Pericardial Disease Flashcards
Hemodynamic findings in tamponade
Equalization of LV and RV pressures
Jugular venous exam finding in tamponade
Blunted or absent y descent
If pt has breast CA, what cardiac issues should you think of?
CM, constriction or tamponade
Where can pericarditis pain radiate to?
Trapezius
What is the yield of serologic studies in acute pericarditis?
Low
COPE trial results for acute pericarditis
Colchicine reduced recurrence rates vs placebo
2 side effects of colchicine
Diarrhea
Bone marrow suppression
Can colchicine be given in renal or hepatic dysfxn?
No
In what case are colchicine’s side effects pronounced?
Interaction with CYP3A4 drugs (CCB, Amio, cyclosporine)
Steroids should be avoided in acute pericarditis unless …?
Contraindications to colchicine
Connective tissue dz
Uremic pericarditis
Diagnostic criteria for post-pericardiotomy syndrome?
2 of the following:
Pleuritic CP, friction rub, pleural effusion, new or worsening pericardial effusion, fever > 1wk postop
Definition of myopericarditis
Elevation of cardiac enzymes or new LV dysfxn
What population is prone to get myopericarditis?
Male age<40
definition of pulsus paradoxus (Tamponade)
inspiratory decrease in SBP >10
what causes false positive results for pulsus paradoxus, making you think there is tamponade?
COPD, PE, constriction
what causes false negatives for pulsus paradoxus?
LVH, AI, ASD, vent, localized effusion, severe hypotension
Rx of tamponade
IVF, inotropes/vasopressors if hypotension persists, pericardiocentesis, avoid vent
what is appearance of Y-descent in constrictive pericarditis?
prominent
inc’d RAP, prominent y-descent, tachycardia. Most likely Dx?
constrictive pericarditis
description of constrictive pericarditis
obliterated pericardial space and adhesive pericarditis
top 5 etiologies behind constrictive pericarditis
idiopathic, prioir cardiac Sx, pericarditis, mediastinal radiation, CTD
what sxs will pt get in constrictive pericaditis if RA = LA are 10mmHg?
hepatomegaly, edema
what sxs will pt get in constrictive pericaditis if RA = LA are > 18mm Hg?
dyspnea, orthopnea
what stage of cardiac cycle do restrictive and constrictive CM effect mainly?
diastole
what is the systolic function (usually) in constriction or restriction?
normal
what is the Kussmaul sign and what dz state is it seen in?
- elevated JVP on inspiration
- constrictive pericarditis
what is Friedrich’s sign and what dz state is it seen in?
- prominent Y descent
- constrictive pericarditis
what do you see on mitral and tricuspid inflow velocities on echo (E wave) in constrictive pericaditis?
respiratory flow variation
on echo in constrictive pericarditis, what is the septum doing?
diastolic bounce
what do the atria look like on echo in constrictive pericarditis?
dilated despite TR/MR
what is an abnormal pericardial thickness?
> 4mm
ventricualr interdependence
constriction
what is the PASP usually in constrictive pericarditis? restrictive?
constrictive PASP < 50
Restrictive PASP > 80
the number one reason to suspect constriction
LV/RV interdependence
what pattern will MV inflow have on echo in constrictive pericarditis?
restrictive pattern
3 factors that deme a worse prognosis s/p pericardiectomy for constriction
age, NYHA class, post-radiation as cause
First line agents to treat acute pericarditis
NSAIDs and colchicine
when do you give corticosteroids for acute pericarditis? why?
- refractory cases or contraindications to first line therapy
- b/c of higher rate of recurrent pericarditis
dissociation of intra-thoracic and intra-cardiac pressures
constrictive pericarditis
what is LVEDP-RVEDP in constriction?
<5mmHg
what is PASP in constriction?
<55mmHg
RVEDP/RVSP in constriction
> 1/3
if LVEDP-RVEDP > 5mmHg and RVEDP/RVSP < 1/3 and PASP > 55, is it constriction or restriction?
restriction
