Pericardial Disease Flashcards
What are the 4 Class 1 indications for TEE for pericardial disease?
- Suspected pericardial disease
- Suspected bleeding in the pericardial space
- Follow up study to evaluate for effusion or to diagnose constriction
- Pericardial friction rub develpping in acute MI accompanied by pain, hypotension and nausea
What are the two pericardial layers?
- Pariental pericardium (outer)
- Visceral Pericardium (inner)
What is the function of the parietal pericardium?
1. Restraint role and prevents heart from dilating
2. AV valve stabilization with improved valve functions
3. Secretory functions
- Prostacyclin
- Sympathetic neuronal regulation
- Coronary Vascular Tone & Cardiac Contractility
4. Fibrinolytic Function (If clot develops)
What is the cutoff for pericardial thickness?
>4 mm = thickened
What does the parietal pericardium blend with inferiorly?
Diaphragm
What does the parietal pericardium apposed to laterally?
Pleural Spaces
What is the term where the pericardial layers meet?
Reflections
Reflections that surround the vena cava and pulmonary veins create a pocket behind the LA are called what?
Oblique Sinus
What is the pericardial reflection around the great vessels called?
What great vessels are these?
Transverse Sinus
Pulmonary Artery and Aorta
What is the normal amount of fluid in the pericardium?
25 - 50 mL
(5-30 mL in some sources)
What is at the arrow?
Oblique Sinus
Where on your omniplane will you see the oblique sinus?
~70 degrees near the LAA
What is seen at the pointer?
Transverse sinus in the Ascending Aorta Short Axis
What is seen at the blue arrow and also at the vessel at the top and middle of the image?
RPA = Top
Transverse Sinus = At blue arrow
Large vessel = Aorta
View = Mid Esophageal Ascending Aorta in long axis
What is Mulibrey Nanism?
Congential disease - Overgrowth of the fibrous sac surrounding the heart (constrictive pericarditis).
Finnish population (Autosomal recessive)
Causing CHF
For negative pressure spontaneous ventilation:
What is the Intrathoracic pressure End of expiration?
-3 = End Expiration
For negative pressure spontaneous ventilation:
What is the Intrathoracic pressure End of inspiration?
-6 at end of inspiration
How much do transtricuspid inflow velocities change during spontaneous negative ventilation?
~20%
How much do transmitral inflow velocities change during spontaneous negative ventilation?
~10%
How does the transtricuspid PWD inflow velocities change during spontaneous expiration compared to spontaneous inspiration?
~20% increase in inflow velocities (see images)
How do you calculate the gradient for RV filling?
Intracardiac pressure - pericardial pressure
Ex: if right atrial pressure is 6 and PP is -6 then the gradient is 12
(RV filling is enhanced by spontaneous inspiration)
How does the RV vs. LV fill during spontaneous inspiration?
RV fills due to increased gradient
Decreased LV filling (pulmonary venous pooling)
How does the septum shift during inspiration?
Shifts towards LV due to RV filling* and *decreased LV filling
How does the RV vs. LV fill during spontaneous expiration?
Decreased gradient for RV filling (Decreased venous return)
Increased LV filling due to compressed lungs
How does spontaneous inspiration affect:
Intrathoracic pressure
Becomes more negative
How does spontaneous inspiration affect:
Pulmonary Veins
Dilates pulmonary veins
How does spontaneous inspiration affect:
venous return
Increases venous return
How does spontaneous inspiration affect:
RV filling and RV stroke volume
Increased RV filling and RV stroke volume
How does spontaneous inspiration affect:
RV afterload
Decreased RV afterload
How does spontaneous inspiration affect:
LA filling
Decreased LA filling
How does spontaneous inspiration affect:
LV stroke volume
Decreased LV stroke volume
How does spontaneous inspiration affect:
LV afterload
Increased LV afterload
How does spontaneous expiration affect:
Intrathoracic pressure?
More positive intrathoracic pressure
How does spontaneous expiration affect:
Pulmonary Vein Tone
Compressed pulmonary veins
How does spontaneous expiration affect:
Venous Return
Decreased Venous Return
How does spontaneous expiration affect:
RV FIlling and RV stroke Volume
Decreased RV FIlling and RV stroke Volume
How does spontaneous expiration affect:
RV afterload
Increased RV afterload
How does spontaneous expiration affect:
LA Filling
Increased LA filling
How does spontaneous expiration affect:
LV Stroke Volume
Increased LV Stroke Volume
How does spontaneous expiration affect:
LV Afterload
Decreased LV afterload
During spontaneous ventilation, how does Trans Mitral inflow velocities change during expiration?
Increase 10%
During spontaneous ventilation, how does Trans Tricuspid inflow velocities change during expiration?
Decrease 20%