Lecture 4 Pericarditis Flashcards
most common cause of pericarditis
idiopathic
what kind of cancer treatment can cause pericarditis?
radiation
most common viral cause of pericarditis?
coxsackie
also echo, adenovirus
____ pericarditis = pericarditis caused late post MI
dressler’s
3 drugs that can cause lupus induced pericarditis?
HIP
Hydraliazine, isoniazid, procainamide
describe the gross surface of a heart with pericarditis
roughened surface; “bread and butter”
Pericarditis symptoms–chest pain:
chest pain ____ to exertion. it is typically ____ onset. it is sharp and ____ in nature
unrelated; sudden; pleuritic
pericarditis chest pain: what makes it worse typically? what makes it better?
worse = laying down flat/inspiration
better = seated and leaning forward
Pericarditis causes ____ ___ due to friction between the two inflamed layers of pericardium. it is described as ___phasic with __, ___ sounds that come and go
friction rub;
tri-;
scratchy, leathery
lab findings:
_____ may be slightly elevated due to inflammation. it is ____
troponin;
prognostic
ie higher troponin = more inflammation
ECG changes with pericarditis:
____ ____ segment elevation, except in lead ___.
____ ____ depression
later, see ___ ____ wave inversion
diffuse ST, aVR (posterior lead);
diffuse PR;
diffuse T
Pericarditis shows more (diffuse or localized) ST segment elevation changes when compared to MI
diffuse
In young healthy people, there is sometimes a slight ___ elevation and a ___ point notch after each _____
ST; J;
QRS
For idiopathic pericarditis, what are the 2 mainstays of treatment?
colchine (3 months)
NSAID such as indomethacin
Post MI, what should you use for pericarditis?
aspirin and colchine
avoid NSAIDS-interfere with healing
accumulation of fluid within the pericardial space is called _____ ____. pericardial fluid pushing on the heart causes _____ _____
pericardial effusion;
cardiac tamponade
ECG changes in cardiac tamponade: (2)
electrical alternans, low-voltage QRS,
also sinus tachy
electrical alternans is alternating amplitudes on ECG due to what?
“swinging movement” of heart in large effusion
presentation of cardiac tamponade: ____ symptoms with clear lungs ie peripheral edema, enlarged ____
CHF;
liver
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
interpericardial;
diastolic, diastolic
cardiac tamponade–>pulsus paradoxus = ___ in amplitude of ___ blood pressure by 10 mm Hg during ____
decrease, systolic;
inspiration
the mechanism of pulsus paradoxus is due to increased ventricular _____. during inspiration, the increase in ____ return causes a septal shift, impinging on __ volume
interdependence;
venous, LV
pulsus paradoxus = There is decreased LV filling, thus, a decreased ___ ____ during _____
stroke volume, inspiration
Pericardial tamponade: there is elevated ___ with loss of ___ ____
JVP, Y descent
With pericardial tamponade, patients should receive ____ ___. Prompt ____ should also occur
IV fluid, pericardiocentesis
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
diastolic;
early
3 causes of constrictive pericarditis:
idiopathic/viral, post-surgery, radiation
Constrictive pericarditis presentation: ____ process. unexplained ____ ___ _____, presenting as systemic congestion and dsypnea. often misdiagnosed as ?
slow;
right heart failure;
cirrhosis
physical findings of constrictive pericarditis:
elevated ___ with prominent __ and ___ Descents;
____ sign;
pericardial ___
JVP, X, Y;
kussmaul’s
knock
What is kussmaul’s sign?
lack of inspiratory decline in JVP or increase in JVP
Constrictive pericarditis:
you see simultaneous equalization of ___ and ___ ______ pressures
LV, RV diastolic
A CT would show ____ of the pericardium in constrictive pericarditis
calcification
