L3: Pericardial Diseases Flashcards
1
Q
Anatomy of Pericardium
A
2
Q
Physiology of Pericardium
A
3
Q
Functions of Pericardium
A
4
Q
Def of Pericarditis
A
5
Q
Etiology of Acute Dry Percarditis
A
6
Q
Etiology of Acute Dry Percarditis
- Idiopathic
A
most probably vira
7
Q
Etiology of Acute Dry Percarditis
- Infection
A
8
Q
Etiology of Acute Dry Percarditis
- Infarction
A
may occur as early or late complication.
9
Q
Etiology of Acute Dry Percarditis
- Irradiation
A
10
Q
Etiology of Acute Dry Percarditis
- Immunological
A
SLE, RA.
11
Q
Etiology of Acute Dry Percarditis
- Iatrogenic
A
hydralazine,procainamide.
12
Q
Etiology of Acute Dry Percarditis
- Infiltration
A
leukemia, lymphoma , breast cancer.
13
Q
Etiology of Acute Dry Percarditis
- Rheumatic Fever
A
…
14
Q
Etiology of Acute Dry Percarditis
- Renal Failure
A
- AKI
- CKD
15
Q
Etiology of Acute Dry Percarditis
- Post MI
A
Dressler Syndrome
16
Q
CP of Acute Dry Percarditis
A
17
Q
CP of Acute Dry Percarditis
- General Symptoms
A
FHMA (fever, headache, malaise, anorexia)
18
Q
CP of Acute Dry Percarditis
- Local Symptoms
A
Pain
19
Q
Pain in Acute Dry Percarditis
- Site
- Characcters
- Radiation
- Duration
- Increased By
- Decreased By
- Associated With
A
20
Q
Signs in Acute Dry Percarditis
A
Pericardial Rub
21
Q
Pericardial Rub in Acute Dry Percarditis
- Due to
- Characters
- Timing
- Increased by
- decreased By
- Relation to holding of respiration
A
22
Q
Pain in Acute Dry Percarditis is positional, Explain
A
23
Q
INVx in Acute Dry Percarditis
A
24
Q
INVx in Acute Dry Percarditis
- ECG
A
Elevated ST segment & inverted T wave.
25
DDx of Elevated ST Segment
26
DDx of Elevated ST Segment
- ST Segment
- ECG Leads
- Pathological Q
- Cardiac Enzymes
27
TTT of **Acute Dry Pericarditis**
- Treatment of the cause
- Analgesics & Anti inflammatory : Indomethacin.
28
How to Diffrentiate Between Acute Pericarditis & STEMI?
29
How to Diffrentiate Between Acute Pericarditis & STEMI?
- Chest Pain
- Radiation
- Fever
- Pericardial Rub
30
Mechanism of **Pericardial Effusion**
31
Etiology of **Pericardial Effusion**
32
**Exudative Pericardial Effusion**
33
Mechanism of **Exudative Pericardial Effusion**
due to → ⭡ capillary permeability .
34
Most Causative Cause of **Exudative Pericardial Effusion**
- Produced by all causes of dry pericarditis .
- TB is the most common cause of pericardial effusion.
35
Labs in **Exudative Pericardial Effusion**
- ⭡ cell
- ⭡ protein content > 3gm%
- ⭡ specific gravity >1018
36
Hemorrhagic Effusion in **Exudative Pericardial Effusion**
exudate with excessive RBCs e.g. malignancy , Ml , TB , CRF.
37
**Transudative Pericardial Effusion**
38
Labs in **Transudative Pericardial Effusion**
- Low cell
- Low protein content < 3gm%
- ↓ specific gravity<1018
39
Causes of **Transudative Pericardial Effusion**
The same causes of generalized edema :
- Heart failure → ⭡ hydrostatic pressure .
- Liver cirrhosis, Nephrotic syndrome , Malnutrition → hypoproteinemia.
40
Causes of **Hemopericardium**
- Trauma
- Rupture aortic aneurysm
41
Chylous Pericardial Effusion
Accumulation of lymph
e.g. Obstruction or injury of thoracic du
42
Hemodynamics in **Pericardial Effusion**
43
CP of **Pericardial Effusion**
44
CP of **Pericardial Effusion**
- Symptoms
45
Symptoms of **Pericardial Effusion**
- Symptoms of Systemic Congestion
....
46
Symptoms of **Pericardial Effusion**
- Symptoms of LCOP
....
47
Symptoms of **Pericardial Effusion**
- Pain
dull aching pain due to stretch of parietal pericardium .
48
Symptoms of **Pericardial Effusion**
- Pressure Manifestations
- On lung → dyspnea, improved by sitting up & leaning forward.
- On esophagus → dysphagia.
- On left recurrent laryngeal nerve → hoarseness of voice.
