Pericardial Disease

Question 1

Normal pericardial thickness

Answer 1

1-2 mm

Question 2

Congenital absence pericardium usual location

Answer 2

Left hemi-pericardium

Question 3

Congenital absence pericardium heart position

Answer 3

Shifts left

Question 4

Congenital absence pericardium apical imaging

Answer 4

RV at center, not LV apex
Cardiac teardrop appearance
Small atrial

Question 5

Congenital absence pericardium PLAX

Answer 5

RV appears large

Question 6

Pericardial constriction causes

Answer 6

Heart surgery
Radiation
Idiopathic
CTD - RA / SLE
Infection - TB / histo
Malignancy

Question 7

Ddx of restrictive filling

Answer 7

Constriction
Other organic heart disease
Restrictive cardiomyopathy

Question 8

Constriction pathophysiology

Answer 8

Dissociation of intrathoracic (PCWP) and intracardiac pressure (LV diastolic)
Exaggerated LV-RV interdependence

Question 9

Constriction doppler assessment

Answer 9

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)

Question 10

Constriction tissue doppler

Answer 10

Restrictive filling
E’ normal to high (low in myocardial disease)
Annulus reverses - lateral < medial in 75% of cases

Question 11

Constriction longitudinal strain

Answer 11

Reduced lateral strain

Relatively spared longitudinal strain (decrease in RCM)

Question 12

Epicardial fat

Answer 12

Echolucency usually anterior over RV

Evident tissue planes

Question 13

Pericardial cyst

Answer 13

Discrete, thin walled, echolucent, fluid filled

Usually right cardiophrenic angle

Question 14

Potentially catastrophic violation of closed pericardial space

Answer 14

Coagulated blood in space
MI
Dissection
catheter manipulation
Cardiac surgery
Endocarditis

Question 15

Tamponade path

Answer 15

Intrapericardial pressure > intracardiac pressure

Question 16

Tamponade chambers

Answer 16

Right chamber collapse specific but not sensitive

Question 17

Tamponade inspiration

Answer 17

septum to left, mitral inflow decreases

Question 18

Tamponade expiration

Answer 18

Septum to right, hepatic diastolic flow reversal

Question 19

Hepatic vein doppler expiratory diastolic reversal

Answer 19

Constriction

Question 20

Hepatic vein doppler inspiratory diastolic reversal

Answer 20

Myocardial disease

Question 21

Hepatic vein doppler systolic flow reversal

Answer 21

Severe TR

Question 22

Constriction + AF

Answer 22

May have systolic flow reversal, rapid rise

Annulus reversus

Question 23

Mayo constriction criteria

Answer 23

Septal motion abnormality
MV flow restrictive
Medial e’ >= 8
Hepatic diastolic reversal with expiration

Question 24

Most common primary cardiac neoplasm w/ pericardial effusion

Answer 24

Angiosarcoma

Question 25

Most common location of pericardial cyst

Answer 25

Right cardiophrenic angle

Question 26

E/e’ and PCWP in CP

Answer 26

inversely related

Question 27

SVC velocity in CP

Answer 27

Loss of normal respiratory variation in velocity

Question 28

Maneuver for CP if lack of respiratory variation

Answer 28

Tilting, sitting

Question 29

Strain in radiation disease

Answer 29

Normal longitudinal, reduced circumferential