Lecture 4 Pericarditis

Question 1

most common cause of pericarditis

Answer 1

idiopathic

Question 2

what kind of cancer treatment can cause pericarditis?

Answer 2

radiation

Question 3

most common viral cause of pericarditis?

Answer 3

coxsackie

also echo, adenovirus

Question 4

____ pericarditis = pericarditis caused late post MI

Answer 4

dressler’s

Question 5

3 drugs that can cause lupus induced pericarditis?

HIP

Answer 5

Hydraliazine, isoniazid, procainamide

Question 6

describe the gross surface of a heart with pericarditis

Answer 6

roughened surface; “bread and butter”

Question 7

Pericarditis symptoms–chest pain:

chest pain ____ to exertion. it is typically ____ onset. it is sharp and ____ in nature

Answer 7

unrelated; sudden; pleuritic

Question 8

pericarditis chest pain: what makes it worse typically? what makes it better?

Answer 8

worse = laying down flat/inspiration

better = seated and leaning forward

Question 9

Pericarditis causes ____ ___ due to friction between the two inflamed layers of pericardium. it is described as ___phasic with __, ___ sounds that come and go

Answer 9

friction rub;
tri-;
scratchy, leathery

Question 10

lab findings:

_____ may be slightly elevated due to inflammation. it is ____

Answer 10

troponin;
prognostic

ie higher troponin = more inflammation

Question 11

ECG changes with pericarditis:
____ ____ segment elevation, except in lead ___.
____ ____ depression

later, see ___ ____ wave inversion

Answer 11

diffuse ST, aVR (posterior lead);
diffuse PR;
diffuse T

Question 12

Pericarditis shows more (diffuse or localized) ST segment elevation changes when compared to MI

Answer 12

diffuse

Question 13

In young healthy people, there is sometimes a slight ___ elevation and a ___ point notch after each _____

Answer 13

ST; J;

QRS

Question 14

For idiopathic pericarditis, what are the 2 mainstays of treatment?

Answer 14

colchine (3 months)

NSAID such as indomethacin

Question 15

Post MI, what should you use for pericarditis?

Answer 15

aspirin and colchine

avoid NSAIDS-interfere with healing

Question 16

accumulation of fluid within the pericardial space is called _____ ____. pericardial fluid pushing on the heart causes _____ _____

Answer 16

pericardial effusion;

cardiac tamponade

Question 17

ECG changes in cardiac tamponade: (2)

Answer 17

electrical alternans, low-voltage QRS,

also sinus tachy

Question 18

electrical alternans is alternating amplitudes on ECG due to what?

Answer 18

“swinging movement” of heart in large effusion

Question 19

presentation of cardiac tamponade: ____ symptoms with clear lungs ie peripheral edema, enlarged ____

Answer 19

CHF;

liver

Question 20

pericardial effusion increases ______ pressure. this impedes ___ filling of the LV and RV, so the ___ pressure of the LV and RV rises–>decrease in SV and CO

Answer 20

interpericardial;

diastolic, diastolic

Question 21

cardiac tamponade–>pulsus paradoxus = ___ in amplitude of ___ blood pressure by 10 mm Hg during ____

Answer 21

decrease, systolic;

inspiration

Question 22

the mechanism of pulsus paradoxus is due to increased ventricular _____. during inspiration, the increase in ____ return causes a septal shift, impinging on __ volume

Answer 22

interdependence;

venous, LV

Question 23

pulsus paradoxus = There is decreased LV filling, thus, a decreased ___ ____ during _____

Answer 23

stroke volume, inspiration

Question 24

Pericardial tamponade: there is elevated ___ with loss of ___ ____

Answer 24

JVP, Y descent

Question 25

With pericardial tamponade, patients should receive ____ ___. Prompt ____ should also occur

Answer 25

IV fluid, pericardiocentesis

Question 26

Constrictive pericarditis: chronic thickening/scarring of pericardium leads to encasement of the heart and impaired ____ filling of the LV and RV. However, ____ filling is unimpaired

Answer 26

diastolic;

early

Question 27

3 causes of constrictive pericarditis:

Answer 27

idiopathic/viral, post-surgery, radiation

Question 28

Constrictive pericarditis presentation: ____ process. unexplained ____ ___ _____, presenting as systemic congestion and dsypnea. often misdiagnosed as ?

Answer 28

slow;
right heart failure;

cirrhosis

Question 29

physical findings of constrictive pericarditis:
elevated ___ with prominent __ and ___ Descents;
____ sign;
pericardial ___

Answer 29

JVP, X, Y;
kussmaul’s
knock

Question 30

What is kussmaul’s sign?

Answer 30

lack of inspiratory decline in JVP or increase in JVP

Question 31

Constrictive pericarditis:

you see simultaneous equalization of ___ and ___ ______ pressures

Answer 31

LV, RV diastolic

Question 32

A CT would show ____ of the pericardium in constrictive pericarditis

Answer 32

calcification