Pericardial Disease

Question 1

What is the pericardium?

Answer 1

A double-layered sac surrounding the heart that provides protection and reduces friction.

Question 2

What are the main functions of the pericardium?

Answer 2

Protects the heart, limits acute distension, reduces friction, and acts as a barrier to infection.

Question 3

What are the common causes of pericardial diseases?

Answer 3

Infections, autoimmune disorders, malignancy, trauma, metabolic disorders, and drug-induced causes.

Question 4

What are the main types of pericardial diseases?

Answer 4

Acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis.

Question 5

What are the common symptoms of acute pericarditis?

Answer 5

Sharp, pleuritic chest pain relieved by sitting forward, pericardial friction rub, and fever.

Question 6

What is the classic ECG finding in acute pericarditis?

Answer 6

Diffuse concave ST-segment elevation and PR-segment depression.

Question 7

What are the four ECG stages of acute pericarditis?

Answer 7

Stage I: ST elevation and PR depression; Stage II: Normalization; Stage III: T-wave inversion; Stage IV: ECG returns to normal.

Question 8

What is the primary investigation for diagnosing pericardial effusion?

Answer 8

Echocardiography.

Question 9

What are the signs of cardiac tamponade?

Answer 9

Hypotension, muffled heart sounds, jugular venous distension (Beck’s triad), and pulsus paradoxus.

Question 10

What is electrical alternans, and what condition is it associated with?

Answer 10

Alternating QRS complex amplitude seen in massive pericardial effusion and tamponade.

Question 11

What is pulsus paradoxus?

Answer 11

A drop in systolic blood pressure >10 mmHg during inspiration, seen in cardiac tamponade.

Question 12

What imaging modality confirms pericardial effusion?

Answer 12

Echocardiography.

Question 13

What is the hallmark echocardiographic finding in cardiac tamponade?

Answer 13

Right atrial and right ventricular diastolic collapse.

Question 14

What are common causes of pericardial effusion?

Answer 14

Infections, malignancy, autoimmune diseases, renal failure, and post-cardiac surgery.

Question 15

What is the treatment for large symptomatic pericardial effusion?

Answer 15

Pericardiocentesis.

Question 16

What is constrictive pericarditis?

Answer 16

A condition where the pericardium becomes thickened and non-compliant, restricting heart filling.

Question 17

What is the Kussmaul sign, and what condition is it associated with?

Answer 17

A paradoxical rise in jugular venous pressure during inspiration, seen in constrictive pericarditis.

Question 18

What is the most common cause of constrictive pericarditis?

Answer 18

Tuberculosis in endemic regions; idiopathic or post-surgical causes elsewhere.

Question 19

What is the definitive treatment for constrictive pericarditis?

Answer 19

Pericardiectomy.

Question 20

What is the characteristic auscultatory finding in constrictive pericarditis?

Answer 20

Pericardial knock—an early diastolic sound.

Question 21

How does pericardial effusion affect heart sounds?

Answer 21

Muffled heart sounds due to fluid accumulation.

Question 22

What is the gold standard for diagnosing pericardial constriction?

Answer 22

Cardiac MRI or CT scan.

Question 23

What ECG changes are seen in large pericardial effusion?

Answer 23

Low voltage QRS complexes and electrical alternans.

Question 24

What is Dressler’s syndrome?

Answer 24

Post-myocardial infarction pericarditis, occurring weeks after MI.

Question 25

What is the role of colchicine in pericarditis?

Answer 25

It reduces recurrence rates of pericarditis.

Question 26

Which drug is contraindicated in acute pericarditis due to MI?

Answer 26

Corticosteroids (they increase risk of myocardial rupture).

Question 27

What is Beck’s triad in cardiac tamponade?

Answer 27

Hypotension, muffled heart sounds, and jugular venous distension.

Question 28

What condition presents with ST-segment elevation in all leads?

Answer 28

Acute pericarditis.

Question 29

What condition mimics pericarditis but has reciprocal ST depressions?

Answer 29

ST-elevation myocardial infarction (STEMI).

Question 30

What are the indications for pericardiocentesis?

Answer 30

Cardiac tamponade, large symptomatic pericardial effusion, or suspicion of bacterial pericarditis.

Question 31

What is paradoxical pulse?

Answer 31

Exaggerated drop in systolic BP during inspiration (>10 mmHg).

Question 32

What is the role of NSAIDs in pericarditis treatment?

Answer 32

First-line treatment to reduce inflammation and pain.

Question 33

What infection is commonly associated with viral pericarditis?

Answer 33

Coxsackievirus B.

Question 34

What is the mainstay of treatment for tuberculous pericarditis?

Answer 34

Anti-TB therapy with corticosteroids if constrictive features develop.

Question 35

What is the most common malignancy causing pericardial effusion?

Answer 35

Lung cancer.

Question 36

What is the significance of pericardial calcification on chest X-ray?

Answer 36

Suggests constrictive pericarditis.

Question 37

What condition is associated with ‘water bottle’ heart on X-ray?

Answer 37

Large pericardial effusion.

Question 38

What is the primary cause of uremic pericarditis?

Answer 38

Advanced renal failure leading to pericardial inflammation.

Question 39

What is tamponade physiology?

Answer 39

Impaired ventricular filling due to increased pericardial pressure.

Question 40

What differentiates restrictive cardiomyopathy from constrictive pericarditis?

Answer 40

Constriction is pericardial thickening; restriction is myocardial fibrosis.

Question 41

What is the most common cause of chronic pericardial effusion?

Answer 41

Idiopathic or viral causes.

Question 42

How is purulent pericarditis managed?

Answer 42

Urgent pericardial drainage and IV antibiotics.

Question 43

What ECG finding suggests resolution of acute pericarditis?

Answer 43

Normalization of ST segments and T waves.

Question 44

How does pericardial tamponade affect preload?

Answer 44

It decreases preload due to impaired diastolic filling.

Question 45

What does an exaggerated Y descent in JVP indicate?

Answer 45

Constrictive pericarditis.

Question 46

What medications should be avoided in pericarditis with myocardial infarction?

Answer 46

Corticosteroids and NSAIDs (except aspirin).

Question 47

What is the most specific echocardiographic finding of cardiac tamponade?

Answer 47

Diastolic right atrial and right ventricular collapse.

Question 48

What is the mechanism of colchicine in pericarditis?

Answer 48

Inhibits microtubule assembly, reducing inflammation.

Question 49

What is the role of pericardiectomy?

Answer 49

Definitive treatment for constrictive pericarditis.

Question 50

What type of effusion is seen in malignancy-related pericardial effusion?

Answer 50

Exudative effusion.

Question 51

How does tuberculosis affect the pericardium?

Answer 51

Causes chronic pericarditis with fibrosis and constriction.

Question 52

What is the role of diuretics in pericardial diseases?

Answer 52

Used for symptom relief in constrictive pericarditis but not in tamponade.

Question 53

What condition can cause chronic pericardial effusion without symptoms?

Answer 53

Hypothyroidism.