Pericardial Disease Flashcards
Pericarditis Basic Principles
- typical chest pain
- widespread ST elevation or PR depression on ECG (ST elevation also due to acute myocardial infarction)
- Pericardial rub on auscultation
- new or increasing pericardial effusion
pericarditis can be due to…
- bacterial or viral infection
- trauma
- uremia
- transmural myocardial infarction
Tamponade physiology occurs when…
the pressure in the pericardium exceeds the pressure in the cardiac chambers, resulting in impaired cardiac filling
loculated effusion
the effusion is localized by adhesions to a small area of the pericardial space or consists of several separate areas of pericardial effusion, separated by adhesions
Pericardial Tamponade basic principles
- RA systolic collapse > 1/3 systole
- RV diastolic collapse
- Reciprocal respiratory changes in RV and LV volumes (septal shifting)
- Reciprocal respiratory changes (>25%) in RV and LV filling
- Reduced early-diastolic tissue Doppler velocity
- Severe dilatation of the inferior vena cava
Respiratory changes with inhalation and exhalation in MV and TV
Exhalation: MV increase, TV decrease
Inhalation: MV decrease, TV increase
Pericardial Constriction basic principles
- LV systolic function is normal
- LA enlargement
- IVC and hepatic veins are dilated
- RA elevated pressure
- the serous surfaces of the visceral and parietal pericardium are adherent, thickened, and fibrotic, with resultant loss of the pericardial space and impairment of diastolic ventricular filling
physiology of constrictive pericarditis is characterized by
- impaired diastolic cardiac filling due to the abnormal pericardium surrounding the cardiac structures
- early-diastolic filling is rapid, with abrupt cessation of ventricular filling as diastolic pressure rides
Pericardial Effusion Severity Scale
Small: < 1 cm
Moderate: 100-500 ml and 1-2 cm
Large: >500 ml and >2 cm
