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Echo 2 > Module 17 : Pericardial Disease > Flashcards

Module 17 : Pericardial Disease Flashcards

1
Q

what are the anatomical layers of the pericardium from inner to outer

A
  • visceral layer (epicardium)
  • fluid
  • partial layer
  • fibrous layer
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2
Q

where does the pericardium insert posteriorly

A
  • IVC and superiors to the pulmonary veins
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3
Q

where does the pericardium insert superiorly

A
  • great vessels
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4
Q

where is the normal amount of serous fluid

A

20-50 ml

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5
Q

what are 4 functions of the pericardium

A
  • limits over distension of the heart
  • helps distribute diastolic pressure
  • reduces friction
  • infection barrier
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6
Q

what is the epicardial fat

A
  • layer of fat anterior to the heart

- usually along the AV groove & inter ventricular & coronary after tracts

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7
Q

what is the purpose of the epicardial fat

A
  • protects from blunt force trauma
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8
Q

what is/causes a pericardial effusion

A
  • increased amount of fluid within pericardial space

- irritation/injury to pericardium

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9
Q

what is pericardial tamponade

A
  • marked or fast increase in intrapericardial pressure above intracardiac pressures
  • compresses the heart and impairs its ability to fill
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10
Q

what is pericarditis and what does it do

A
  • inflammation of the pericardial surfaces

- restricts diastolic function

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11
Q

what two things cause pericardial effusion

A
  • injury to/inflammation of pericardium

- when irritated visceral pericardium secretes fluid

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12
Q

what is a consequence of pericardial effusion and what are the consequences dependant on

A
  • large effusions that accumulate fast reduces SV by restricted filling
  • effects depend on the amount of fluid and rate of accumulation
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13
Q

what are the 3 descriptors of pericardial effusion

A
  • location
  • amount
  • hemodynamic comprise
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14
Q

what is common about most locations of pericardial effusions

A
  • tends to be dependant (posterior at first)

- will then extend anterior to aorta

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15
Q

what are the 3 different ways to describe amount of pericardial

A
  • small
  • moderate
  • large
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16
Q

what are 2 different ways to describe locations pericardial effusions

A
  • circumferential

- loculated

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17
Q

what are 6 different aetiologies of pericardial effusions

A
  • infectious
  • inflammation
  • anasarca
  • malignant
  • trauma
  • iatrogenic
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18
Q

what are the signs and symptoms

A
  • chest pain
  • SOB
  • increased JVP
  • pericardial rub
  • quiet heart sounds
  • sand paper
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19
Q

what will the ECG look like with pericardial effusions

A
  • low voltage ECG

- electrical alterans

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20
Q

what are the intrapericardial and intracardial pressures in normal heart

A
  • low intrapericardial

- high intracardiac

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21
Q

what are the intrapericardial and intracardial pressure in effusion and what does it cause

A
  • high intrapericardial
  • high intracardiac
  • diastolic collapse of right heart
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22
Q

what happens with PP > RAP

A
  • MAP and CO fall
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23
Q

what happens with PP > RVP

A
  • MAP and CO fall even more
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24
Q

what is the 2D role of echo with effusions

A
  • location
  • potential collapse of chambers
  • differentiation of pleural effusion
  • size
  • clear space or echoes within
  • pericardial thickness
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25
Q

what are the doppler roles of echo with pericardial effusions

A
  • diastolic function assessment

- changes in LV and RV filling with respiration

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26
Q

what is the characteristics of physiological pericardial effusion

A
  • 2-5mm space in systole

- 20-50 ml of fluid

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27
Q

what is the characteristics of mild pericardial effusion

A
  • < 0.5-1 cm space in systole and diastole

- 50-100 ml

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28
Q

what is the characteristics of moderate pericardial effusion

A
  • 1-2 cm (posterior space in systole and diastole)

- 100-500 ml fluid

29
Q

what is the characteristics of large pericardial effusion

A
  • > 2cm and and posterior space in systole and diastole

- >500ml

30
Q

when is pericardial effusion measured

A
  • end diastole in PSAX or LAX at pap muscle level
31
Q

what is pericardial effusion always anterior to

A

anterior to descending AO

32
Q

what is pleural effusions always posterior to

A

heart

33
Q

when is the pericardial effusion measured in M mode

A
  • anechoic space between epicardium and pericardium to be measured in diastole
34
Q

when does the posterior wall lift off the pericardial border in M mode

A

systole

35
Q

which way does the septum shift with inspiration and expiration

A
  • left = inspiration

- right = expiration

36
Q

what are the 2D imaging considerations with PE

A
  • gain too high fills in space
  • image depth too shallow miss
  • anterior pericardial fat
  • dilated coronary sinus
  • pseudo aneurysms
  • large pleural effusion
37
Q

what are the M mode considerations with PE

A
  • parasternal beam transects DAO misten for PE
38
Q

pathophysiology of pericardial tamponade

A
  • rapid accumulation of fluid
  • heart swings in chest
  • high pressure intrapericardial cavity
  • impairs cardiac chamber filling due to a rise in intrapericardial pressure thus impatiens SV and CO
  • life threatening
  • intrapericardial pressure rises
39
Q

