Pericardial disease

Question 1

First line treatment of acute pericarditis

Answer 1

Cochicine 0.6 mg daily (<70 kg) or BID (= 70 kg) for 3 months + NSAID (typically high-dose aspirin three times a day or ibuprofen).

If NSAID CI, then steroids.

Question 2

effusive-constrictive pericarditis

Answer 2

Failure of the right atrial pressure to fall by 50% or to a level <10 mm Hg after pericardiocentesis

Question 3

incidental pericardial effusion

Answer 3

CRP-> treat for acute pericarditis if elevated

Question 4

labwork for confirmed pericarditis

Answer 4

get troponin to rule out myopericarditis

Question 5

most common etiology of pericarditis in developing countries.
clinical recurrent pericarditis.

Answer 5

TB.
just treat with colchicine+NSAID without further testing.

Question 6

refractory pericarditis treatment

Answer 6

azathioprine, intravenous immunoglobulin

Question 7

most important in predicting hemodynamic consequences of a pericardial effusion

Answer 7

rate of accumulation

Question 8

elevated right heart filling pressures with Kussmaul’s sign (jugular venous distension without inspiratory decline)

Answer 8

constrictive pericarditis. If there’s LGE on MRI, need to use anti-inflammatories too.

Question 9

young woman with facial flushing, myalgia+ pericarditis

Answer 9

get ANA

Question 10

constrictive pericarditis echo

Answer 10

> 30% inspiratory drop in the mitral inflow velocities , interventricular septal “bounce”, expiratory diastolic flow reversal in hepatic veins

Question 11

pericarditis workup

Answer 11

blood work, CXR, EKG, Echo

Question 12

recurrent malignant pericardial effusion

Answer 12

window not pericardiocentesis

Question 13

Most sensitive diagnostic factor for tamponade

Answer 13

IVC dilation. If absent-> not tamponade

Question 14

hypotension, jugular venous distention, and decreased heart sounds

Answer 14

Beck’s triad, tamponade, TTE is first line test