Pericardial Disease

Question 1

Myocarditis and patho

Answer 1

Inflammation of the myocardium
- mild to lethal
- inflammation with degeneration and cardiac necrosis
- conduction disruption

Question 2

Most common cause of myocarditis

Answer 2

Viruses—often foxsacke virus

Question 3

Pericarditis

Answer 3

Pericardium surrounding the heart and roots of the vessels are inflamed
- fluid accumulates—pericardial effusion

Question 4

Cardiac tamponade

Answer 4

MEDICAL EMERGENCY
- with over 200 mL fluid
- fluid compresses the heart and it can’t pump
- heart chambers are restricted
- a little fluid is ok

Question 5

S/s acute pericarditis

Answer 5

Sharp chest pain—worsens with deep breaths
- fever
- dyspnea
- pericardial friction rub—scratching heard thru stethoscope
- EKG chx—ST elevation or depression

Question 6

Signs of cardiac tamponade

Answer 6

BECK TRIAD
- hypotension
- JVD
- muffled heart sounds

Question 7

Pulsus paradoxus

Answer 7

• SBP decreases over at least 10 mmHg with inspiration
• may be seen with an arterial line

Question 8

Tx for pericarditis

Answer 8

• NSAIDs, ASA, steroids (not first line)
• colchicine—2nd to NSAIDs
• quick drain with pericardiocentesis

Question 9

Aneurysms

Answer 9

• localized dilation or outpouching of vessel wall
• true aneurysm includes all 3 layers of the arterial wall
• often with uncontrolled BP—vessel dilates—turbulent blood flow—vessel bursts
• aorta and cerebral arteries most common
• can hear bruit over it

Question 10

Risk dx for aneurysms

Answer 10

HTN, athero, trauma, tobacco, 65+, diseases of BVs

Question 11

Aortic dissecting aneurysm

Answer 11

• can be dissecting, thoracic, abdominal aortic (triple A)
• sudden severe tearing pain in back, jaw, neck, abs, head
• hemiplagia, syncope, lower paralysis
• layers of the vessel wall separate and blood enters the region
• early BP change and later no BP

Question 12

Types of aneurysms

Answer 12

Aortic, cerebral, false (pseudo), saccular

Question 13

Aortic dissection tx

Answer 13

• Emergency surgery
• CT or MRI dx
• beta blocker and nitrates may heal on own

Question 14

False (pseudo) aorta

Answer 14

Local tear in inner arterial wall (hematoma)
- often a complication of vascular procedures

Question 15

Saccular aneurysm

Answer 15

• balloon shaped, wide neck, involves only 1 part of the circumference

Question 16

Berry aneurysm, location, dx and tx

Answer 16

• aneurysm at the bifurcation, small neck
• often at the circle of Willis at the base of the brain—supply blood to the brain
• dx with angiography—dye injected
• tx - medical control of HTN and vasospasm, surgically drain, clip, coil
• can be fatal

Question 17

Fusiform aneurysm

Answer 17

• progression dilation
• whole circumference of vessel
• potentially extensive involvement
• often r/t sclerotic involvement
• may sit and watch

Question 18

Triple A

Answer 18

• abdominal aortic aneurysm
• auscultate bruit over ab aorta
• don’t do deep palpation but may feel mass

Question 19

Big risk of aneurysm

Answer 19

Can bleed out quick