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Foundations- Pericarditis > Foundations-Pericarditis > Flashcards

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
Q

Define Pericardial Effusion

A

Present when the amount of fluid inside of the pericardium (15-50mL) exceeds the normal amount that is present

26
Q

When is the ability of the pericardium to stretch the greatest?

A

with slower development of effusion–>more time to adapt

27
Q

What causes pericardial effusion?

A

Usually secondary to injury or insult to the pericardium, such as pericarditis

28
Q

Clinical presentation of Pericardial Effusion

A
  • Usu. asymptomatic!
  • ->often discovered incidentally
  • CP, pressure, or discomfort
  • Syncope
  • Palpitations
  • Respiratory sx’s: cough, dyspnea, hoarseness
29
Q

CV Physical Exam findings of Pericardial Effusion

A

Pericardial friction rub
Elevated JVP
Tachycardia

30
Q

Respiratory Physical Exam findings of Pericardial Effusion

A

Tachypnea

Decreased breath sounds at the lung bases (if concurrent pleural effusion)

31
Q

GI Physical Exam findings of Pericardial Effusion

A

hepatosplenomegaly

32
Q

Extremities Physical Exam findings of Pericardial Effusion

A

Weakened peripheral pulses Edema

Cyanosis

33
Q

Define Pulsus Paradoxus

A

Decrease in systolic blood pressure of more than 10mmHg with inspiration, signaling a falling cardiac output during inspiration

34
Q

ECG findings on Pericardial Effusion

A

Low-voltage QRS
Sinus tachycardia
Electrical alternans

35
Q

Define Electrical alternans

A

Shift in the QRS axis associated with mechanical swinging of the heart “to and fro”

36
Q

CXR findings with pericardial effusion

A

Enlarged cardiac silhouette with larger effusions

37
Q

What is the imaging modality of choice?

A

Echocardiography

38
Q

Pericardial effusion treatment

A

NSAID +/- colchicine if you suspect concurrent pericarditis

39
Q

When would you perform a pericardiectomy

A

Reaccumulation of fluid despite repeat pericardiocentesis

40
Q

Define Hemorrhagic Pericardial effusion

A

Blood fills the pericardial space, instead of serous fluid

41
Q

Define cardiac tamponade

A

Compression of all cardiac chambers due to increased pericardial pressure

42
Q

Causes of subacute cardiac tamponade

A

Neoplastic
Uremic
Idiopathic

43
Q

Causes of acute cardiac tamponade

A

Trauma

Rupture of the heart or aorta, Complication of invasive procedure

44
Q

Define Regional cardiac tamponade

A

Localized hematoma–> only selective chambers become compressed
Post-pericardiotomy or post-MI

45
Q

Beck’s Triad

A

Hypotension
JVD
Muffled heart sounds
*Specific to acute cardiac tamponade

46
Q

Cardiogenic shock

A 
Persistent hypotension (SBP<80mmHg)
Severe reduction in cardiac index (CI <1.8L/min)
47
Q

What does hemodynamic effects of pericardial effusion depend on?

A
  1. Size of the effusion

2. Rapidity of its accumulation

48
Q

Cardiac Tamponade Treatment

A
  • STAT cardiology consult, hospital admission
  • Urgent echo-guided pericardiocentesis if hemodynamic compromise
  • Surgical drainage (can also get biopsy this way)
49
Q

Constrictive Pericarditis

A
  • Scarring and loss of normal elasticity of the pericardial sac
  • CHRONIC process!
50
Q

What is the most common clinical presentation of constrictive pericarditis

A

Symptoms of heart failure

51
Q

Physical Exam findings of constrictive pericarditis

A
  • Elevated JVP
  • Pulsus paradoxes
  • Kussmaul’s Sign
  • Pericardial “knock”
  • Peripheral edema, Anasarca, Cardiac Cachexia
  • Hepatomegaly, Hepatojugular reflux
52
Q

Kussmaul’s Sign

A

Lack of inspiratory decline in JVP with inspiration

53
Q

Pericardial “knock”

A

abnormal heart sound heard slightly earlier than an S3

54
Q

CXR findings in constrictive pericarditis

A

Pericardial calcification

55
Q

What is the only definitive treatment for constrictive pericarditis?

A

Pericardiectomy

Foundations- Pericarditis (1 decks)

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