L34 Flashcards
4 clinical syndromes of pericardial disease
Pericarditis
Effusion
Tamponade
Constrictive pericarditis
Acute pericarditis
- 3 infectious causes
- Pathology
- Clinical maifestation
Infectious causes: - Viral: echo or CoxB - TB - Pyogenic bacteria Pathology = serofibrinous pericarditis - "Bread and butter" b/c fibrin deposits Clinical: - Pleuritic chest pain (when you breathe) - Fever - 3 part pericardial friction rub - Changes to EKG
Transudate vs exudate
Transudate = non-inflam - Clear fluid w/ low protein Exudate = infection, cancer, or collagen defect of vasculature - B/c of vasc permeability - Bloody or pussy w/ high protein count
Effusion clinical presentation
ASYMPTOMATIC
Or…
- L chest dull ache
- Compression of nearby structures: dysphagia, dyspnea, hoarseness, hiccups
Hemodynamics of pericardial tamponade
- Fluid in pericardium - increasing pericardial P
- All pressures in heart chambers are equal during DIASTOLE b/c of external pressure applied
- Decrease V filling b/c no forward movement
- Decrease SV - progressive low CO - hypotension
Pulsus paradoxus
= drop BP > 10mmHg during inspiration
TAMPONADE
Pulse disappears during systole
Electrical alternans
Change in size every other QRS
EKG for severe TAMPONADE - heart is swinging in large pleural effusion
JVP of pericardial tamponade vs pericardial constriction
Tamponade = increase JVP (everything is backing up!)
Other physical finding differences for pericardial tamponade vs constriction
Tamponade
- Low BP
- Quiet heart
What are the 3 part of the friction rub of acute pericarditis
Hear this
Atrial contraction before S1
Ventricular contraction between S1-2
Ventricular diastole after S2
Describe the presentation for pleuritic chest pain of acute pericarditis
Sharp, stabbing, pleuritic pain the radiates to scapula
EKG for acute pericarditis
DIFFUSE ST elevation
- Esp if see PR depression
Elevation b/c outer wall involved
Treat acute pericarditis
Supportive - resolves on own
3 bugs that will cause purulent pericarditis
Staph aureus
Pneumococcus
GN rods
Dressler’s syndrome
Delayed pericarditis after STEMI
Which cancers would met to cardiac tissue to cause pericarditis
Lung
Lymphoma
Breast
What 2 drugs can cause pericarditis
Procainamide
Hydralazine
What 4 diseases would cause transudate effusion
Big organs - not infections
- CHF
- Cirrhosis
- Nephrotic syndrome
- Hypothyroidism
Clinically what are you hearing/seeing for effusion
Hard to hear soft heart sounds
Can’t feel apical beat
Dullness over post lung
Effusion on CXR
Big heart not because of cardiomegaly but because of effusion - hazy
Chose the most important aspect of rising pericardial P
- Volume of fluid in pericardium
- Rate of fluid accumulation
- Pericardium compliance
Rate of accumulation
- Add the same volume chronically, significant less P increase
Triad of tamponade symptoms
Low BP
High JVP
Soft heart sounds
How might the ECHO look for tamponade
- RA
- RV
- IVC
Think - increased P + fluid backup
- RA & RV collapse
- IVC dilated
3 ways to treat tamponade
Pericardiocentesis
Pericardiotomy
Pericardial window
Causes and hemodynamics of pericardial constriction
Causes 1. Idiopathic 2. Post-cardiac surg 3. Pericarditis 4. Radiation Calcification of pericardium - Confines max relaxation during diastole
PE of constriction
Pericardial knock
Y in jugular vein
Sign of constriction on Wiggers
Dip and plateau
Square root sign
