pericardial disease

Question 1

types of pericardial disease:

Answer 1

1. Acute Pericarditis
2. Pericardial Effusion without hemodynamic compromise
3. Cardiac tamponade
4. Constrictive Pericarditis

Question 2

Constrictive Pericarditis

Answer 2

a chronic process in which the pericardium thickens to the point where it compresses the heart to the point where it limits cardiac output.

Question 3

acute pericarditis dx

Answer 3

1. Chest pain varies with position, breathing
2. Pericardial rub on cardiac exam
3. EKG- Diffuse ST elevation
4. ECHO- Pericardial fluid
5. Response to anti-inflammatory agents

Question 4

acute pericarditis: most common causes

Answer 4

1. viral illness
2. c.t. or autoimmune disease
3. uremia
4. metastatic tumor

Question 5

acute pericarditis: presentation

Answer 5

1. Sudden onset chest pain - often severe

2. Chest pain varies with position and breathing

Question 6

Rx. Acute Pericarditis

Answer 6

1. Ibuprofen 300-800 mg p.o. every 6 to 8 hours.
2. Ibuprofen is the nonsteroidal anti-inflammatory drug of choice but others may be effective as well.
3. Aspirin 325-650 mg is an alternative.

Question 7

pericardial effusion: common causes

Answer 7

1. Viral or acute idiopathic pericarditis
2. Metastaticmalignancy
3. Uremia
4. AutoimmuneDisease
5. Hypothyroidism

Question 8

pericardial effusion is best dx with

Answer 8

by Xray or Echocardiogram

Question 9

Small effusions without high intrapericardial pressure may be

Answer 9

asymptomatic

Question 10

Large effusions with high intrapericardial pressures cause

Answer 10

cardiac tamponade where myocardial compression impairs diastolic filling

Question 11

The key point about pericardial tamponade is that because of the high intrapericardial pressure, there is ____.

Answer 11

impaired filling of the right side of the heart.

This decreases right ventricular output. Therefore, the lungs are not congested.

Question 12

the cause of pericardial effusion with tamponade is

Answer 12

Rapidly accumulating moderate sized or large effusions

Question 13

presentation of pericardial effusion with tamponade

Answer 13

1. Decreased RV diastolic filling during inspiration
2. Distended neck veins
3. Inspiratory decrease in arterial pressure (Paradoxical Pulse)

Question 14

an echo in tamponade displays

Answer 14

1. collapse of RA and RV in end-diastolic

2. dilation of inferior vena cava without the normal >50% reduction during inspiration

Question 15

in cardiac tamponade, the IVC is

Answer 15

dilated and does not collapse during inspiration

Question 16

EKG in cardiac tamponade displays

Answer 16

1. Low voltage with sinus tachycardia
   (also seen in pulmonary disease, cardiomyopathy)
2. electrical alternans with sinus tachycardia
   (can rarely be seen in severe HF)

Question 17

causes of constrictive pericarditis

Answer 17

scarring and loss of elasticity of pericardium

Question 18

etiology of constrictive pericarditis

Answer 18

1. idiopathic
2. after cardiac surgery
3. radiation
4. infectious

Question 19

pathophysiology of constrictive pericarditis

Answer 19

impaired diastolic filling with normal systolic function

Question 20

presentation of constrictive pericarditis

Answer 20

1. markedly elevated JVP
2. tachycardia
3. often with hepatomegaly
4. edema
5. ascities

Question 21

diagnosis of constrictive pericarditis

Answer 21

1. Transthoracic echo may sometimes see pericardial thickening
2. Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) often demonstrate pericardial thickening
3. Cardiac Catheterization shows an early dip and plateau pattern and equalization of the diastolic
   pressures in the right & left ventricles

Question 22

catheterization in constrictive pericarditis

Answer 22

1. Dip and Plateau (“square root sign”) during diastole.

2. Equalization of diastolic pressures between LV andRV.

Question 23

constrictive pericarditis clinical points

Answer 23

1. A chronic disease that usually takes considerable time to develop
2. Cardiac silhouette usually normal size but encased by thickened pericardium
3. Lungs not congested because constriction selectively impairs filling of right ventricle
4. Often mistaken for liver disease because prolonged
   high venous pressure causes hepatic enlargement and ascites

Question 24

constrictive pericarditis: treatment

Answer 24

Surgical stripping of the pericardium