Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CV Final Material > Pericardial Disease > Flashcards

Pericardial Disease Flashcards

1
Q

The pericardium is composed to two layers what are they?

A

visceral and parietal pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the visceral pericardium?

A
  • Membrane composed of single layer mesothelial cells
  • Similar to pleural and peritoneal cavity
  • Adherent to the epicardial surface of the heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the parietal pericardium?

A

– Fibrous layer 2mm in thickness
– Contains collagen and elastic fibers
– Collagen: Low levels of stretch –>Wavy bundles & High levels of stretch–> Straight bundles
– Reflects the mechanical characteristics of the pericardial tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens to the pericardium near the origin of the great vessels?

A

visceral pericardium reflects back near the origin of the great vessels and becomes the parietal pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pericardial space?

A
  • space between the visceral and parietal pericardium
    – Contains ≈ 50ml serous fluid
    – Part of posterior wall of the left atrium is extrapericardial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The pericardium is stabilized by ligamentous attachments?

A

– Diaphragm
– Sternum
– Spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where do the phrenic nerves run?

A

enveloped by parietal pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does phrenic nerve irritation cause?

A

hiccups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the major functions of the pericardium?

A
  • Maintains heart position
  • Lubrication of visceral and parietal layers
  • Barrier to infection
  • Prostaglandin secretion
  • Restraining effect on cardiac volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does the pericardium restrain cardiac volume?

A

– Mechanical properties of pericardial tissue
– Small reserve volume
– Tensile strength similar to rubber
– Normal cardiac volume: More elastic –> stretches easily
– Increase cardiac volumes: Pericardial tissue becomes stiff –> resistant to further stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Acute vs chronic cardiac dilatation effects on pericardium?

A
  • Chronic cardiac dilatation results in adaptations to accomodate increased cardiac volumes.
  • Pericardial growth occurs in response to chronic stretch
  • Pressure volume curve shifts to the right with decreased slope
  • Slowly accumulating pericardial effusions can become very large before becoming symptomatic (Hypothyroidism)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the major cause of acute pericarditis?

A

Majority (80-90%) of cases “Idiopathic” most of which are assumed to be viral but that rarely alters management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some of the infectious causes of acute pericarditis?

A
  • viral: echo, coxsackie, adenovirus, CMV, HIV
  • bacterial: pneumococcus, strep, staph, myclplasma, haemophilus
  • mycobacteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

General categories of possible causes of pericarditis?

A 
idopathic
infectious
radiation
blunt & penetrating trauma
connective tissue disorders
Post MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Symptoms of acute pericarditis include:

A

– Chest pain
– Almost always present
– Usually moderate to severe in intensity
– Better sitting forward, worse when lying down
– Sharp, pleuritic like
– Substernal, epigastric, left chest, trapezius muscle area
– Can be associated with dyspnea, cough, hiccups, fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Differential diagnoses for chest pain in pericarditis:

A 
– Pneumonia with pleurisy (Pleuro-pericarditis)
– PE with infarction
– Costochondritis
– GERD
– Intraabdominal processes
– Aortic dissection
– Pneumothorax
– Herpes Zoster (Before skin lesions)
– Myocardial ischemia/infarction
17
Q

Physical exam findings for acute pericarditis?

A
  • Uncomplicated acute pericarditis
  • Fever, tachycardia, anxiety (Not always present)
  • Pericardial friction rub
18
Q

What is pericardial friction rub?

A

– Contact between parietal and visceral
– Best heard at left LSB, with patient leaning forward
– Dynamic (Similar to ECG findings)
– Disappearing/returning over short periods of time

19
Q

What are the ECG findings for acute pericarditis?

A
  • ECG changes are dynamic
  • ST segment elevation: Diffuse (Not in leads AVR,V1), Occasionally focal (Trauma and post-op), ST segment concave & No reciprocal changes
  • Upright T waves
  • PR depression (Elevation in AVR)
  • PR depression may be only ECG finding
20
Q

What do you see on chest radiograph for acute pericarditis?

A

– Usually normal in uncomplicated pericarditis

– Abnormal CXR findings consided secondary to disorders: Pleural effusions, Infilrates, Mass lesions, CHF

21
Q

What do you see on an echo of acute pericarditis?

A
  • Small otherwise clinically silent effusion not uncommon
  • Large effusion consider secondary disorder
  • LV function assessment in pt with myocarditis
  • Check for WMA if ischemia/MI suspected
22
Q

Treatment course for acute pericarditis?

A

– Uneventfull recovery in 70% - 90% of patients
– Treatment with NSAIDS (Post MI use aspirin)
– Colchicine With NSAIDS or Alternative to NSAIDS, Decreased incidence of recurrent pericarditis
– Steroids: Rapid response to treatment but may encourage relapses (Avoid if possible)

23
Q

How does colchicine work?

A
  • Exact mechanism of colchicine action not fully understood.
  • Related to its capacity to disrupt microtubules.
  • Inhibits the process of microtubule self-assembly
  • This takes place either in the mitotic spindle or in the interphase stage
24
Q

What cells does colchicine specifically work against?

A

Colchicine has preferential concentration in leukocytes where it Inhibits movement of intercellular granules and the secretion of various substances causing significant anti-inflammatory effect

25
Q

Does colchicine have evidence to back up treatment of acute pericarditis?

A

For sure it is evidence based medicine

26
Q

To diagnose acute pericarditis you need two of what criteria?

A

Typical chest pain (sharp and pleuritic, improved by sittng up and leaning forward)
– A pericardial friction rub
– Suggestive changes of on ECG (widespreadST-segment elevation or PR depression)
–New or worsening pericardial effusion

27
Q

What is incessant pericarditis?

A

patients with persistent pericarditis or those with symptom-free intervals of less than 6 weeks duration.

28
Q

What is Hydropericardium?

A

accumulation of serous transudate in the pericardial space. Associatedwith congestive heart failure, hyponatremia or chronic kidney or liver diseases

29
Q

What is Hemopericardium?

A

accumulation of blood in the pericardiac sac. Likely causes are trauma of either the heart or aorta; myocardial rupture after acute MI

30
Q

Pericardial effusion most common cardiac manifestation of what viral disease?

A

HIV

31
Q

Pt with acute pericarditis gets catheter sampling of aortic pressure what do you see preintervention hemodynamics?

A

pressure spikes are uneven with exaggerated fall in systolic pressure with inhalation

32
Q

Pt with acute pericarditis gets catheter sampling of aortic pressure what do you see postintervention hemodynamics?

A

dramatic improvement in systolic wave pulse pressure. healthy people can have slight variations in pulse pressure peak with breathing with a difference less than 10 mmHg

CV Final Material (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions