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A. MLA Map Cardiovascular > Pericardial Disease > Flashcards

Pericardial Disease Flashcards

1
Q

The heart has an outer layer that covers it called the pericardium. The pericardium covers the heart and the roots of the great vessels (aorta etc.). It has 2 layers, which are called what?

1 - endocardium
2 - visceral (also called serous layer)
3 - parietal
4 - myocardium

A

2 - visceral (also called serous layer)
- contact with myocardium

3 - parietal
- contact with fibrous pericardium

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2
Q

The pericardial cavity is the space contained between the pericardium layers (visceral and parietal)?

1 - blood vessels that supply coronary blood vessels
2 - lymphatic fluid drained from the heart
3 - serous fluid
4 - air

A

3 - serous fluid

  • acts as a cushion for the heart
  • typically there is <50ml fluid
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3
Q

In addition to providing a cushion for the heart, what is another key function of the pericardium?

1 - supply blood to coronary blood vessels
2 - drain lymphatic fluid from the heart
3 - anchor heart to mediastinum
4 - all of the above

A

3 - anchor heart to mediastinum
- ensures heart is not twisted, which would obstruct the great vessels

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4
Q

What is the name of the layer that surrounds the parietal pericardium?

1 - mediastinum
2 - fibrous pericardium
3 - endocardium
4 - pericardium obstructor

A

2 - fibrous pericardium
- ensures heart cannot over stretch

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5
Q

Pericardial disease is due to an inflammation of the pericardium. This can be caused by all of the following, EXCEPT which one?

1 - virus
2 - bacteria
3 - fungi/parasite
4 - metabolic disturbances
5 - autoimmune
6 - MI
7 - drugs
8 - idiopathic

A

6 - MI

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6
Q

If the cause of pericarditis is due to a viral infection, which of the following is NOT a common cause?

1 - coxsackie vurys
2 - herpes virus
3 - adenoviruses
4 - aspergillus

A

4 - aspergillus
- this is a fungal cause

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7
Q

Procalcitonin is a biomarker present in the blood. If this is high, does it indicate inflammation/viral infection or a bacterial infection?

A
  • bacterial infection
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8
Q

Pericardial disease is due to an inflammation of the pericardium. Patients with acute pericarditis can present acutely. They can present with chest pain where?

1 - severe retrosternal chest pain
2 - neck
3 - shoulders and back
4 - painful on each breath
5 - all of the above

A

5 - all of the above
- painful on each breath as the pericardium is compressed as the lungs expand

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9
Q

Pericardial disease is due to an inflammation of the pericardium. Patients with acute pericarditis can present acutely. They can present with severe retrosternal chest pain that radiates to the neck, shoulders and back. It is worse with each breath as the expanding lungs compress the pericardium. Is the pain lessened when the patient is supine and lying or sitting and leaning forwards?

A
  • sitting and leaning forwards
  • reduces pressure on the pericardium
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10
Q

If a patient has pericarditis due to a viral infection, which of the following symptoms may they present with?

1 - fever and malaise
2 - myalgia
3 - arthralgia
4 - URTI symptoms
5 - pericardial rub
6 - all of the above

A

5 - all of the above

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11
Q

If a patient has pericarditis, which of the following could be present on an ECG?

1 - ST elevation
2 - PR depression
3 - tachycardia
4 - all of the above

A

4 - all of the above

  • 60% of patients have concave upward ST elevation in most, if not all leads, almost saddle shaped
  • PR depression is more specific
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12
Q

When trying to diagnose a patient with pericarditis, we can perform a full blood workup. Which 4 of the following are likely to be raised in myocarditis?

1 - troponin
2 - CRP
3 - Na+
4 - BNP
5 - ESR
6 - WBC
7 - D-dimer

A

1 - troponin
2 - CRP
5 - ESR
6 - WBC

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13
Q

When trying to diagnose a patient with pericarditis, we can perform a chest X-ray and/or echocardiogram. What may we see?

1 - pericardial effusion
2 - tracheal deviation
3 - cardiomegaly
4 - hyper-inflated lungs

A

1 - pericardial effusion
- looks like a water bottle

  • typically there is <50ml fluid
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14
Q

When treating a patient with pericarditis which of the following medications should be used in the 1st 1-2 weeks?

1 - NSAIDs
2 - anti-emetics
3 - aspirin
4 - all of the above

A

4 - all of the above
- relieves pain and hopefully the cause will settle on its own

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15
Q

When treating a patient with pericarditis, they are often given NSAIDs and/or aspirin with anti-emetics to protect the stomach for 1-2 weeks. If the pericarditis is not relieving, what should be added for a period of 3 months to reduce the risk of re-occurrence?

1 - vancomycin
2 - colchicine
3 - IL-1 antagonists
4 - steroids

A

2 - colchicine
- anti-inflammatory properties and inhibits neutrophil motility
- steroids, IL-1 antagonists and other medications may be used by a specialist only

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16
Q

Fluid can collect in the pericardial space surrounding the heart and can fill between 500-1L of fluid. Which of the following are causes of a pericardial effusion?

1 - pericarditis
2 - myocardial rupture
3 - aortic dissection
4 - malignancy
5 - pericardium filling with pus
6 - all of the above

A

6 - all of the above

17
Q

In a patient with a pericardial effusion, they can be asymptomatic, but they can also present with all of the following EXCEPT which one?

