Pericardial and Congenital Heart Disease

Question 1

What is acute pericarditis?

Answer 1

An idiopathic syndrome, most likely viral, that lasts 1-3 weeks and presents with sharp substernal pleuritic positional pain with pericardial friction rub

Question 2

What does an ECG of acute pericarditis look like?

Answer 2

STEMI not confined to a coronary artery, shows concavity upwards!

Question 3

What are the 2 pathologic types of pericarditis?

Answer 3

Serous
Fibrinous
Hemorrhagic
Purulent
constrictive

Question 4

Describe the appearance of serous pericarditis.

Answer 4

smooth surface, scant neutrophils, lymphocytes and macrophages, usually with effusion of 50-200 ml of thin fluid (protein <50% of serum level)

Question 5

Describe the appearance of fibrinous pericarditis.

Answer 5

dry, roughened, shaggy, “bread and butter” surface, more neutro-phils, lymphocytes and macrophages, serofibrinous if with effusion

Question 6

What are the causes of serous pericarditis?

Answer 6

heart failure, lymphatic obstruction by tumor, hypoalbuminemia

Question 7

What are the causes of fibrinous pericarditis?

Answer 7

viral myopericarditis, uremia, acute myocardial infarction, metastatic malignancy, autoimmune

Question 8

Describe the appearance of hemorrhagic pericarditis.

Answer 8

serous, fibrinous or purulent plus hemorrhage, +/- effusion or exudate with blood added

Question 9

Describe the appearance of purulent pericarditis.

Answer 9

red granular surface coated with pus, lots of subsurface neutrophils, up to 500 ml exudate in the pericardium

Question 10

Describe the appearance of constrictive pericarditis.

Answer 10

very rare

Question 11

What are the two forms of post-MI pericarditis?

Answer 11

1) Extension of visceral pericarditis to parietal over large transmural infarct (uncommon, <5% of MIs)
2) Dressler syndrome 2-12 weeks after infarction (autoimmune, rare)

Question 12

Who gets autoimmune pericarditis?

Answer 12

30% of lupus patients with polyserositis and simultaneous pleuritis and peritonitis

RA patients

Question 13

What drugs can induce pericarditis?

Answer 13

Procainamide

Hydralazine

Question 14

Hemorrhagic pericarditis is associated with what 3 conditions?

Answer 14

1) metastatic carcinoma
2) Leukemia (thrombocytopenia)
3) Tb

Question 15

What are 2 important tests for unexplained pericarditis?

Answer 15

Tb skin test

Chest X-ray

Question 16

What is “constrictive pericarditis”?

Answer 16

Encasement of the heart in a dense fibrous or fibrocalcific scar which prevents cardiac hypertrophy or dilatation

Question 17

What usually causes (rarely) constrictive pericarditis?

Answer 17

purulent or Tb pericarditis

Question 18

Constrictive pericarditis has a pathophysiology similar to what?

Answer 18

cardiac tamponade

Question 19

How do you treat constrictive pericarditis?

Answer 19

surgically strip off the thickened pericardium

Question 20

How much fluid is normally contained in the pericardial sac?

Answer 20

15-50 mL (used to lubricate the touching of the pericardium and the heart)

Question 21

How high must the pericardial fluid raise (suddenly) to cause a problem?

Answer 21

between 250-300 mL

Question 22

If the pericardial fluid increases slowly, how much fluid can be contained within the pericardial sac?

Answer 22

up to 1 L

Question 23

List the common causes of pericardial effusion.

Answer 23

Viral myopericarditis
Metastatic malignancy
Autoimmune disease
Drug-induced
Renal failure
Bleeding (Hemopericardium)

Question 24

What are the signs of cardiac tamponade?

Answer 24

JV distension, muffled heart sounds, hypotension, pulsus paradoxus

Question 25

How do you detect cardiac tamponade?

Answer 25

echocardiogram shows diastolic collapse of RA and RV

Question 26

How do you treat cardiac tamponade?

Answer 26

pericardiocentesis