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Y4R7 - Medicine III 🩺 > L3: Pericardial Diseases > Flashcards

L3: Pericardial Diseases Flashcards

1
Q

Anatomy of Pericardium

A
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2
Q

Physiology of Pericardium

A
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3
Q

Functions of Pericardium

A
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4
Q

Def of Pericarditis

A
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5
Q

Etiology of Acute Dry Percarditis

A
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6
Q

Etiology of Acute Dry Percarditis

  • Idiopathic
A

most probably vira

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7
Q

Etiology of Acute Dry Percarditis

  • Infection
A
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8
Q

Etiology of Acute Dry Percarditis

  • Infarction
A

may occur as early or late complication.

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9
Q

Etiology of Acute Dry Percarditis

  • Irradiation
A
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10
Q

Etiology of Acute Dry Percarditis

  • Immunological
A

SLE, RA.

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11
Q

Etiology of Acute Dry Percarditis

  • Iatrogenic
A

hydralazine,procainamide.

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12
Q

Etiology of Acute Dry Percarditis

  • Infiltration
A

leukemia, lymphoma , breast cancer.

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13
Q

Etiology of Acute Dry Percarditis

  • Rheumatic Fever
A

…

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14
Q

Etiology of Acute Dry Percarditis

  • Renal Failure
A
  • AKI
  • CKD
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15
Q

Etiology of Acute Dry Percarditis

  • Post MI
A

Dressler Syndrome

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16
Q

CP of Acute Dry Percarditis

A
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17
Q

CP of Acute Dry Percarditis

  • General Symptoms
A

FHMA (fever, headache, malaise, anorexia)

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18
Q

CP of Acute Dry Percarditis

  • Local Symptoms
A

Pain

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19
Q

Pain in Acute Dry Percarditis

  • Site
  • Characcters
  • Radiation
  • Duration
  • Increased By
  • Decreased By
  • Associated With
A
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20
Q

Signs in Acute Dry Percarditis

A

Pericardial Rub

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21
Q

Pericardial Rub in Acute Dry Percarditis

  • Due to
  • Characters
  • Timing
  • Increased by
  • decreased By
  • Relation to holding of respiration
A
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22
Q

Pain in Acute Dry Percarditis is positional, Explain

A
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23
Q

INVx in Acute Dry Percarditis

A
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24
Q

INVx in Acute Dry Percarditis

  • ECG
A

Elevated ST segment & inverted T wave.

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25
Q

DDx of Elevated ST Segment

A
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26
Q

DDx of Elevated ST Segment

  • ST Segment
  • ECG Leads
  • Pathological Q
  • Cardiac Enzymes
A
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27
Q

TTT of Acute Dry Pericarditis

A
  • Treatment of the cause
  • Analgesics & Anti inflammatory : Indomethacin.
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28
Q

How to Diffrentiate Between Acute Pericarditis & STEMI?

A
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29
Q

How to Diffrentiate Between Acute Pericarditis & STEMI?

  • Chest Pain
  • Radiation
  • Fever
  • Pericardial Rub
A
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30
Q

Mechanism of Pericardial Effusion

A
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31
Q

Etiology of Pericardial Effusion

A
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32
Q

Exudative Pericardial Effusion

A
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33
Q

Mechanism of Exudative Pericardial Effusion

A

due to → ⭡ capillary permeability .

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34
Q

Most Causative Cause of Exudative Pericardial Effusion

A
  • Produced by all causes of dry pericarditis .
  • TB is the most common cause of pericardial effusion.
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35
Q

Labs in Exudative Pericardial Effusion

A
  • ⭡ cell
  • ⭡ protein content > 3gm%
  • ⭡ specific gravity >1018
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36
Q

*

Hemorrhagic Effusion in Exudative Pericardial Effusion

A

exudate with excessive RBCs e.g. malignancy , Ml , TB , CRF.

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37
Q

Transudative Pericardial Effusion

A
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38
Q

Labs in Transudative Pericardial Effusion

A
  • Low cell
  • Low protein content < 3gm%
  • ↓ specific gravity<1018
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39
Q

Causes of Transudative Pericardial Effusion

A

The same causes of generalized edema :

  • Heart failure → ⭡ hydrostatic pressure .
  • Liver cirrhosis, Nephrotic syndrome , Malnutrition → hypoproteinemia.
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40
Q

Causes of Hemopericardium

A
  • Trauma
  • Rupture aortic aneurysm
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41
Q

Chylous Pericardial Effusion

A

Accumulation of lymph

e.g. Obstruction or injury of thoracic du

42
Q

Hemodynamics in Pericardial Effusion

43
Q

CP of Pericardial Effusion

44
Q

CP of Pericardial Effusion

  • Symptoms
45
Q

Symptoms of Pericardial Effusion

  • Symptoms of Systemic Congestion
46
Q

Symptoms of Pericardial Effusion

  • Symptoms of LCOP
47
Q

Symptoms of Pericardial Effusion

  • Pain
A

dull aching pain due to stretch of parietal pericardium .

