Exam 2

Question 1

Clinical signs of Pericarditis

Answer 1

-Chest Pain: worse supine and with inspiration
-Widespread ST elevation
-Pericardial Friction Rub
-New or increasing pericardial effusion
-Possible dyspnea, tachycardia, fever and palpitations

Question 2

Quantification for Pericardial Effusion

Answer 2

Normal/Very Small: posterior echo free space in systole
Small: posterior echo free space in systole and diastole
Moderate to Large: Anterior and Posterior echo free space in systole and diastole
Large: Anterior and Posterior echo free space and swinging motion
Tamponade: RA collapse and Swinging Motion

Question 3

Otto Rating scale for Pericardial Effusion

Answer 3

small <.5 cm
moderate .5 to 2 cm
large > 2 cm

Question 4

Reynolds rating scale for Pericardial Effusion

Answer 4

small < 1 cm space in systole/diastole in posterior
moderate < 1 cm space in systole/diastole in posterior/anterior
large > 1 cm space in systole/diastole surrounding heart

Question 5

Pericardial effusion from Pleural effusion

Answer 5

Pericardial effusion: fluid build up in pericardium
>Pericardial: tracks anterior to descending Aorta
Pleural effusion: build up of fluid in space between lungs and chest cavity ; transudative and exudative
>Left pleural: extends posterolateral to the descending Aorta
>Right pleural: seen in subcostal view on opposite side of diaphragm

Question 6

Transudative Pleural Effusion

Answer 6

high pressure pushes fluid out of vessels into interstitial, airways, and pleural space

Question 7

Exudative Pleural Effusion

Answer 7

inflammation of vessel walls allows fluid and proteins/large particles to leave vessel

Question 8

Loculated Pericardial Effusion

Answer 8

-localized pockets of fluid
-common post operative and in recurrent pericardial disease

isolated areas of pericardial sac adhere and trap fluid

Question 9

Pericardial Masses

Answer 9

1) Epicardial Fat Pad: small hypoechoic space anterior to RV in PLAX
2) Pleural Effusion: Echo free space superior to RA in A4
3) Metastatic PE: hard to distinguish, fibrin, appear nodular
4) Pericardial Cysts: benign, echo free shell
5) Hematoma: common against RA post surgery
6) Pseudoaneurysm: caused by myocardial rupture

Question 10

Cardiac Tamponade Definition

Answer 10

When pericardial effusion causes pressure in the pericardium to exceed the pressure in the chambers impairing cardiac filling

Question 11

Constrictive Pericarditis Definition

Answer 11

Visceral and Parietal layers become adhered, thickened, and fibrotic impairing the diastolic filling, leading to decreased cardiac output

Question 12

Symptoms of Cardiac Tamponade

Answer 12

-Dyspnea
-Tachycardia
-Hypotension
-Cough
-Jugular Venous Distention
-Hoarseness

Question 13

Symptoms of Constrictive Pericarditis

Answer 13

-Fatigue
-Malaise
-Dyspnea
-Jugular Venous Distention
-Hepatomegaly
-Ascites
-Peripheral Edema

Question 14

Echo Findings in Cardiac Tamponade

Answer 14

-Large Pericardial Effusion
-Swinging heart
-RA systolic collapse
-RV diastolic collapse
-Hyperkinetic LV

Question 15

Echo findings in Constrictive Pericarditis

Answer 15

2D:
-Echogenic Pericardial Thickening
-Binded/bound appearance
-Septal shift with Inspiration
-Normal to dilated atria
-Dilated IVC/Hepatic Veins

MMode:
LV: -Multi dense linear reflections
-diastolic septal notch
-posterior wall shows early diastolic descent followed by flattening
PV: -exaggerated premature opening of PV

Question 16

Mitral Inflow patterns of Cardiac Tamponade

Answer 16

-Early diastolic filling has small E wave at TV or MV on PW doppler
-Mid to late diastolic shows gradual deceleration slope and bigger A wave at TV or MV on PW doppler

Question 17

Mitral Inflow Patterns of Constrictive Pericarditis

Answer 17

-Early diastolic shows a prominent E wave at the TV or MV on PW doppler
-Mid diastolic shows a steep deceleration slope and a very small A wave at the TV or MV on PW doppler
-Pressure tracing shows initial Early diastolic drop in atrial and ventricle pressures, quickly followed by equalization of pressures

Question 18

Using Doppler to rule in Cardiac Tamponade

Answer 18

Exaggerated respiratory changes
Respiratory change >25%

Question 19

Using Doppler to rule in Constrictive Pericarditis

Answer 19

• significant respiratory change at TV/MV
• prominent E wave, rapid deceleration and small A wave
• diastolic flow reversal in Hepatics

Question 20

Auscultation in Pericarditis

Answer 20

Pericardial friction rub
“pericardium rubbing against itself”

Question 21

Auscultation in Cardiac Tamponade

Answer 21

-distant heart sounds
-Pulsus Paradoxus
-Palpitation
-systolic BP drops by 10 mmHg with inspiration

Question 22

Auscultation in Constrictive Pericarditis

Answer 22

-distant heart sounds
-diastolic pericardial knock
-pulsus paradoxus

Question 23

Echo role in treatment of Cardiac Tamponade

Answer 23

Echo guided pericardiocentesis reduces complications
-needle aspiration of pericardial fluid

Question 24

Constrictive Pericarditis strain

Answer 24

Normal longitudinal medial strain values with a preserved global strain value “hot septum”

Question 25

Respiratory Change Equation

Answer 25

(Highest Velocity - Lowest Velocity) / Highest Velocity × 100

Question 26

Ewarts Sign (Cardiac Tamponade)

Answer 26

Broncial Breathing and dullness to percussion at lower angle of the left scapula due to fluid collapsing the lower left lobe

Question 27

Becks Triad (Cardiac Tamponade)

Answer 27

Distant heart sounds + Hypotension + JVD

Question 28

Kussmauls sign (Constrictive Pericarditis)

Answer 28

a rise in jugular venous pressure on inspiration due to RV noncompliance pushing fluid back into the venous system