1 - dyspnoea
2 - fatigue
3 - nausea (diaphragm)
4 - dysphagia (oesophagus)
5 - hoarse voice (recurrent laryngeal nerve)
6 - heart murmur
7 - hiccoughs (phrenic nerve)

A

6 - heart murmur
- not a common symptom

18
Q

When trying to diagnose a patient with a pericardial effusion, we can perform a chest X-ray and/or echocardiogram. What may we see?

1 - globular cardiomegaly
2 - tracheal deviation
3 - cardiomegaly
4 - hyper-inflated lungs

A

1 - globular cardiomegaly
- heart is not getting bigger here

19
Q

If a patient has pericarditis, which 2 of the following could be present on an ECG?

1 - ST elevation
2 - PR depression
3 - sinus tachycardia
4 - small complexes (QRS height may fluctuate)

A

3 - sinus tachycardia
4 - small complexes

  • ECG leads are further away so lower voltage
20
Q

If the patient is haemodynamically stable, would a drainage of the pericardium be performed?

A
  • typically no
  • pericardiocentesis may be performed to diagnose though
21
Q

When would a drainage of the pericardial effusion be performed?

1 - if recurrent effusions occur
2 - if effusion if virally infected
3 - if cardiogenic shock occurs
4 - all of the above

A

3 - if cardiogenic shock occurs

22
Q

What is the main distinction between a pericardial effusion and cardiac tamponade?

1 - lower fluid levels restricting heart
2 - increased fluid restricting hearts ability to contract
3 - poor perfusion of coronary blood vessels
4 - increased CO2 build up

A

2 - increased fluid restricting hearts ability to contract
- tamponade is french for to plug up and smash
- lots of fluid means heart cannot contract properly

23
Q

If the fluid in the pericardial space continues to build up, can the fibrous layer expand to help with heart contractions?

A
  • no
  • relatively fixed so fluid is trapped, limiting how the heart can expand in size
24
Q

In cardiac tamponade what can happen to the heart chambers?

1 - RA and RV dilate
2 - LV and LA hypertrophy
3 - RA and RV diastolic collapse
4 - all of the above

A

3 - RA and RV diastolic collapse
- reduces ventricle filling

25
Q

In cardiac tamponade, we have something called Becks triad. Which of the following is NOT part of this triad?

1 - hypotension
2 - raised JVP
3 - collapsing pulse
4 - muffled heart sounds

A

3 - collapsing pulse

  • hypotension = reduced cardiac output
  • raised JVP = blood backing up
  • muffled heart sounds = fluid makes it harder to hear the heart sounds
26
Q

In addition to Becks triad, which other clinical signs from those here might we see?

1 - tachycardia
2 - kussmauls sign (increased JVP on inspiration)
3 - increased pulse
4 - all of the above

A

4 - all of the above

27
Q

When trying to diagnose a patient with a cardiac tamponade, we can perform an echocardiogram. What may we see?

1 - echo free zone around the heart
2 - increased resonance around the heart
3 - thickened myocardium
4 - ventricular regurgitation

A

1 - echo free zone around the heart

28
Q

If a patient has cardiac tamponade, is a drainage important?

A
  • yes
  • can cause cardiogenic shock and death
29
Q

All of the following are locations used when performing a pericardial drainage in a patient with cardiac tamponade, EXCEPT which one?

1 - right of the xiphoid process
2 - under the costal margin
3 - aim for the right mid clavicle
4 - aim of the left mid clavicle

A

3 - aim for the right mid clavicle

30
Q

Constrictive pericarditis is a stiff pericardium that limits the ability of the heart to contract. Is this an acute or chronic process?

A
  • chronic
  • pericardium becomes thick and scarred
31
Q

Which of the following is NOT a typical cause of constructive pericarditis?

1 - idiopathic
2 - TB
3 - viral infection
4 - recurrent pericarditis
5 - post cardiac surgery complication

A

3 - viral infection

32
Q

Constructive pericarditis is often referred to as heart in a box. What is the main aspect of the heart that is affected?

1 - systolic function
2 - diastolic function
3 - electrical conduction
4 - all of the above

A

2 - diastolic function
- heart cannot stretch and fill enough
- can be heard as a pericardial knock during diastole

33
Q

All of the following are signs of congestive pericarditis, EXCEPT which one?

1 - raised JVP
2 - kussmauls sign (raised JVP on inspiration)
3 - barrel chested
4 - quiet heart sounds
5 - hepatomegaly and ascites
6 - oedema

A

3 - barrel chested
- common in COPD

34
Q

In congestive pericarditis is the pressures within the chambers of heart affected?

A
  • yes chambers all have an equal pressure
35
Q

Which imaging modality can be used to differentiate between a pericardial effusion and pericardial thickening?

1 - MRI
2 - ultrasound
3 - echocardiogram
4 - chest X-ray

A

1 - MRI

36
Q

Constrictive pericarditis is a permanent condition, which typically progresses. Which 2 medications are typically given to manage the patient medically?

1 - furosemide
2 - bisoprolol
3 - ramipril
4 - atenolol

A

1 - furosemide
- reduces oedema

2 - bisoprolol
- reduce tachycardia
- increase diastolic duration and filling

37
Q

In patients with severe constrictive pericarditis, they can have surgery called pericardiectomy (pericardial stripping) where the pericardium is remove to allow the heart to function properly. What is the mortality of this surgery?

1 - 1.2%
2 - 12%
3 - 24%
4 - 50%

A

2 - 12%
- higher mortality in patients who are symptomatic as well

A. MLA Map Cardiovascular (20 decks)

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