Pericardial Disease Flashcards
3 Functions of Pericardium
Maintains position/decreases friction
Protection from adjacent infection
Prevents sudden dilation
4 Increasingly Severe Inflammatory Fluid Secretions of Pericarditis
Serous
Serofibrinous
Purulent (exudate)
Hemorrhagic
Most Common Etiology
Idiopathic. Haha fuck you guys if you thought about this really hard and it ended up being this bullshit answer
Physical Exam Finding
Pericardial rub one out Ronak
Dressler Syndrome
Autoimmune cause of pericarditis weeks/months after MI
3 ECG Findings on Stage I (and how to distinguish from MI)
PR Depression
Diffuse ST Elevation
Concave upward ST segments - classic finding
MI pattern is more localized (fewer leads showing) and has convex ST
2 Stage III ECG Findings
Isoelectric ST segment
Diffuse T wave inversions
Colchicine
Very good therapy for pericarditis, take steroids if this shit don’t work
2 ECG Signs of Pericardial Effusion
Low voltage and Electrical Alternans - cycling of large and small amplitude as heart swings back and forth in fluid
Chest X Ray Sign of Effusion
“water bottle” configuration (more like floppy canteen if you sat it down - fat on bottom)
Diagnosis of Pericardial Effusion
Echocardiography
Tamponade Fluid Infusion Volume and V Pressure
If rapid, pressure in vents skyrockets, but if over long period of time (chronic), vents can adapt to keep pressure down a little better
Adaptation to Fluid Infusion
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
4 Physical Exam Signs of Tamponade
Tachycardia
Hypotension
JVD (RA has increased P around it)
Pulsus Paradoxus (drop in systolic BP at least 10-15mmHg during normal inspiration)
2 Reasons for Pulsus Paradoxus
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
4 Echocardiogram Signs of Tamponade
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
2 Hemodynamic Changes of Tamponade
Elevated and equalization of diastolic pressures (RA = RVEDP = Pericardial Pressure)
Prominent x-descent w/ decrease of y-descent (bc pressure high so flow slower)
2 Specific Signs of Pericardial Constriction
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
Main ECG Sign of Pericardial Constriction
Nonspecific ST wave abnormalities
Hemodynamics of Pericardial Constriction
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
Pericardial Constriction Echocardiogram and CXR Signs
Thick pericardium and calcification, but each kinda rare to see
