Pericardial Disease Flashcards
Normal pericardial thickness
1-2 mm
Congenital absence pericardium usual location
Left hemi-pericardium
Congenital absence pericardium heart position
Shifts left
Congenital absence pericardium apical imaging
RV at center, not LV apex
Cardiac teardrop appearance
Small atrial
Congenital absence pericardium PLAX
RV appears large
Pericardial constriction causes
Heart surgery Radiation Idiopathic CTD - RA / SLE Infection - TB / histo Malignancy
Ddx of restrictive filling
Constriction
Other organic heart disease
Restrictive cardiomyopathy
Constriction pathophysiology
Dissociation of intrathoracic (PCWP) and intracardiac pressure (LV diastolic)
Exaggerated LV-RV interdependence
Constriction doppler assessment
Mitral inflow, PV, LVOT drops with inspiration, recovers with expiration
Hepatic vein expiratory diastolic reversal (retrograde flow in diastole due to septum moving back rightward with expiration)
Constriction tissue doppler
Restrictive filling
E’ normal to high (low in myocardial disease)
Annulus reverses - lateral < medial in 75% of cases
Constriction longitudinal strain
Reduced lateral strain
Relatively spared longitudinal strain (decrease in RCM)
Epicardial fat
Echolucency usually anterior over RV
Evident tissue planes
Pericardial cyst
Discrete, thin walled, echolucent, fluid filled
Usually right cardiophrenic angle
Potentially catastrophic violation of closed pericardial space
Coagulated blood in space MI Dissection catheter manipulation Cardiac surgery Endocarditis
Tamponade path
Intrapericardial pressure > intracardiac pressure
Tamponade chambers
Right chamber collapse specific but not sensitive
Tamponade inspiration
septum to left, mitral inflow decreases
Tamponade expiration
Septum to right, hepatic diastolic flow reversal
Hepatic vein doppler expiratory diastolic reversal
Constriction
Hepatic vein doppler inspiratory diastolic reversal
Myocardial disease
Hepatic vein doppler systolic flow reversal
Severe TR
Constriction + AF
May have systolic flow reversal, rapid rise
Annulus reversus
Mayo constriction criteria
Septal motion abnormality
MV flow restrictive
Medial e’ >= 8
Hepatic diastolic reversal with expiration
Most common primary cardiac neoplasm w/ pericardial effusion
Angiosarcoma
Most common location of pericardial cyst
Right cardiophrenic angle
E/e’ and PCWP in CP
inversely related
SVC velocity in CP
Loss of normal respiratory variation in velocity
Maneuver for CP if lack of respiratory variation
Tilting, sitting
Strain in radiation disease
Normal longitudinal, reduced circumferential
