CO
What are characteristic findings in routine evaluation for acute pericarditis?
What are the four EKG stages of acute pericarditis?
- 2 weeks
- widespread STE and PR depression with reciprocal changes in aVR
- 1-3 weeks
- normalization of ST changes
- generalized T wave flattening
- 3- several weeks
- flattened T waves become inverted
- Weeks-months
- EKG returns to normal
****less than 50% of patients progress through all four classical stages and evolution of changes may not follow this typical pattern
What is one treatment tat has been shown to reduce the risk of recurrence of acute pericarditis?
Colchicine
- should be given with NSAIDs
- 0.6mg x 3 months
- < 70 kg –> daily
- > 70 kg –> BID
What is one treatment that has been shown to increase the risk of pericarditis recurrence?
Corticosteroids
- not recommended as first-line therapy (class III, level C per ESC guidelines)
- can be considered if contraindication or failure of aspirin/NSAIDs and colchicine and if infection is excluded or if another indication (class IIa, level C per ESC guidelines)
Describe the stages of pericarditis with regards to:
- Imaging
- Treatment
