Pericarditis can be due to? 4

1. idiopathic/viral 2. bacterial 3. inflammatory 4. trauma

Constrictive Pericarditis from what? 4

TB radiation viruses, histoplasmosis surgery

Constrictive Pericarditis dx 4 imaging

1. EKG 2. Echo 3. Cardiac CT/MRI 4. Cath

Constrictive Pericarditis tx

1. aggressive diuretics 2. anti-inflammatories 3. may require pericardiectomy

Restrictive Pericarditis tx

treat underlying condition transplant

Pericardial Disease Flashcards by Mikaela Koller

function of the pericardium

stabilize heart within thoracic cavity
protect from trauma and infection
decrease friction
prevent excessive dilation

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Pericarditis

what is it

acute inflammation of the pericardium

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Pericarditis

can be due to?

idiopathic/viral
bacterial
inflammatory
trauma

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Pericarditis

EKG findings

diffuse ST elevation that rarely exceeds 5 mm
no reciprocal ST segment lead changes
PR depression common

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Pericarditis

CXR findings

usually normal, may have effusion

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Pericarditis

why should you get an echo?

to rule out effusion

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Pericarditis

lab work p

4 required, 4 supplemental

Absolutely Order
1. CBC
2. ESR
3. CRP
4. Troponin

Consider Ordering
1. blood cultures
2. ANA
3. TB test
4. Lyme test

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Pericarditis

tx w/ dosing

ASA 750-1000mg or Ibuprofen 600mg Q8 hrs, 1-2 wks
above with Cochicine 0.5mg PO BID, 3 mo

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Pericarditis

follow up

close monitoring of sx
ECG
repeat CRP

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Pericarditis

what to do with:
* non-competitive athletes
* competitive athletes
* myopericarditis in athletes

restrict until resolution of sx and ECG/biomarkers WNL
clear an evaluation and be out at least 3 mo
if myo, sit out 6 mo

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Pericarditis

which viral causes are most common?

echovirus
coxsackie

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Pericarditis

who may be eligible for inpatient tx?

tamponade
mod to large pericardial effusion
immunosuppressed
anti-coagulated
acute trauma
failure to respond to tx

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Constrictive Pericarditis

occurs how?

thickened, fibrotic, adherent pericardium reduces elastic properties of myocardium and/or intracellular matrix

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Constrictive Pericarditis

from what?

TB
radiation
viruses, histoplasmosis
surgery

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Constrictive Pericarditis

effects

restricts diastolic filling
produces elevated venous pressures

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Constrictive Pericarditis

signs/sx

progressive dyspnea, fatigue, weakness
chronic edema, hepatic congestion, ascites
may have afib
elevated JVP, kussmaul’s sign

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Constrictive Pericarditis

what is kussmaul’s sign?

paradoxical rise in right atrial pressure during inspiration

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Constrictive Pericarditis

4 imaging

EKG
Echo
Cardiac CT/MRI
Cath

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Constrictive Pericarditis

EKG findings

no changes

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Constrictive Pericarditis

echo findings

thickened pericardium
septal bounce

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Constrictive Pericarditis

cardiac ct/mri findings

thickened pericardium
may have pericardial effusion

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Constrictive Pericarditis

aggressive diuretics
anti-inflammatories
may require pericardiectomy

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Restrictive Pericarditis

typically due to?

infiltrative (amyloidosis)

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Restrictive Pericarditis

treat underlying condition
transplant

# Pericardial Effusion what is it?

extra fluid in pericardial space which creates pressure on the heart chambers when they beat

# Pericardial Effusion causes | 10

1. inflammation 2. autoimmune 3. metastatic 4. cancer 5. radiation/chemo 6. uremia 7. hypothyroid 8. trauma 9. infection 10. meds

# Pericardial Effusion presentation

1. can be asx 2. constant dull ache, tachycardiac, hypotension, JVD, pulsus paradoxus, dysphagia, dyspnea, hoarseness, hiccups 3. diminished heart sounds (muffled) 4. Ewart's sign

# Pericardial Effusion what is ewart's sign

dullness to percussion over L lung over angle of scapula

# Pericardial Effusion what must you rule out?

tamponade

# Pericardial Effusion work up components

1. EKG 2. CXR 3. Echo 4. CBC, CMP, TSH, ANA, pericardial fluid analysis, pericardial bx

# Pericardial Effusion EKG findings

1. low QRS voltage 2. sinus tachy 3. electrical alternans

# Pericardial Effusion what are electrical alternans

changing amplitude of the QRS which is caused by the heart swinging in the pericardium

# Pericardial Effusion CXR findings

enlarged cardiac silhouette with clear lungs

# Pericardial Effusion echo findings

need to quantify effusion and assess hemodynamic impact

# Pericardial Effusion tx

* monitor for stability * NSAIDs, corticosteroids, colchicine * Pericardiocentesis if tamponade * pericardiectomy for recurrent

# Pericardial Effusion what sx to watch for with colchicine

gi upset

# Pericardial Effusion avoid which meds?

vasodilators and diuretics

# Cardiac Tamponade this is a???

MEDICAL EMERGENCY

# Cardiac Tamponade how does this occur?

impaired filling pressure impairs cardiac output

# Cardiac Tamponade presentation | 7

1. tachycardia 2. tachypnea 3. HYPOTENSION 4. narrow pulse pressure 5. pulsus paradoxus 6. ELEVATED JVP 7. MUFFLED/DISTANT HEART SOUNDS

# Cardiac Tamponade what is pulsus paradoxus?

decline of > 10 mmHg in systolic pressure during inspiration

# Cardiac Tamponade dx

1. EKG 2. Echo

# Cardiac Tamponade EKG findings

low voltage, sinus tachy

# Cardiac Tamponade echo findings

RV collapse during diastole, dilated IVC

# Cardiac Tamponade tx

1. urgent pericardial window 2. urgent pericardiocentesis

# Myocarditis what is it

* inflammation of myocardium * can be acute or chronic * inflammation can be focal or diffuse

# Myocarditis presentation | 5 components

* variable, depends on stage * unexplained heart failure * decreased exercise tolerance * chest discomfort * arrhythmias

# Myocarditis dx

* suspect in pts +/- cardiac sx * rise in troponin * EKG changes consistent with ischemia * arrhythmia * unexplained changes to ventricular function

# Myocarditis work up

1. history/PE 2. Labs: ESR, CRP, serial troponin, pro-BNP 3. EKG, CXR, echo

# Myocarditis what can you consider for dx?

1. cath: r/o ischemia 2. cardiac MRI: additional supportive evidence 3. endomyocardial bx: if it will help guide tx

# Myocarditis tx

1. supportive care 2. activity restriction 3. ACE/ARB/ARNI/BB 4. Cardiac rehab

# Myocarditis what should you absolutely avoid?

NSAIDs

# Giant Cell Arteritis AKA

1. Temporal Arteritis 2. Horton Disease

# Giant Cell Arteritis what is it?

vasculitis of extracranial branches of carotid artery

# Giant Cell Arteritis associated with?

polymyalgia rheumatica

# Giant Cell Arteritis presentation | 5

1. headache 2. jaw claudication 3. visual changes 4. acute vision loss 5. fever/malaise/night sweats

# Giant Cell Arteritis PE findings | 3

1. scalp tenderness 2. thickened temporal artery 3. tongue necrosis (blackened!)

# Giant Cell Arteritis work up

* clinical dx * increased ESR, CRP * temporal bx * temporal artery ultrasound

# Giant Cell Arteritis treatment

* high dose corticosteroid ASAP * ASA low dose * complication is blindness