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Cardiology > Pericardial disease > Flashcards

Pericardial disease Flashcards

1
Q

What is the normal pericardium?

A

A fibroelastic sac containing a thin layer of fluid (50mL) that surrounds the heart and roots of the great vessels

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2
Q

What are the most common causes of acute pericarditis?

A

Most commonly due to viral infection- Coxackie B, echovirus, HIV infection- or following on from MI

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3
Q

What are the other causes of acute pericarditis?

A 
Uraemia
Autoimmune rheumatic disease
Trauma
Bacterial/tuberculosis/fungal infection
Malignancy- breast, lung, leukaemia and lymphoma
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4
Q

What is the characteristic pain of acute pericarditis? How is it relieved? What exacerbates the pain?

A

Sharp retrosternal chest pain which is characteristically relieved by leaning forward. Worse on inspiration

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5
Q

Where does the pain of acute pericarditis radiated?

A

The neck and shoulders

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6
Q

What is heard on auscultation of a patient with acute pericarditis?

A

Pericardial friction rub

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7
Q

How is acute pericarditis diagnosed?

A

ECG?

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8
Q

What does the ECG look like in a patient with acute pericarditis?

A

Global, saddle shaped ST elevation

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9
Q

How is a pericardial friction rub best heard?

A

Lower left sternal edge with the patient leaning forward

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10
Q

How is acute pericarditis managed?

A

Treatment of underlying disorder + NSAIDs

Systemic corticosteroids are used in resistant cases

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11
Q

When should NSAIDs not be used to treat acute pericarditis? Why?

A

In the first few days following MI. This is because they are associated with a higher rate of myocardial rupture

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12
Q

What are the complications of acute pericarditis?

A 
Pericardial effusion
Chronic pericarditis (>6-12 months)
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13
Q

What is pericardial effusion?

A

An accumulation of fluid in the pericardial sac

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14
Q

What causes pericardial effusion

A

Any of the causes of acute pericarditis

Hypothyroidism also causes pericardial effusion

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15
Q

What is pericardial tamponade?

A

A medical emergency which occurs when a large amount of pericardial fluid which has often accumulated rapidly restricts diastolic ventricular filling and causes a marked reduction in cardiac output

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16
Q

What is the main clinical feature of pericardial effusion?

A

The effusion obscures the apex beat and heart sounds are soft

17
Q

What are the signs of pericardial tamponade?

A

Hypotension
Tachycardia
Elevated JVP which rises with inspiration
Pulsus paradoxus

18
Q

What is seen on an X ray in pericardial effusion?

A

Large globular heart

19
Q

What is seen on an ECG in pericardial effusion?

A

Low voltage complexes

20
Q

What is the diagnostic test for pericardial effusion? What does it show?

A

Echo

Shows an echo free space around the heart

21
Q

When are invasive tests to establish the cause of a pericardial effusion necessary?

A

If the effusion is persistent
If a purulent or tuberculosis effusion is suspected
If the effusion is not known to be secondary to an underlying illness

22
Q

What invasive tests might be used to establish the cause of a pericardial effusion?

A

Percardiocentesis: aspiration of fluid under echocardigram guidance
Pericardial biopsy for culture, cytology/histololgy and PCR (for TB) give a greater diagnostic yield with larger effusions

23
Q

How is cardiac tamponade treated?

A

Emergency pericardiocentesis
Pericardial fluid is dained percutaneously by introducing a needle into the pericardial sac. If the effusion recurs, in spite of treatment of the underlying cause, excision of a pericardial segment may be necessary. Fluid is then absorbed through the pleural and mediastinal lymphatics

24
Q

What is constrictive pericarditis?

A

The heart becomes encased within a rigid fibrotic pericardial sac which prevents adequate diastolic filling of the ventricles.

25
Q

What are the clinical features of constrictive pericarditis?

A 
The clinical features resemble those of right-sided heart failure:
Jugular venous distension
Dependent oedema
Hepatomegaly
Ascites
Kaussmaul's sign
Pulsus paradoxus
Atrial fibrillation
Pericardial knock on auscultation (caused by rapid ventricular filling)
26
Q

What is Kussmaul’s sign?

A

JVP rising paradoxically with inspiration. Indicative of impaired right ventricular filling due to heart failure

27
Q

What other condition can constrictive pericarditis not be distinguished from clinically?

A

Restrictive cardiomyopathy

28
Q

How is diagnosis of constrictive pericarditis made?

A

CT or MRI which show pericardial thickenick and calcification

29
Q

How is constrictive pericarditis treated?

A

Surgical excision of the pericardium

Cardiology (18 decks)

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