pericardial

Question 1

idiopathic
cox b
SLE
RA
uremia

Answer 1

serous pericardial

Question 2

Dressler
uremia
rheumatic

Answer 2

fibrinous pericardial

Question 3

TB

malignancy

Answer 3

hemorrhagic pericardial

Question 4

chest radiation therapy
open heart surgery
viral illness
TB

Answer 4

constrictive pericardial

Question 5

pathogenesis:
1. chest pain caused by inflammation
2. friction rub
3. pericardial effusion

Answer 5

Pericardial

Question 6

Hx and PE

1. chest pain: pleuritic, sharp, constricting
2. retrosternal/ L sided
3. relieved by sitting up and leaning forward
4. intensified by lying supine
5. fever may be present
6. friction rub
7. kussnaul sign
8. pericardial knock

large pericardial effusion

1. hiccups
2. Ewarts sign: bronchial breathing + dullness to percussion @ left base

Answer 6

pericardial

Question 7

ECG: 
acute pericarditis: diffuse St elevation and PR depression (except avR)
pericardial effusion (large): electrical alternans and low voltage QRS complex

Answer 7

Pericardial

Question 8

rigid, thickened pericardium, normal ventricular filling, pericardium reaches it elastic limit, abrupt decrease in ventricular filling = diastolic knock

Answer 8

chronic constrictive pericarditis

Question 9

Hx: slow progressive dyspnea, abdominal discomfort and enlargement, chronic peripheral edema

Answer 9

chronic constrictive pericarditis

Question 10

PE: R sided congestion (JVP elevated with rapid y descent, kussmauls sign), congestive hepatomegaly, peripheral edema, pulses paradoxus, pericardial knock

Answer 10

chronic constrictive pericarditis

Question 11

CXR: pericardial calcification in tuberculosis pericarditis

TTE: pericardial thickening, sharp halt in ventricular filing in early diastole

MRI: definitive Dx - pericardial thickening/ calcification

Answer 11

chronic constrictive pericarditis

Question 12

DDX for chronic constrictive pericarditis

1. rheumatic fever, RHF, MS like murmur
2. SYS HTN, advanced parenchymal pulmonary disease, RV heave, loud P2, R sided S4

Answer 12

1. tricuspid stenosis

2. cor pulmonale

Question 13

accumulation of fluid in pericardial space that restricts ventricular filling

Answer 13

cardiac tamponade

Question 14

pathogenesis

1. increase pericardial pressure > compression of the cardiac chambers > decrease CO and BP
2. pulses paradoxus: decrease systolic BP > 10 on inspiration

Answer 14

cardiac tamponade

Question 15

HX: chest pain, SOB, fatigue, diaphoresis

Answer 15

cardiac tamponade

Question 16

PE:

1. Becks triad - hypotension, increase JVP, muffled or absent heart sounds
2. tachycardia
3. friction rub may be present
4. clear lungs
5. poor pulses and cold extremities

Answer 16

cardiac tamponade

Question 17

TTE - chest of choice

1. diastolic collapse of right heart
2. fluid in the pericardial space
3. swinging of heart with in the effusion

Management: percutaneous pericardiocentesis

Answer 17

cardiac tamponade

Question 18

DDx for cardiac tamponade

Answer 18

1. constrictive pericarditis

2. tension pneumothorax - decrease or absent breath sounds; hyper resonant percussion