48
Q

Symptoms of Pericardial Effusion

  • Pressure Manifestations
A
  • On lung → dyspnea, improved by sitting up & leaning forward.
  • On esophagus → dysphagia.
  • On left recurrent laryngeal nerve → hoarseness of voice.
49
Q

Signs of Pericardial Effusion

50
Q

Signs of Pericardial Effusion

  • Systemic Congestion
51
Q

Signs of Pericardial Effusion

  • Neck Veins
52
Q

Signs of Pericardial Effusion

  • Liver
A

Enlarged tender liver

53
Q

Signs of Pericardial Effusion

  • Ascites before edema LL (ascitesprecox)
A
  • Kinking of hepatic vein.
  • Obstruction of lymphatics passing through central tendon of diaphragm causes accumulation of lymph in peritoneum.
54
Q

Signs of Pericardial Effusion

  • LCOP
A

cold hand, pallor, los systolic blood pressure, weak pulse.

55
Q

Signs of Pericardial Effusion

  • Prayers Position
56
Q

Signs of Pericardial Effusion

  • Pulsus Paradoxus
57
Q

Def of Pulsus Paradoxus

A

exaggerated inspiratory fall in systolic BP ( >10 mmHg ).

58
Q

Pulsus Paradoxus is abnormal, What is normal?

59
Q

Explanation of Pulsus Paradoxus

60
Q

Causes of Pulsus paradoxus

61
Q

Cardaic Examination of Pericardial Effusion

  • Inspection & Palpation
A
  • Apex is not visible or palpable.
  • Pericardial pulge in children.
62
Q

Cardaic Examination of Pericardial Effusion

  • Percussion
63
Q

Cardaic Examination of Pericardial Effusion

  • Auscultation
A

weak distant heart sounds

64
Q

Complications of Pericardial Effusion

A
  • Cardiac tamponade.
  • Constrictive pericarditis.
65
Q

INVx in Pericardial Effusion

66
Q

INVx in Pericardial Effusion

  • X-Ray
A
  • Flask shaped heart ( narrow base ) with sharp border.
67
Q

INVx in Pericardial Effusion

  • ECG
A

low voltage

68
Q

INVx in Pericardial Effusion

  • ECHO
A

The most important for diagnosis & for detection of severity.

69
Q

INVx in Pericardial Effusion

  • Catheterization
A

Not needed any more after echo.

70
Q

INVx in Pericardial Effusion

  • Aspiration (Pericadiocentesis)
A
  • may needed for diagnosis of the cause by analysis of the pericardial fluid.
71
Q

DDx of Pericardial Effusion

72
Q

TTT of Pericardial Effusion

73
Q

TTT of Pericardial Effusion

  • The Cause
74
Q

TTT of Pericardial Effusion

  • Pericardial aspiration ( pericardiocentesis)
75
Q

TTT of Pericardial Effusion

  • Surgical
A

Pericadiectomy or pericardio-pleural window.

76
Q

TTT of Pericardial Effusion

  • Steroids
A

to prevent adhesions

77
Q

Def of Cardiac Tamponade

A

It’s a severest form of pericardial effusion.

78
Q

Etiology of Cardiac Tamponade

79
Q

CP of Cardiac Tamponade

80
Q

INVx for Cardiac Tamponade

A

The same as pericardial effusion

81
Q

TTT of Cardiac Tamponade

A

The same as pericardial effusion

82
Q

Def of Constrictive Pericarditis

A

Fibrosis & marked adhesion between the 2 layer of the pericardium.

83
Q

Etiology of Constrictive Pericarditis

A
  • The same as dry pericarditis with exception of rheumatic fever.
  • The most common cause is → TB & irradiation
84
Q

Hemodynamics in Constrictive Pericarditis

85
Q

CP of Constrictive Pericarditis

86
Q

CP of Constrictive Pericarditis

  • Symptoms
A

Similar to pericardial effusion but :
- Without or with minimal pressure manifestations.
- AF in 30% of cases.

87
Q

CP of Constrictive Pericarditis

  • Signs
A

Similar to pericardial effusion but with no special decubitus ( no prayer’s position)

88
Q

CP of Constrictive Pericarditis

  • Cardiac Signs
A
  • Weak or absent apical pulsation.
  • Pericardial knock → High pitched early diastolic sound due to sudden halting of the relaxing ventricles by rigid pericardium.
89
Q

INVx in Constrictive Pericarditis

90
Q

INVx in Constrictive Pericarditis

  • X-Ray
A

Calcification

91
Q

INVx in Constrictive Pericarditis

  • ECG
A

Low voltage , Flat or inverted T wave

92
Q

INVx in Constrictive Pericarditis

  • ECHO
A

Pericardial thickening , calcification , exclude the effusion.

93
Q

INVx in Constrictive Pericarditis

  • CT & MRI
A

Highly diagnostic.

94
Q

TTT of Constrictive Pericarditis

A
  • Pericardiectomy.
  • Treatment of the cause e.g. TB. & complications e.g. AF.
95
Q

Def of Adhesive Pericarditis

A
  • Adhesions between the pericardium & the surrounding mediastinal strictures & chest wall.
96
Q

Etiology of Adhesive Pericarditis

A
  • It occurs as a late complication of rheumatic fever
  • or may be due to an extension of inflammation from neighbor strictures.
97
Q

Mechanism of Cardiac Tamponade

98
Q

INvx in Cardiac Tamponade

99
Q

Beck’s Triad

100
Q

Pericardiocentesis

101
Q

Mechanism of Constrictive Pericarditis

Y4R7 - Medicine III 🩺 (26 decks)

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