OnlineMedEd: Cardiology - "Pericardial Disease"

Question 1

List the four broad categories of pericarditis causes.

Answer 1

•Infection:

• Viral
• Fungal
• TB
• Bacterial

• Autoimmune:

• Dressler syndrome (post-MI)
• Lupus
• Uremia
• RA

•Trauma
- Penetrating trauma is the most common

•Cancer:

• Breast
• Lung
• Lymphoma
• Esophageal

Question 2

The three types of pericardial disease are ________________.

Answer 2

pericarditis (inflammatory response), pericardial effusion, and constrictive pericarditis

Question 3

Two common causes of pericarditis are _____________.

Answer 3

uremia and infection

Question 4

The best diagnostics for pericarditis are _______________.

Answer 4

ECG (diffuse ST elevation and PR depression) and MRI (inflamed tissue)

Question 5

How should pericarditis be treated?

Answer 5

There are a couple options: 
•NSAIDs and colchicine
• NSAIDs
• Colchicine
•Steroids

The first is the best choice, unless they have CKD, low platelets, or PUD – then do not give NSAIDs.

Colchicine is the next best option, but it is dose-limited due to diarrhea.

Steroids actually increase the recurrence rate of pericarditis, so they should only be given in severe cases and when NSAIDs and colchicine cannot be given.

Question 6

Describe the presentation of pericardial effusion.

Answer 6

Pericardial effusion is often a result of pericarditis, so it will also present with pleuritic chest pain that is positional. Symptoms unique to pericardial effusion include pulsus paradoxus, JVD, decreased heart sounds, and Kussmaul’s sign.

Question 7

How do you treat pericardial effusion?

Answer 7

• Treat the pericarditis

* Pericardial window if the effusion does not resolve with pericarditis treatment

Question 8

Pericardial effusion can be diagnosed with _______________.

Answer 8

echocardiography

Question 9

Pulsus paradoxus is normal unless the difference in pressure exceeds __________.

Answer 9

10 mm Hg

Question 10

Pericardial tamponade is diagnosed by what triad of symptoms?

Answer 10

Beck’s triad: JVD, hypotension, and decreased heart sounds

Question 11

How do you treat pericardial tamponade?

Answer 11

• First, pericardiocentesis
• Second, IVF (to increase preload and push outward on the effusion)
• Third, pericardial window

Question 12

Repeated episodes of pericarditis can lead to ________________.

Answer 12

constrictive pericarditis

Question 13

How do you treat constrictive pericarditis?

Answer 13

Pericardectomy – the change is permanent

Question 14

Pericardial knock and _____________ are suggestive of constrictive pericarditis.

Answer 14

diastolic heart failure