what is the order of chambers that would collapse with pericardial tamponade

A
  • RA
  • RV
  • LAP
  • LV
40
Q

what happens to the right heart with tamponade

A 
- affected first 
  \+ RA systolic collapse
  \+ RV diastolic collapse
  \+ reciprocal RV/LV respiratory changes (septal shifting)
  \+ reduced TD velocities
  \+ SVC nad IVC dilated
41
Q

what happens to the left heart with tamponade

A
  • LV diastolic filling imparied
  • volume changed with respiration
  • SV drops= BP drops
  • tachycardia
42
Q

what type of pericardial tamponade is most common

A
  • subacute and chronic
43
Q

what are the two types of causes of pericardial tamponade

A
  • acute

- subacute chronic

44
Q

what are the causes of acute tamponade

A
  • trauma
  • AO dissection
  • dressers
  • MI
  • iatrogenic
45
Q

what are the causes of subacute chronic tamponade

A
  • idiopathic
  • viral pericaditis
  • mets
  • radiation
  • fluid varys
  • pericardium stretches
  • fibrin strains seen
46
Q

what will tamponade look like on ECG

A
  • tachycardia

- electrical alterans ( alternating amplitudes QRS changes)

47
Q

what are the clinical signs of tamponade

A
  • becks triad

- pulses paradoxus

48
Q

what is Becks triad

A
  • low arterial BP
  • distended neck veins
  • muffled heart sounds
49
Q

what is pulsus paradoxes

A
  • abnormally large decrease in pulse amplitude during inspiration
50
Q

what are complications to tamponade

A
  • shock
  • hypotension
  • altered mental state
  • death
51
Q

what is ventricular interdependence

A
  • any size, shape pressure or volume of one ventricle changes the size shape volume of other ventricle
  • becomes prominent with pericardial effusion
52
Q

how does inspiration and expiration change the echo findings in echo with tamponade

A
  • insp = increased RV volume, decreased LV volume

- exp = decreased RV volume

53
Q

what are the doppler findings of tamponade

A
  • > /= 25-30% change of MV E velocities

- TV E velocities > 50-60% change with respiration

54
Q

what are the 2 treatments of tamponade

A
  • pericardiocentiusis = echo guided, low risk, needle aspirated, drain from catheter
  • pericardial window = surgical, reserved for chronic effusions and chronic pericarditis
55
Q

what is hemoperricardium

A
  • collection of blood in pericardial sac

- blood does not usually clot due to antithrombotic factors in pericardial effusion

56
Q

what is the definition of pericarditis

A
  • inflammation of pericardial sac
57
Q

what is the result of pericarditis

A
  • fibrosis
  • thickenin g
  • purulent ( stuck pericardium)
58
Q

what is constrictive pericarditis

A
  • parietal pericardium no compliant

- RV and LV diastolic filling is reduced and restricted Grade 3 DD

59
Q

what are the common aetiologies of pericarditis

A
  • acute infection
  • trauma
  • post surgical
  • post MI
  • chronic pericardial effusion
60
Q

what happens with constrictive pericarditis

A
  • normally heart allowed to expand
  • with fluid in pericardial sac&raquo_space; decreased expansion
  • with further restricted pericardium&raquo_space; decreased expansion worse
61
Q

what are the sounds heard with pericarditis

A
  • friction rub
  • heard with auscultation
  • may be caused by crystals
62
Q

what are the symptoms of pericarditis

A
  • chest pain

- JVP pressure increases with inspiration

63
Q

what is the ECG look like with

A
  • diffuse ST segment elevation
64
Q

what are the 2D findings with pericarditis

A
  • thickened echo genie pericardium
  • fibrotic
  • shadow
  • pericardium may be stuck to myocardium
  • pericardial fluid
  • pleural effusion
  • IVC dilated
65
Q

what are the M mode features of constrictive pericarditis

A
  • posteriori LV wall stuck to pericardium
  • pericardial layers look bright and thickened
  • RAIL ROAD TRACK appearance
66
Q

what are the doppler findings of constrictive pericarditis

A 
- restrictive physiology 
  \+ increased MV E/A ratio
  \+ decreased MV DT
  \+ decreased IVRT
  \+ IVC plethora 
- tissue doppler E prime increased (septal > lateral)
67
Q

how is filling changed with inspiration with CP

A
  • decreased LV filling
  • increased RV filling
  • IVS shift toward the left
  • > 25 - 30% change in MV inflow velocity is abnormal
68
Q

how is filling changed with expiration with CP

A
  • increase LV filling
  • decreased RV filling
  • IVS shifts toward right
  • > 25-30% change in MV inflow velocity is abnormal
69
Q

characteristics of pericardial masses

A
  • invasion of pericardium with mets
  • hard to differentiations form clots of fibrin clusters
  • lung breasts lymphatic

Echo 2 (18 decks)

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