Malozzi- Pericardium Flashcards
2 layers of pericardium
parietal and visceral
is pericardium essential for life
no
causes of this include:
viral
bacterial
fungal
autoimmune
tumor metastasis
metabolic
trauma
pericarditis
inflammatory syndrome of pericardium w/ or w/out effusion and infectious or non-infectious causes
acute pericarditis
most common cause of pericarditis
from viral infection (Coxsackie B)
signs of this include:
fever
sob
chest pain worse when lying down
friction rub
acute pericarditis
happy ST
pericarditis
sad ST
STEMI
what will you see in labs drawn for acute pericarditis
elevated WBC’s, ESR, CRP, troponin I
effusion seen in echo
pericarditis
CXR for pericarditis
Rx acute pericarditis
aspirin and NSAIDs; then corticosteroids
what happens if patient doesn’t complete Rx for acute pericarditis
recurrent pericarditis
to Rx recurrent pericarditis
aspirin and NSAIDs first; then corticosteroids
this is thought to be immune mediated
recurrent pericarditis
can be caused by coxsackie B, herpes, and adenovirus
infectious pericarditis
most common type of infectious pericarditis in developing countries
tuberculous
to Dx tuberculous pericarditis
acid fast bacilli (stain)
2 phases of tuberculous pericarditis seen in 30% of patients
effusive and constrictive
this phase is due to fluid accumulation
effusive
this phase is due to calcified lesion accumulation
constrictive
to Rx tuberculous pericarditis
rifampicin and isoniazid and others for up to 6 months
2 main causes of bacterial pericarditis
staph and strep
what can present with bacterial pericarditis
cardiac tamponade
pericarditis or effusion related to metastatic spread of cancer
malignant pericarditis
to Dx malignant pericarditis
fluid analysis (cytology and tumor markers)
main autoimmune diseases that can cause pericarditis
SLE
sarcoidosis
RA
trauma and surgery can cause what
pericarditis
post MI pericarditis aka
Dressler Syndrome
Rx Dressler syndrome
Aspirin
more exposure to ______ can cause pericarditis
radiation
pericardial effusion
this can be incidental or emergent (cardiac tamponade)
pericardial effusion
2 main ways fluid accumulates in pericardial effusion
exudative
transudative
fluid build up due to inflammation of pericardium layers
exudative fluid
fluid build up due to impaired lymphatic drainage
transudative fluid
pericardium can stretch to a certain degree; what happens when it is maxed out
will put pressure on heart chambers
patient presents as hypotensive and tachycardic (compensatory)
rapid pericardial effusion
patient presents w/ diminished heart sounds, JVD, low voltage on EKG
slow pericardial effusion
this is represented by impaired ventricular diastolic filling
increased jugular venous pressure
electrical alternans seen in pericardial effusion
a drop of >10 mmHg SBP during inspiration
pulses paradoxus in pericardial effusion due to ventricular interdependence
this is due to RV filling and pushing interventricular septum against L heart
pulsus paradoxus
to Rx cardiac tamponade/pericardial effusion
pericardiocentesis
pericardial window
due to ongoing inflammation resulting in fibrosis of pericardial sac
constrictive pericarditis
most common cause in developed world of contrictive pericarditis
radiation
prior cardiac surgery
presents with:
exertional dyspnea
abd distention
edema
JVD
Kussmaul’s sign
constrictive pericarditis
paradoxical increase in JVP with inspiration (seen under mandible)
Kussmaul’s sign
constrictive pericarditis
Decreased compliance (stiffness of pericardium)
Increase filling pressures
Decreased SV and CO
Ventricular interdependence (pressed against LV)
due to fibrosis of pericardium
shows discordance; LVP decreases and RVP increases
constrictive pericarditis
doesn’t have ventricular interdependence b/c muscle problem; shows concordance (LVP and RVP move in same pattern)
restrictive cardiomyopathy
to Rx constrictive pericarditis
pericardiectomy
pericardial window
Kussmaul’s sign seen in what
constrictive pericarditis
pulsus paradoxus seen in what
pericardial effusion/ cardiac tamponade