49
Signs of **Pericardial Effusion**
50
Signs of **Pericardial Effusion**
- Systemic Congestion
51
Signs of **Pericardial Effusion**
- Neck Veins
52
Signs of **Pericardial Effusion**
- Liver
Enlarged tender liver
53
Signs of **Pericardial Effusion**
- Ascites before edema LL (ascitesprecox)
- Kinking of hepatic vein.
- Obstruction of lymphatics passing through central tendon of diaphragm causes accumulation of lymph in peritoneum.
54
Signs of **Pericardial Effusion**
- LCOP
cold hand, pallor, los systolic blood pressure, weak pulse.
55
Signs of **Pericardial Effusion**
- Prayers Position
...
56
Signs of **Pericardial Effusion**
- Pulsus Paradoxus
57
Def of **Pulsus Paradoxus**
exaggerated inspiratory fall in systolic BP ( >10 mmHg ).
58
**Pulsus Paradoxus** is abnormal, What is normal?
59
Explanation of **Pulsus Paradoxus**
60
Causes of Pulsus paradoxus
61
Cardaic Examination of **Pericardial Effusion**
- Inspection & Palpation
- Apex is not visible or palpable.
- Pericardial pulge in children.
62
Cardaic Examination of **Pericardial Effusion**
- Percussion
63
Cardaic Examination of **Pericardial Effusion**
- Auscultation
weak distant heart sounds
64
Complications of **Pericardial Effusion**
- Cardiac tamponade.
- Constrictive pericarditis.
65
INVx in **Pericardial Effusion**
66
INVx in **Pericardial Effusion**
- X-Ray
- Flask shaped heart ( narrow base ) with sharp border.
67
INVx in **Pericardial Effusion**
- ECG
low voltage
68
INVx in **Pericardial Effusion**
- ECHO
The most important for diagnosis & for detection of severity.
69
INVx in **Pericardial Effusion**
- Catheterization
Not needed any more after echo.
70
INVx in **Pericardial Effusion**
- Aspiration (Pericadiocentesis)
- may needed for diagnosis of the cause by analysis of the pericardial fluid.
71
DDx of **Pericardial Effusion**
72
TTT of **Pericardial Effusion**
73
TTT of **Pericardial Effusion**
- The Cause
....
74
TTT of **Pericardial Effusion**
- Pericardial aspiration ( pericardiocentesis)
75
TTT of **Pericardial Effusion**
- Surgical
Pericadiectomy or pericardio-pleural window.
76
TTT of **Pericardial Effusion**
- Steroids
to prevent adhesions
77
Def of **Cardiac Tamponade**
It's a severest form of pericardial effusion.
78
Etiology of **Cardiac Tamponade**
79
CP of **Cardiac Tamponade**
80
INVx for **Cardiac Tamponade**
The same as pericardial effusion
81
TTT of **Cardiac Tamponade**
The same as pericardial effusion
82
Def of **Constrictive Pericarditis**
Fibrosis & marked adhesion between the 2 layer of the pericardium.
83
Etiology of **Constrictive Pericarditis**
- The same as dry pericarditis with exception of rheumatic fever.
- The most common cause is → TB & irradiation
84
Hemodynamics in **Constrictive Pericarditis**
85
CP of **Constrictive Pericarditis**
86
CP of **Constrictive Pericarditis**
- Symptoms
Similar to pericardial effusion but :
- Without or with minimal pressure manifestations.
- AF in 30% of cases.
87
CP of **Constrictive Pericarditis**
- Signs
Similar to pericardial effusion but with no special decubitus ( no prayer's position)
88
CP of **Constrictive Pericarditis**
- Cardiac Signs
- Weak or absent apical pulsation.
- Pericardial knock → High pitched early diastolic sound due to sudden halting of the relaxing ventricles by rigid pericardium.
89
INVx in **Constrictive Pericarditis**
90
INVx in **Constrictive Pericarditis**
- X-Ray
Calcification
91
INVx in **Constrictive Pericarditis**
- ECG
Low voltage , Flat or inverted T wave
92
INVx in **Constrictive Pericarditis**
- ECHO
Pericardial thickening , calcification , exclude the effusion.
93
INVx in **Constrictive Pericarditis**
- CT & MRI
Highly diagnostic.
94
TTT of **Constrictive Pericarditis**
- Pericardiectomy.
- Treatment of the cause e.g. TB. & complications e.g. AF.
95
Def of **Adhesive Pericarditis**
- Adhesions between the pericardium & the surrounding mediastinal strictures & chest wall.
96
Etiology of **Adhesive Pericarditis**
- It occurs as a late complication of rheumatic fever
- or may be due to an extension of inflammation from neighbor strictures.
97
Mechanism of **Cardiac Tamponade**
98
INvx in **Cardiac Tamponade**
99
Beck's Triad
100
Pericardiocentesis
101
Mechanism of **Constrictive Pericarditis**
