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Foundations-Pericarditis Flashcards

1
Q

Potential space

A

Space between visceral and parietal layers

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2
Q

Pericardial dz’s causes what?

A
  1. Inflammation of the layers

2. Increased production of pericardial fluid

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3
Q

Acute pericarditis

A

Inflammation of the pericardial sac

–>termed myopericarditis or perimyocarditis

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4
Q

What is the most common disorder of the pericardium?

A

Acute pericarditis

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5
Q

What are the most common viral infections that cause acute pericarditis?

A

Coxsackie virus B, Influenza,

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6
Q

Chest pain is the presenting symptom in what percentage of pt’s?

A

> 95%

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7
Q

What improves acute pericarditis?

A

Leaning forward

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8
Q

What exacerbates acute pericarditis?

A

coughing, inspiration, lying flat

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9
Q

Physical exam findings of acute pericarditis?

A

Pericardial friction rub

–> 35-85% of pt’s present with this

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10
Q

Where can you hear a pericardial friction rub the loudest?

A

left sternal border

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11
Q

What abnormal finding would you expect to see on an ST?

A

Diffuse ST elevation

PR segment depression (highly specific)

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12
Q

CT chest with contrast findings in acute pericarditis

A

Enhancement of the thickened pericardium

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13
Q

Echocardiography findings in acute pericarditis with effusion

A

“swinging heart”

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14
Q

When would you consider a pericardiocentesis?

A 
Refractory to medical therapy
Hemodynamic compromise (want to remove the fluid)
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15
Q

When would you consider a pericardial biopsy?

A

Illness lasting >3 weeks without a definite diagnosis

Recurrent pericarditis

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16
Q

Where do you insert the needle in a pericardiocentesis?

A

Subxiphoid approach or through 5th/6th ICS @ the LSB

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17
Q

Cardiac biomarkers of acute pericarditis?

A

Elevated Troponin

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18
Q

Inflammatory markers of acute pericarditis?

A

C-reactive protein (CRP)
Erythrocyte sedimentation rate (ESR)
White blood cell count (WBC)
*Non sensitive or specific

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19
Q

If you suspect rheumatologist dz, what would you order?

A

Antinuclear antibody Rheumatoid factor

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20
Q

Diagnostic criteria for acute pericarditis

A
  1. Typical chest pain (sharp, pleuritic, improved when sitting up and leaning forward)
  2. Pericardial friction rub
  3. Characteristic ECG changes (typically diffuse ST elevation)
  4. New/worsening pericardial effusion
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21
Q

Who do we admit to the hospital?

A

High Risk pt’s:

  • Fevers
  • Immunocompromised
  • Subacute onset
  • Hemodynamic compromise
  • Oral anticoagulants–>may develop hemorrhagic effusion
  • Trauma
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22
Q

What are the overall goals of treating acute pericarditis?

A

Relief of pain
Resolve the inflammation
Prevent recurrence

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23
Q

Medical management of acute pericarditis?

A

NSAIDS +/- colchicine
Specific Therapy
Activity restriction

24
Q

When wold you prescribe Glucocorticoids over NSAIS or Colchine?

A

If contraindications to NSAIDS or if indicated for underlying disorder

25
Define Pericardial Effusion
Present when the amount of fluid inside of the pericardium (15-50mL) exceeds the normal amount that is present
26
When is the ability of the pericardium to stretch the greatest?
with slower development of effusion-->more time to adapt
27
What causes pericardial effusion?
Usually secondary to injury or insult to the pericardium, such as pericarditis
28
Clinical presentation of Pericardial Effusion
- Usu. asymptomatic! - ->often discovered incidentally - CP, pressure, or discomfort - Syncope - Palpitations - Respiratory sx's: cough, dyspnea, hoarseness
29
CV Physical Exam findings of Pericardial Effusion
Pericardial friction rub Elevated JVP Tachycardia
30
Respiratory Physical Exam findings of Pericardial Effusion
Tachypnea | Decreased breath sounds at the lung bases (if concurrent pleural effusion)
31
GI Physical Exam findings of Pericardial Effusion
hepatosplenomegaly
32
Extremities Physical Exam findings of Pericardial Effusion
Weakened peripheral pulses Edema | Cyanosis
33
Define Pulsus Paradoxus
Decrease in systolic blood pressure of more than 10mmHg with inspiration, signaling a falling cardiac output during inspiration
34
ECG findings on Pericardial Effusion
Low-voltage QRS Sinus tachycardia Electrical alternans
35
Define Electrical alternans
Shift in the QRS axis associated with mechanical swinging of the heart “to and fro”
36
CXR findings with pericardial effusion
Enlarged cardiac silhouette with larger effusions
37
What is the imaging modality of choice?
Echocardiography
38
Pericardial effusion treatment
NSAID +/- colchicine if you suspect concurrent pericarditis
39
When would you perform a pericardiectomy
Reaccumulation of fluid despite repeat pericardiocentesis
40
Define Hemorrhagic Pericardial effusion
Blood fills the pericardial space, instead of serous fluid
41
Define cardiac tamponade
Compression of all cardiac chambers due to increased pericardial pressure
42
Causes of subacute cardiac tamponade
Neoplastic Uremic Idiopathic
43
Causes of acute cardiac tamponade
Trauma | Rupture of the heart or aorta, Complication of invasive procedure
44
Define Regional cardiac tamponade
Localized hematoma--> only selective chambers become compressed Post-pericardiotomy or post-MI
45
Beck's Triad
Hypotension JVD Muffled heart sounds *Specific to acute cardiac tamponade
46
Cardiogenic shock
``` Persistent hypotension (SBP<80mmHg) Severe reduction in cardiac index (CI <1.8L/min) ```
47
What does hemodynamic effects of pericardial effusion depend on?
1. Size of the effusion | 2. Rapidity of its accumulation
48
Cardiac Tamponade Treatment
- STAT cardiology consult, hospital admission - Urgent echo-guided pericardiocentesis if hemodynamic compromise - Surgical drainage (can also get biopsy this way)
49
Constrictive Pericarditis
- Scarring and loss of normal elasticity of the pericardial sac - CHRONIC process!
50
What is the most common clinical presentation of constrictive pericarditis
Symptoms of heart failure
51
Physical Exam findings of constrictive pericarditis
- Elevated JVP - Pulsus paradoxes - Kussmaul's Sign - Pericardial "knock" - Peripheral edema, Anasarca, Cardiac Cachexia - Hepatomegaly, Hepatojugular reflux
52
Kussmaul's Sign
Lack of inspiratory decline in JVP with inspiration
53
Pericardial “knock”
abnormal heart sound heard slightly earlier than an S3
54
CXR findings in constrictive pericarditis
Pericardial calcification
55
What is the only definitive treatment for constrictive pericarditis?
Pericardiectomy

Foundations- Pericarditis (1 decks)

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