Pericardial Disease

Question 1

3 Functions of Pericardium

Answer 1

Maintains position/decreases friction
Protection from adjacent infection
Prevents sudden dilation

Question 2

4 Increasingly Severe Inflammatory Fluid Secretions of Pericarditis

Answer 2

Serous
Serofibrinous
Purulent (exudate)
Hemorrhagic

Question 3

Most Common Etiology

Answer 3

Idiopathic. Haha fuck you guys if you thought about this really hard and it ended up being this bullshit answer

Question 4

Physical Exam Finding

Answer 4

Pericardial rub one out Ronak

Question 5

Dressler Syndrome

Answer 5

Autoimmune cause of pericarditis weeks/months after MI

Question 6

3 ECG Findings on Stage I (and how to distinguish from MI)

Answer 6

PR Depression
Diffuse ST Elevation
Concave upward ST segments - classic finding
MI pattern is more localized (fewer leads showing) and has convex ST

Question 7

2 Stage III ECG Findings

Answer 7

Isoelectric ST segment

Diffuse T wave inversions

Question 8

Colchicine

Answer 8

Very good therapy for pericarditis, take steroids if this shit don’t work

Question 9

2 ECG Signs of Pericardial Effusion

Answer 9

Low voltage and Electrical Alternans - cycling of large and small amplitude as heart swings back and forth in fluid

Question 10

Chest X Ray Sign of Effusion

Answer 10

“water bottle” configuration (more like floppy canteen if you sat it down - fat on bottom)

Question 11

Diagnosis of Pericardial Effusion

Answer 11

Echocardiography

Question 12

Tamponade Fluid Infusion Volume and V Pressure

Answer 12

If rapid, pressure in vents skyrockets, but if over long period of time (chronic), vents can adapt to keep pressure down a little better

Question 13

Adaptation to Fluid Infusion

Answer 13

Inhibits SV, so heart increases HR to keep CO and MAP up. Eventually it can’t keep up so you’re boned though and they start to drop

Question 14

4 Physical Exam Signs of Tamponade

Answer 14

Tachycardia
Hypotension
JVD (RA has increased P around it)
Pulsus Paradoxus (drop in systolic BP at least 10-15mmHg during normal inspiration)

Question 15

2 Reasons for Pulsus Paradoxus

Answer 15

Decreased Pulmonary VP during insp causes decreased LA/LV filling (bc pressure already high in these from tamponade)
Also increased VR to RV leads to septum displacement reducing LV volume

Question 16

4 Echocardiogram Signs of Tamponade

Answer 16

RA collapse - might just mean impending tamponade
RV Diastolic Collapse - specific finding
Vena Cava Plethora (dilated from elevated RAP)
Insp increase of RV inflow w/ decrease of MV outflow

Question 17

2 Hemodynamic Changes of Tamponade

Answer 17

Elevated and equalization of diastolic pressures (RA = RVEDP = Pericardial Pressure)
Prominent x-descent w/ decrease of y-descent (bc pressure high so flow slower)

Question 18

2 Specific Signs of Pericardial Constriction

Answer 18

Kussmaul’s Sign - elevation in x and y descents and mean RA pressure upon inspiration, bc increased VR to R side and it can’t accomodate (also JVD from this)
Pericardial Knock - third heart sound due to initial rapid diastolic filling then deceleration. So like S3 but not a muscle thing. Instead heart fills fine on early diastole but then mid/late diastole constricted by pericardium

Question 19

Main ECG Sign of Pericardial Constriction

Answer 19

Nonspecific ST wave abnormalities

Question 20

Hemodynamics of Pericardial Constriction

Answer 20

Square root of x/y/pressure as it drops, then increases on filling but can’t fill more in mid/late diastole so it plateaus

Question 21

Pericardial Constriction Echocardiogram and CXR Signs

Answer 21

Thick pericardium and calcification, but each kinda rare to see