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Clin Med II MHM - Cardio 1 > Pericardial Disease > Flashcards

Pericardial Disease Flashcards

1
Q

Functions of the pericardium

A
  • Stabilizes and restricts chamber dilatation

- Minimizes friction b/w heart and pulmonary pleura/vessels

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2
Q

Causes of pericardial disease?

A
  • Infection (viral MC)
  • Idiopathic
  • Systemic (mets neoplasm, rheumatic fever)
  • Trauma (s/p acute MI - Dressler’s syndrome)
  • Cardiac surgery
  • Mediastinal radiation
  • Uremia
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3
Q

Categories of pericardial disease by chronicity

A

-Acute

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4
Q

Categories of pericardial disease by pathology

A
  • Fibrous (dry, no effusions)
  • Effusive (purulent, hemorrhagic exudate)
  • Constrictive (impedes diastolic filling, occurs after acute pericarditis)
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5
Q

Which types of pericardial disease can lead to tamponade?

A
  • Effusive

- Constrictive

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6
Q

What are the MC causes of acute pericarditis?

A

Viral and idiopathic make up 90% of cases

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7
Q

What viruses cause acute pericarditis?

A
  • Coxsackie virus A/B
  • Echo virus 8
  • Mumps
  • Adenovirus
  • Hepatitis
  • HIV
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8
Q

Who is affected by pericarditis?

A
  • Onset at 20-50 yo
  • Males > females
  • Approx 5% of chest pain complaints in the ED
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9
Q

Cardinal manifestations of acute pericarditis

A
  • Chest pain
  • Pericardial friction rub (along LSB)
  • ECG changes
  • Pericardial effusion (w or w/o tamponade)
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10
Q

Presentation of patient with acute pericarditis

A
  • Few days or more with low grade fever and myalgias/weakness
  • Sudden onset of severe anterior chest pain that worsens with breathing and lying down
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11
Q

When is a pericardial friction rub heard best?

A
  • Sitting up/leaning forward at end of expiration

- LSB

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12
Q

What diagnoses acute pericarditis?

A
  • Diffuse ECG ST elevations, PR depressions, NO Q waves
  • Pericardial effusion on echo
  • Systemic inflamm markers (CRP, ESR, high WBC)
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13
Q

Describe the chest pain a/w acute pericarditis

A
  • Pain is positional (lying, coughing, swallowing) and not related to exertion
  • Pain does not respond to nitroglycerine
  • Radiates to trapezius ridge
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14
Q

What can a CXR show with acute pericarditis?

A

“Water bottle” heart silhouette

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15
Q

What diagnostic tool can assess for tamponade?

A

Echo

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16
Q

1st line treatment for acute pericarditis

A
  • 2 weeks NSAIDs (or ASA for post-MI)
  • 3 months colchicine
  • PPI
17
Q

Treatment for severe symptomatic acute pericarditis

A

1-2 weeks prednisone + colchicine

18
Q

Why aren’t NSAIDs a part of post-MI pericarditis (Dressler’s) treatment?

A
  • Can slow myocardial healing

- So ASA is used instead

19
Q

Non-pharm treatments of acute pericarditis

A
  • Pericardiocentesis (tap)

- Pericardiectomy (stripping)

20
Q

When is pericardiectomy indicated to treat pericarditis?

A
  • Recurrent pericarditis
  • Constrictive with adhesions
  • Resistant to meds
21
Q

What are the 2 main complications of pericarditis?

A
  • Cardiac effusion

- Cardiac tamponade

22
Q

Define cardiac tamponade

A

Compression of the heart due to fluid accumulation within the pericardium

23
Q

What determines seriousness of tamponade?

A

Rate of effusion accumulation

24
Q

How does tamponade affect the heart?

A
  • All chambers compressed d/t increased intrapericardial pressure
  • Decreased chamber size = decreased diastolic compliance = decreased venous return
25
Q

Beck’s triad of tamponade

A
  1. JVD (MC finding)
  2. Hypotension
  3. Distant to absent heart sounds
26
Q

Pulsus paradoxus

A
  • 10+ mm Hg drop in SBP with inspiration
  • Consequence of ventricular interdependence (competition for space)
  • RV bulges into LV = decreased filling/EDV = decreased SV = decreased BP
  • Complication of pericarditis
27
Q

Define ventricular interdependence

A

To fill one ventricular chamber, the other has to fill less

competition for space

28
Q

Treatment of tamponade

A
  • If stable and small effusion = monitor through JVD, paradoxical pulses, serial echo
  • If necessary, pericardiocentesis

Clin Med II MHM - Cardio 1 (7 decks)

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