Pericardial disease

Question 1

Four types of pericardial disease

Answer 1

Acute pericarditis, pericardial effusion w/out hemodynamic compromise, cardiac tamponade, constrictive pericarditis

Question 2

Causes of acute pericarditis

Answer 2

viral, CT disease, autoimmune disease, uremia, metastatic tumors

Question 3

Acute pericarditis presentation

Answer 3

Severe sudden onset of chest pain that varies with position and breathing

Question 4

Acute pericarditis diagnostic criteria

Answer 4

Chest pain varies with position, breathing, Pericardial rub on cardiac exam, EKG-Diffuse ST elevation, ECHO-Pericardial fluid, Response to anti-inflammatory agents

Question 5

Acute pericarditis treatment

Answer 5

Ibuprofen is best. Also aspirin as alternative

Question 6

Pericardial effusion causes

Answer 6

1. Viral or acute idiopathic pericarditis 2. Metastaticmalignancy 3.Uremia (kidney disease) 4.Autoimmune Disease 5.Hypothyroidism

Question 7

Pericardial effusion diagnosis

Answer 7

X-ray or echo: Enlarged heart w/out congested lungs. Small effusions without high intrapericardialpressure may be asymptomatic. Large effusions with high intrapericardialpressures cause cardiac tamponade where myocardial compression impairs diastolic filling

Question 8

Pericardial effusion with tamponade causes

Answer 8

rapidl accumulating moderate/large effusions put pressure on the heart

Question 9

Pericardial effusion w/ tamponade presentation

Answer 9

High intrapericardial pressure impairs filling of right heart, decreasing RV output (thus lungs are NOT congested). Decreased RV diastolic filling during inspiration backs up causing distended neck veins. Also paradoxical pulse (decrease in arterial pressure with inspiration b/c increased filling of RV impinges on the LV lowering SV)

Question 10

What is pulsus paradoxus

Answer 10

> 10mmHg drop in systolic pressure during inspiration, seen in pericardial effusion

Question 11

Tamponade Echo

Answer 11

Collapse of right atrium and right ventricle in end-diastole. Dilation of inferior vena cava w/out normal 50% reduction during inspiration

Question 12

Cardiac tamponade EKG

Answer 12

Low voltage with sinus tachycardia (also seen in pulmonary disease, cardiomyopathy) and electrical alternans with sinus tachycardia

Question 13

What is electrical alternans

Answer 13

movement of heart back/forth in sea of fluid from pericardium

Question 14

Cardiac tamponade treatment

Answer 14

Aspiration of fluid

Question 15

Constrictive pericarditis cause

Answer 15

Scarring & loss of elasticity of the pericardium

Question 16

Constrictive pericarditis etiologies

Answer 16

Idiopathic, after cardiac surgery, radiation, infectious

Question 17

Constrictive pericarditis pathophys

Answer 17

Impaired diastolic filling with normal systolic function

Question 18

Constrictive pericarditis presentation

Answer 18

Markedly elevated jugular venous pressure, tachycardia Often with hepatomegaly,edema, ascites due to prolonged high venous pressure

Question 19

Constrictive pericarditis diagnosis

Answer 19

Echo, X-ray (thickened or calcifed pericardium), catheterization shows early diastolic filling wave with no further filling plus LV and RV have same filing pressures (normally RV is lower than LV)

Question 20

Constrictive pericarditis treatment

Answer 20

surgical stripping of pericardium

Question 21

Why are the lungs not congested in constrictive pericarditis?

Answer 21

constriction selectively impairs filling of RV

Question 22

Distinguish pericardial pain from other causes of chest pain

Answer 22

The distinguishing symptomatic feature of pericardial pain is that it is “pleuritic” i.e. aggravated by deep breathing and “positional” i.e. relieved by sitting up or other postural changes.

Question 23

What do Pericardial Tamponade and Congestive Heart Failure have in common

Answer 23

In common: Distended neck veins, tachycardia, low blood pressure, large cardiac silhouette on xray.

Question 24

Compare lungs in tamponade and CHF

Answer 24

In tamponade the lungs are usually clear on physical exam and xray but in CHF the lungs are congested with presence of rales on exam.

Question 25

Compare pulsus paradoxus in tamponade and CHF

Answer 25

present in tamponade, not in CHF

Question 26

Heart sounds in tamponade vs CHF

Answer 26

In tamponade heart sounds tend to be distant and the apex may not be palpable, whereas in CHF it is more common to have normal heart sounds often with murmurs and an S3, and presence of ventricular lifts.

Question 27

Echo in tamponade vs CHF

Answer 27

In tamponade a large pericardial effusion, right atrial collapse, and lack of normal decrease in inferior vena cava diameter are present. In CHF poor contractile function and dilation of the ventricles are typical

Question 28

Tamponade and constrictive pericarditis common features

Answer 28

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

Question 29

Tamponade vs constrictive pericarditis X-ray

Answer 29

Tamponade has a large cardiac silhouette on xray whereas the silhouette is often normal and may have pericardial calcification in constriction

Question 30

Pulsus paradoxus in tamponade vs constrictive pericarditis

Answer 30

present in tamponade, not constrictive

Question 31

Time course of tamponade vs constrictive pericarditis

Answer 31

Constrictive pericarditis typically develops very slowly over considerable time and is often accompanied by hepatic congestion, ascites and marked pedal edema whereas these findings are uncommon in tamponade which tends to develop more quickly

Question 32

Echo in tamponade vs constrictive pericarditis

Answer 32

The echocardiogram demonstrates pericardial fluid, and right atrial collapse with inspiration in tamponade but these are absent in constriction