Pericardial Disease Flashcards
If a chronic pericardial effusion develops, the pericardium can hold up to ____ of fluid
1L
Normally, the pericardial cavity holds __-__mL of fluid
20-50mL
The heart can’t handle acute accumulations of any more than this
What is the typical pressure within the pericardium
Similar to pleural pressure, and varies with respiration between -4 and +4mmHg
Function of the pericardium
Lubricates the heart
Facilitates motion within the sac
Protects the heart from excessive displacement
Maintains optimum shape of the heart
Applies compensatory hydrostatic pressure to the heart to compensate for alterations in gravitational force
Is acute pericarditis an emergency?
YES!!!
Causes of acute pericarditis and how is it diagnosed?
Causes:
- Viral infection
- MI (Dressler’s Syndrome)
- -> autoimmune inflammatory reaction to myocardial neo-antigens formed as a result of an MI
Diagnosis:
- Sudden onset of severe chest pain that’s exaggerated by INSPIRATION
- DIFFUSE ST elevation across all leads, PR segment depression, T wave inversion
- Pericardial friction rub on auscultation
Medical treatment for acute pericarditis
Pain and inflammation reduction
1) ASA or NSAIDs to reduce inflammation
2) Analgesics (very painful)
3) Corticosteroids
Does pericarditis WITHOUT effusion alter cardiac function?
No.
It’s the effusion that’s the true problem.
Effusion = emergency surgery
No effusion = treat medically
Acute Pericardial Effusion
Rapid effusion = no time for the heart to accommodate.
Even small volumes of 100-200cc will cause tamponade when accumulated rapidly.
Gradual Pericardial Effusion
If gradual, the pericardium will stretch to accommodate the fluid.
Up to 1L of fluid can accumulate without significant increases in pressure on the heart.
Diagnosis of pericardial effusion
ECHO
What happens in cardiac tamponade?
The increase in pericardial pressure impairs diastolic filling. This shit is an emergency.
S/S of cardiac tamponade
Hypotension (low CO and SV)
Increased CVP and JVD (stuff is backing up)
Muffled heart sounds
Low voltage on ECG (no filling = lack of starling force)
Pulsus paradoxus
Equalization of cardiac filling pressures
Tachypnea
SNS activation***
Treatment for pericardial tamponade
Remove the fluid!
1) Pericardiocentesis
2) Subxiphoid pericardiostomy
3) Thoracic pericardiostomy (open or thoroscopic)
Anesthetic management for cardiac tamponade
1) Maintain the SNS!!
2) Expand volume (try to increase filling pressures against the pericardium)
3) Increase contractility (isoproterenol)
4) Correct metabolic acidosis (reduce likelihood of dysrhythmia. May be in acidosis b/c probably in cardiogenic shock)