Exam 2 Flashcards
Clinical signs of Pericarditis
-Chest Pain: worse supine and with inspiration
-Widespread ST elevation
-Pericardial Friction Rub
-New or increasing pericardial effusion
-Possible dyspnea, tachycardia, fever and palpitations
Quantification for Pericardial Effusion
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
Otto Rating scale for Pericardial Effusion
small <.5 cm
moderate .5 to 2 cm
large > 2 cm
Reynolds rating scale for Pericardial Effusion
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
Pericardial effusion from Pleural effusion
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
Transudative Pleural Effusion
high pressure pushes fluid out of vessels into interstitial, airways, and pleural space
Exudative Pleural Effusion
inflammation of vessel walls allows fluid and proteins/large particles to leave vessel
Loculated Pericardial Effusion
-localized pockets of fluid
-common post operative and in recurrent pericardial disease
isolated areas of pericardial sac adhere and trap fluid
Pericardial Masses
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
Cardiac Tamponade Definition
When pericardial effusion causes pressure in the pericardium to exceed the pressure in the chambers impairing cardiac filling
Constrictive Pericarditis Definition
Visceral and Parietal layers become adhered, thickened, and fibrotic impairing the diastolic filling, leading to decreased cardiac output
Symptoms of Cardiac Tamponade
-Dyspnea
-Tachycardia
-Hypotension
-Cough
-Jugular Venous Distention
-Hoarseness
Symptoms of Constrictive Pericarditis
-Fatigue
-Malaise
-Dyspnea
-Jugular Venous Distention
-Hepatomegaly
-Ascites
-Peripheral Edema
Echo Findings in Cardiac Tamponade
-Large Pericardial Effusion
-Swinging heart
-RA systolic collapse
-RV diastolic collapse
-Hyperkinetic LV
Echo findings in Constrictive Pericarditis
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
Mitral Inflow patterns of Cardiac Tamponade
-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
Mitral Inflow Patterns of Constrictive Pericarditis
-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
Using Doppler to rule in Cardiac Tamponade
Exaggerated respiratory changes
Respiratory change >25%
Using Doppler to rule in Constrictive Pericarditis
- significant respiratory change at TV/MV
- prominent E wave, rapid deceleration and small A wave
- diastolic flow reversal in Hepatics
Auscultation in Pericarditis
Pericardial friction rub
“pericardium rubbing against itself”
Auscultation in Cardiac Tamponade
-distant heart sounds
-Pulsus Paradoxus
-Palpitation
-systolic BP drops by 10 mmHg with inspiration
Auscultation in Constrictive Pericarditis
-distant heart sounds
-diastolic pericardial knock
-pulsus paradoxus
Echo role in treatment of Cardiac Tamponade
Echo guided pericardiocentesis reduces complications
-needle aspiration of pericardial fluid
Constrictive Pericarditis strain
Normal longitudinal medial strain values with a preserved global strain value “hot septum”
Respiratory Change Equation
(Highest Velocity - Lowest Velocity) / Highest Velocity × 100
Ewarts Sign (Cardiac Tamponade)
Broncial Breathing and dullness to percussion at lower angle of the left scapula due to fluid collapsing the lower left lobe
Becks Triad (Cardiac Tamponade)
Distant heart sounds + Hypotension + JVD
Kussmauls sign (Constrictive Pericarditis)
a rise in jugular venous pressure on inspiration due to RV noncompliance pushing fluid back into the venous system
