Nichols- Pericardial Heart Disease Flashcards
Fluid in the pericardial sac is called?
Pericardial effusion
How much fluid is normally in the pericardial sac
15-50mL
A sharp increase to over ____mL would lead to a sharp increase in pressure in the pericardial sac
200mL
A slow, gradual increase to ____mL could occur WITHOUT a significant rise in pressure
2000mL (2L)
List the 5 causes of pericardial effusion
MR. HAV
- Viral myopericariditis
- Metastatic malignancy
- Autoimmune Disease
- Renal failure
- Hemopericardium
Symptoms of pericardial effusion?
Dull chest pain, dyspnea, hiccups, dysphagia
Diagnosis of pericardial effusion is by?
- CXR- cannot differentiate between pericardial effusion and cardiomegaly
- Echo- can differentiate
Hemopericardium is usually considered separately from pericardial effusion. It is rare but FATAL. What are 5 causes of hemopericaridum?
2 Ruptures in ATL
- Cardiac rupture (day 5 post MI)
- Aortic dissection rupture
- Trauma
- Anticoagulation
- Leukemia
When fluid in pericardial sac is enough to impair filling & function of the heart.
Cardiac tamponade- think ACUTE, RUPTURE, HEMOPERICARDIUM, HUGE MI
Altered mental status, dyspnea, CV collapse and cardiac arrest are symptoms of a sudden or chronic cardiac tamponade?
SUDDEN!
Fatigue, leg edema, and dyspnea on exertion are symptoms of sudden or chronic cardiac tamponade?
Chronic
The signs of cardiac tamponade are referred to as Beck’s triad. What is Beck’s triad?
- JVD
- Muffled heart sounds
- Hypotension
Another sign of cardiac tamponade is pulsus paradoxus. What does this mean?
Pulsus paradoxus is an exaggeration of the normal decrease in BP with inspiration
What diagnostic tests should you use to diagnose cardiac tamponade?
Echo (shows right atrium and ventricle COLLAPSE during diastole), Swan-Ganz right heart catheterization
Treatment of cardiac tamponade
Tap it!
List the types of pericarditis
- Serous
- Fibrinous
- Purulent
- Hemorrhagic
- Constrictive- “does not deserve the name”
In this type of pericarditis, the pericardium has a smooth surface, scant neutrophils, lymphocytes, & macrophages. The fluid has a low protein content
Serous pericarditis
SHAGGY, dry, rough pericardial surface with many neutrophils, lymphocytes, and macrophages
Fibrinous pericarditis
Red granular surface coated with PUS
Purulent pericarditis.. remember purulent exudate!
Any pericarditis where blood is involved
Hemorrhagic pericarditis
Most common type of clinical pericarditis is acute “idiopathic” pericarditis, but it is usually caused by?
Virus: Echovirus or Coxsackie virus (haha)
A patient comes in with chest pain. The pain goes away when they sit down and lean their torso forward. What diagnosis comes to mind?
Acute pericarditis
You listen to the hunched over patient’s heart. You hear a friction rub. Do you feel better about your differential of acute pericarditis?
Yes you do! Pericardial friction rubs are a pretty specific sign of acute pericarditis
A patient with pericarditis has elevated troponin I levels. What do dis mean?
Myopericarditis.. The myocardium is being destroyed and is releasing its enzymes (troponin I)
You need 2 out of 4 of these findings to diagnose acute pericarditis
- Typical chest pain
- Pericardial friction rub
- “Suggestive” changes on ECG (ST elevation, PR segment elevation)
- Pericardial effusion
Acute pericarditis due to pyogenic bacteria is rare with purulent exudate. What bugs typically cause it?
S. aureus, strep pneumoniae
Autoimmune pericarditis is strongly associated with what two autoimmune diseases?
- Lupus
2. Rheumatoid arthritis
This pericarditis is when the heart is “encased” in fibrous tissue, so that it is not allowed to dilate or hypertrophy.
Constrictive pericarditis
How do you treat constrictive pericarditis?
Strip it! Surgically
