pericardial disease 2

Question 1

in constrictive pericarditis, filling occurs very abruptly only in:

Answer 1

early diastole.

Unlike the normal filling curve there is little or no further filling later in diastole.

Question 2

constrictive pericarditis: diastolic filling pressures are

Answer 2

very high and equalized between the right and left ventricles.

Question 3

Normally during diastole the RV pressure is

Answer 3

much lower than the LV.

Question 4

Distinguishing Pericardial pain from Other Causes of

Chest Pain

Answer 4

The distinguishing symptomatic feature of pericardial pain is that it is “pleuritic”
Distinguish from 
1. acute coronary syndrome
2. acute PE
3. pneumonia

Question 5

pleuritic pain means

Answer 5

1. aggravated by deep breathing and “positional”

2. relieved by sitting up or other postural changes.

Question 6

Pain from acute coronary syndromes is

Answer 6

not altered by breathing, cough or positional changes.

Question 7

Pain from acute pulmonary embolus:

Answer 7

1. may be pleuritic but
2. lacks the EKG changes of pericarditis or a pericardial rub
3. pain often occurs in conjunction with recent surgery or after long automobile or plane travel in which deep vein thrombosis,
4. often with localized tenderness,
5. occurs in the lower extremities.

Question 8

Pneumonias pain:

Answer 8

1. may be pleuritic pain
2. generally localized rales in the ling fields
3. sputum production

Question 9

Distinguishing Pericardial Tamponade from Congestive

Heart Failure

Answer 9

1. In tamponade, the major impairment is in right heart filling during diastole.
2. In CHF there is usually no impairment in right heart filling but diminished myocardial function causes pulmonary and systemic congestion.

Question 10

CHF and pericardial tamponade: common findings

Answer 10

Both have

1. Distended neck veins,
2. tachycardia,
3. low blood pressure,
4. large cardiac silhouette on xray.

Question 11

CHF and pericardial tamponade: different findings on physical exam

Answer 11

Tamponade

1. the lungs are clear
2. lungs clear on xray
3. Pulsus paradoxus found

CHF the

1. lungs are congested
2. rales
3. redistribution of blood flow to the upper lobes
4. xray findings.
5. Pulsus paradoxus absent

Question 12

CHF and pericardial tamponade: difference in heart sounds

Answer 12

tamponade: heart sounds are
1. distant
2. the apex is not palpable

CHF:

1. normal heart sounds
2. often with murmurs
3. S3 present
4. presence of ventricular lifts.

Question 13

EKG difference in CHF and pericardial tamponade

Answer 13

Tamponade:

1. Low voltage
2. pulsus alternans
3. large pericardial effusion
4. right atrial collapse
5. lack of normal decrease in inferior vena cava diameter

CHF:

1. not low voltage
2. no pulsus alternans
3. poor contractile function and dilation of the ventricles

Question 14

Pericardial Tamponade and Constrictive Pericarditis: similarities

Answer 14

1. Reduced diastolic function with preserved systolic function. 2. Jugular venous distention
2. Tachycardia and tendency to low blood pressure

Question 15

Pericardial Tamponade and Constrictive Pericarditis: X ray

Answer 15

Tamponade
1. large cardiac silhouette on xray.

Constriction:
1. on Xray silhouette is often normal and may have pericardial calcification

Question 16

Pericardial Tamponade from and Constrictive Pericarditis: findings

Answer 16

Tamponade:

1. Pulsus paradoxus present.
2. develop more quickly.

Constrictive

1. no Pulsus paradoxus
2. develops very slowly over considerable time
3. hepatic congestion
4. ascites
5. marked pedal edema

Question 17

Pericardial Tamponade from and Constrictive Pericarditis: EKG

Answer 17

tamponade

1. pericardial fluid
2. right atrial collapse with inspiration

Constriction
1. those are absent