Pericardial Disease

Question 1

What are symptoms of acute pericarditis?

Answer 1

Sudden or gradual onset of sharp or stabbing pain in the chest with radiation to back, neck, L shoulder or arm. Pain more severe with lying supine. Low grade fever and dyspnea. intermittent friction rub

Question 2

What is the most common cause of pericarditis?

Answer 2

viral (coxsackie)

Question 3

When is the diagnosis of acute pericarditis made?

Answer 3

audible pericardial friction rub or CP with typical EKG findings (most notably ST- segment elevation in all leads = GLOBAL ST elevation) and PR depression

Question 4

What is the treatment for acute pericarditis?

Answer 4

bed rest. NSAID for relieving symptoms of chest pain. Colchicine may be a useful adjunct in those who do not respond to NSAIDs. Sometimes, steroids are useful

Question 5

What is the prognosis of acute pericarditis?

Answer 5

usually benign. But can lead to an effusion and tamponade which can lead to death. Pericarditis can also progress to pericardial constriction from scarring and heart failure

Question 6

What are the symptoms of constrictive pericarditis?

Answer 6

sx of heart failure, chest pain, abdominal sx, atrial arrhythmia, cardiac tamponade

Question 7

What are physical findings of constrictive pericarditis?

Answer 7

Elevated JVP, peripheral edema, Ascites, pulsatile hepatomegaly, pleural effusion, S3, Cachexia in later stages

Question 8

What diagnostic tests should be done for constrictive pericarditis?

Answer 8

CT, Cardiac MRI, Cath – GOLD STANDARD

Question 9

What is Kussmauls sign?

Answer 9

Constrictive pericarditis – Increased venous return cannot be accommodated in RV because of high EDP. So JVP rises on inspiration

Question 10

What is treatment for constrictive pericarditis?

Answer 10

complete surgical resection of the pericardium (pericardectomy). Mortality for procedure ranges from 5-16% (that’s high, guys!)

Question 11

What is pericardial effusion?

Answer 11

Accumulation of fluid within the pericardial space

Speed of accumulation determines physiologic significance

Question 12

What is cardiac tamponade?

Answer 12

Characterized by elevated intrapericardial pressure >15mmHg. Increased pressure restricts venous return and filling. SV and pulse pressure decrease. HR and venous pressure rise

Question 13

What are symptoms of cardiac tamponade?

Answer 13

Dyspnea, orthopnea, Chest Pain, Feeling of “Fullness”, Nausea/Abdominal pain, Cold and clammy

Question 14

What are physical exam findings of cardiac tamponade?

Answer 14

tachycardic, hypotensive and tachypnea. Diminished heart sounds. Pulses Paradoxus. Decreased urine output. Possible friction rub

Question 15

What is Beck’s triad of cardiac tamponade?

Answer 15

Decreased arterial BP, Increased JVP, Quiet heart sounds

Question 16

What is pulsus paradoxus?

Answer 16

an exaggeration of the normal inspiratory decrease in BP. “Abnormal” pulsus paradoxus = >10mmHg difference. Increase in right heart volume increases intrapericardial pressure further

Question 17

What is pericardiocentesis?

Answer 17

definitive therapy to remove the excessive fluid. May be performed in the cath lab but COMMONLY done ‘blind’ in an intensive care or emergency department environment