Pericardial Disease Flashcards
Name the layers of the heart from outer to inner
Fibrous pericardium, serous (parietal then visceral) pericardium, myocardium, endocardium
What is a normal amount of serous fluid?
20-50mL
Name 2 functions of the pericardium
Limits over distension, helps distribute diastolic pressure, reduces friction, infection barrier
Increased amount of fluid within pericardial space
Pericardial effusion
Fast increase in fluid accumulation
Tamponade
Inflammation of the pericardial surfaces
Pericarditis
What are the main signs of pericardial effusion?
Friction rub and muffled heart sounds
ECG findings in pericardial effusion
- Low voltage ECG
- electrical alternans
Higher intrapericardial pressures than diastolic intracardiac causes what?
Diastolic collapse of RT heart
Fluid seen posterior to the descending AO
Pleural effusion
When should the effusion be measured?
End diastole at pap level
Tamponade impairs the cardiac chamber filling, what does this affect?
SV and CO
Beck’s Triad
- Low arterial BP
- Distended neck veins (increased JVP)
- Distant, muffled heart sounds
Tamponade ECG findings
- tachycardia
- electrical alternans
How does tamponade change the RT heart?
RV diastolic collapse, RA systolic and diastolic collapse, septal shifting, SVC/IVC become dilated
RV volume on inspiration (tamponade)
Increased
LV volume on inspiration (tamponade)
Decreased
RV volume on expiration (tamponade)
Decreased
How does inspiration affect septal shifting?
Inspiration: RT to LT
Expiration: normalization
How does breathing affect MV (>25%) and TV (>50%) E velocities?
MV: insp: decreased, exp: increased
TV: insp: increased, exp: decreased
Pericardium is not compliant, reducing diastolic function (grade 3, restricted)
Constrictive pericarditis
Post MI pericarditis
Dressler’s syndrome
Signs/symptoms of pericarditis
Pericardial friction rub murmur, chest pain, Kussmaul’s sign (JVP increase on inspiration)
ECG presentation with pericarditis
Diffuse ST segment elevation
Thickened, echogenic pericardium
Constrictive pericarditis
Constrictive pericarditis m-mode finding
Railroad track appearance
Similarities between RCM and CP (3)
Increased MV E/A ratio, decreased MV accel time, normal LV size and function
Differentiate RCM and CP
RCM: decreased TDI overall
CP: velocities change with breathing, dilated atria, increased medial e’ while lateral e’ is decreased
Why is only the lateral e’ TDI decreased with CP?
Because the pericardium is stiff and constrictive from outside the heart, thus only affecting the lateral side
Differentiate E/A waveforms with tamponade and CP
Tamponade: E/A is quite similar
CP: E wave is significantly higher than A
What happens during inspiration with CP?
Decreased LV filling, increased RV filling, IVS shifts left
What happens during expiration with CP?
Increased LV filling, decreased RV filling, IVS shifts right
