pericardial Flashcards
idiopathic cox b SLE RA uremia
serous pericardial
Dressler
uremia
rheumatic
fibrinous pericardial
TB
malignancy
hemorrhagic pericardial
chest radiation therapy
open heart surgery
viral illness
TB
constrictive pericardial
pathogenesis:
1. chest pain caused by inflammation
2. friction rub
3. pericardial effusion
Pericardial
Hx and PE
- chest pain: pleuritic, sharp, constricting
- retrosternal/ L sided
- relieved by sitting up and leaning forward
- intensified by lying supine
- fever may be present
- friction rub
- kussnaul sign
- pericardial knock
large pericardial effusion
- hiccups
- Ewarts sign: bronchial breathing + dullness to percussion @ left base
pericardial
ECG: acute pericarditis: diffuse St elevation and PR depression (except avR) pericardial effusion (large): electrical alternans and low voltage QRS complex
Pericardial
rigid, thickened pericardium, normal ventricular filling, pericardium reaches it elastic limit, abrupt decrease in ventricular filling = diastolic knock
chronic constrictive pericarditis
Hx: slow progressive dyspnea, abdominal discomfort and enlargement, chronic peripheral edema
chronic constrictive pericarditis
PE: R sided congestion (JVP elevated with rapid y descent, kussmauls sign), congestive hepatomegaly, peripheral edema, pulses paradoxus, pericardial knock
chronic constrictive pericarditis
CXR: pericardial calcification in tuberculosis pericarditis
TTE: pericardial thickening, sharp halt in ventricular filing in early diastole
MRI: definitive Dx - pericardial thickening/ calcification
chronic constrictive pericarditis
DDX for chronic constrictive pericarditis
- rheumatic fever, RHF, MS like murmur
- SYS HTN, advanced parenchymal pulmonary disease, RV heave, loud P2, R sided S4
- tricuspid stenosis
2. cor pulmonale
accumulation of fluid in pericardial space that restricts ventricular filling
cardiac tamponade
pathogenesis
- increase pericardial pressure > compression of the cardiac chambers > decrease CO and BP
- pulses paradoxus: decrease systolic BP > 10 on inspiration
cardiac tamponade
HX: chest pain, SOB, fatigue, diaphoresis
cardiac tamponade
PE:
- Becks triad - hypotension, increase JVP, muffled or absent heart sounds
- tachycardia
- friction rub may be present
- clear lungs
- poor pulses and cold extremities
cardiac tamponade
TTE - chest of choice
- diastolic collapse of right heart
- fluid in the pericardial space
- swinging of heart with in the effusion
Management: percutaneous pericardiocentesis
cardiac tamponade
DDx for cardiac tamponade
- constrictive pericarditis
2. tension pneumothorax - decrease or absent breath sounds; hyper resonant percussion
