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P&T Block 1 > L34 > Flashcards

L34 Flashcards

1
Q

4 clinical syndromes of pericardial disease

A

Pericarditis
Effusion
Tamponade
Constrictive pericarditis

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2
Q

Acute pericarditis

  • 3 infectious causes
  • Pathology
  • Clinical maifestation
A 
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
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3
Q

Transudate vs exudate

A 
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
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4
Q

Effusion clinical presentation

A

ASYMPTOMATIC
Or…
- L chest dull ache
- Compression of nearby structures: dysphagia, dyspnea, hoarseness, hiccups

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5
Q

Hemodynamics of pericardial tamponade

A
  1. Fluid in pericardium - increasing pericardial P
  2. All pressures in heart chambers are equal during DIASTOLE b/c of external pressure applied
  3. Decrease V filling b/c no forward movement
  4. Decrease SV - progressive low CO - hypotension
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6
Q

Pulsus paradoxus

A

= drop BP > 10mmHg during inspiration
TAMPONADE
Pulse disappears during systole

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7
Q

Electrical alternans

A

Change in size every other QRS

EKG for severe TAMPONADE - heart is swinging in large pleural effusion

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8
Q

JVP of pericardial tamponade vs pericardial constriction

A

Tamponade = increase JVP (everything is backing up!)

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9
Q

Other physical finding differences for pericardial tamponade vs constriction

A

Tamponade

  • Low BP
  • Quiet heart
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10
Q

What are the 3 part of the friction rub of acute pericarditis

A

Hear this
Atrial contraction before S1
Ventricular contraction between S1-2
Ventricular diastole after S2

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11
Q

Describe the presentation for pleuritic chest pain of acute pericarditis

A

Sharp, stabbing, pleuritic pain the radiates to scapula

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12
Q

EKG for acute pericarditis

A

DIFFUSE ST elevation
- Esp if see PR depression
Elevation b/c outer wall involved

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13
Q

Treat acute pericarditis

A

Supportive - resolves on own

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14
Q

3 bugs that will cause purulent pericarditis

A

Staph aureus
Pneumococcus
GN rods

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15
Q

Dressler’s syndrome

A

Delayed pericarditis after STEMI

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16
Q

Which cancers would met to cardiac tissue to cause pericarditis

A

Lung
Lymphoma
Breast

17
Q

What 2 drugs can cause pericarditis

A

Procainamide

Hydralazine

18
Q

What 4 diseases would cause transudate effusion

A

Big organs - not infections

  1. CHF
  2. Cirrhosis
  3. Nephrotic syndrome
  4. Hypothyroidism
19
Q

Clinically what are you hearing/seeing for effusion

A

Hard to hear soft heart sounds
Can’t feel apical beat
Dullness over post lung

20
Q

Effusion on CXR

A

Big heart not because of cardiomegaly but because of effusion - hazy

21
Q

Chose the most important aspect of rising pericardial P

  1. Volume of fluid in pericardium
  2. Rate of fluid accumulation
  3. Pericardium compliance
A

Rate of accumulation

- Add the same volume chronically, significant less P increase

22
Q

Triad of tamponade symptoms

A

Low BP
High JVP
Soft heart sounds

23
Q

How might the ECHO look for tamponade

  • RA
  • RV
  • IVC
A

Think - increased P + fluid backup

  • RA & RV collapse
  • IVC dilated
24
Q

3 ways to treat tamponade

A

Pericardiocentesis
Pericardiotomy
Pericardial window

25
Q

Causes and hemodynamics of pericardial constriction

A 
Causes
1. Idiopathic
2. Post-cardiac surg
3. Pericarditis
4. Radiation 
Calcification of pericardium 
- Confines max relaxation during diastole
26
Q

PE of constriction

A

Pericardial knock

Y in jugular vein

27
Q

Sign of constriction on Wiggers

A

Dip and plateau

Square root sign

P&T Block 1 (43 decks)

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