pericardial disease Flashcards
types of pericardial disease:
- Acute Pericarditis
- Pericardial Effusion without hemodynamic compromise
- Cardiac tamponade
- Constrictive Pericarditis
Constrictive Pericarditis
a chronic process in which the pericardium thickens to the point where it compresses the heart to the point where it limits cardiac output.
acute pericarditis dx
- Chest pain varies with position, breathing
- Pericardial rub on cardiac exam
- EKG- Diffuse ST elevation
- ECHO- Pericardial fluid
- Response to anti-inflammatory agents
acute pericarditis: most common causes
- viral illness
- c.t. or autoimmune disease
- uremia
- metastatic tumor
acute pericarditis: presentation
- Sudden onset chest pain - often severe
2. Chest pain varies with position and breathing
Rx. Acute Pericarditis
- Ibuprofen 300-800 mg p.o. every 6 to 8 hours.
- Ibuprofen is the nonsteroidal anti-inflammatory drug of choice but others may be effective as well.
- Aspirin 325-650 mg is an alternative.
pericardial effusion: common causes
- Viral or acute idiopathic pericarditis
- Metastaticmalignancy
- Uremia
- AutoimmuneDisease
- Hypothyroidism
pericardial effusion is best dx with
by Xray or Echocardiogram
Small effusions without high intrapericardial pressure may be
asymptomatic
Large effusions with high intrapericardial pressures cause
cardiac tamponade where myocardial compression impairs diastolic filling
The key point about pericardial tamponade is that because of the high intrapericardial pressure, there is ____.
impaired filling of the right side of the heart.
This decreases right ventricular output. Therefore, the lungs are not congested.
the cause of pericardial effusion with tamponade is
Rapidly accumulating moderate sized or large effusions
presentation of pericardial effusion with tamponade
- Decreased RV diastolic filling during inspiration
- Distended neck veins
- Inspiratory decrease in arterial pressure (Paradoxical Pulse)
an echo in tamponade displays
- collapse of RA and RV in end-diastolic
2. dilation of inferior vena cava without the normal >50% reduction during inspiration
in cardiac tamponade, the IVC is
dilated and does not collapse during inspiration
EKG in cardiac tamponade displays
- Low voltage with sinus tachycardia
(also seen in pulmonary disease, cardiomyopathy) - electrical alternans with sinus tachycardia
(can rarely be seen in severe HF)
causes of constrictive pericarditis
scarring and loss of elasticity of pericardium
etiology of constrictive pericarditis
- idiopathic
- after cardiac surgery
- radiation
- infectious
pathophysiology of constrictive pericarditis
impaired diastolic filling with normal systolic function
presentation of constrictive pericarditis
- markedly elevated JVP
- tachycardia
- often with hepatomegaly
- edema
- ascities
diagnosis of constrictive pericarditis
- Transthoracic echo may sometimes see pericardial thickening
- Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) often demonstrate pericardial thickening
- Cardiac Catheterization shows an early dip and plateau pattern and equalization of the diastolic
pressures in the right & left ventricles
catheterization in constrictive pericarditis
- Dip and Plateau (“square root sign”) during diastole.
2. Equalization of diastolic pressures between LV andRV.
constrictive pericarditis clinical points
- A chronic disease that usually takes considerable time to develop
- Cardiac silhouette usually normal size but encased by thickened pericardium
- Lungs not congested because constriction selectively impairs filling of right ventricle
- Often mistaken for liver disease because prolonged
high venous pressure causes hepatic enlargement and ascites
constrictive pericarditis: treatment
Surgical stripping of the pericardium
