Pericardial Disease

Question 1

Most common cause of pericarditis?

Answer 1

Idiopathic, presumed to be viral

Question 2

Which viruses cause pericarditis?

Answer 2

Coxsackie A/B
Echovirus
Adenovirus
Influenza
HIV

Question 3

What infections are associated with pericarditis caused by HIV?

Answer 3

TB

Histoplasmosis

Question 4

What other causes of the for pericarditis besides viral?

Answer 4

Bacterial
Neoplastic
Radiation
Connective tissue disease
Dressler's syndrome
Uremia

Question 5

Drugs that cause pericarditis via drug induced lupus? (3)

Answer 5

Procainamide
Isoniazid
Hydralazine

Question 6

Fluid accumulation in pericarditis is usually what type?

Answer 6

Serous

Question 7

Clinical features of pericarditis?

Answer 7

Chest pain
Pericardial friction rib
Electrocardiogram changes
Pericardial effusion

Question 8

Patient’s biggest complaint that should alert you to pericarditis?

Answer 8

Chest pain unrelated to exertion

Question 9

Patients will do what to attempt to alleviate pericardial pain?

Answer 9

Sit seated and lean forward

Question 10

When will patient’s chest pain be the worst?

Answer 10

Deep inspiration and laying flat

Question 11

To hear pericardial rub how do you position the patient?

Answer 11

Sit upright, lean forward

Question 12

Where do you listen for pericardial friction rub?

Answer 12

Best heard with diaphragm of stethoscope over left sternal border

Question 13

What will you see on chest x-ray for pericarditis?

Answer 13

Enlarged cardiac silouette

Question 14

Electrocardiogram changes in patients with acute pericarditis signals inflammation of what?

Answer 14

Epicardium since pericardium itself is electrically inert

Question 15

What will you see in changes on a pericarditis ECG?

Answer 15

S-T and P-R segment changes

Question 16

ECG stage 1?

Answer 16

Diffuse ST elevation and PR depression

Question 17

ECG stage 2?

Answer 17

Normalization of ST and PR segments

Question 18

ECG stage 3?

Answer 18

Diffuse T wave inversions after ST segments have become isoelectric

Question 19

ECG stage 4?

Answer 19

Normalization of ECG or indefinite presence of T wave inversions

Question 20

Acute pericarditis complications?

Answer 20

Pericardial effusion and tamponade
Constrictive pericarditis
Relapse

Question 21

How do you treat idiopathic and viral pericarditis?

Answer 21

NSAIDS and Colchicine

Question 22

How do you treat pericarditis post MI?

Answer 22

Aspirin and Colchicine, avoid NSAIDs because they will interfere with healing and scar formation

Question 23

What metabolizes Colchicine?

Answer 23

CYP 450

Question 24

When do you use Glucocorticoids for pericarditis?

Answer 24

Acute pericarditis due to connective tissue disease
Uremic pericarditis
Patients with symptoms refractory to standard therapy

Question 25

When do you do pericardiocentesis?

Answer 25

Tamponade | Suspected purulent pericarditis

Question 26

when do you do intensified hemodialysis?

Answer 26

Uremic pericarditis

Question 27

Electrical Alterans on ECG is due to what?

Answer 27

Heart swinging around in pericardial sac

Question 28

Pericardial effusion will compress what?

Answer 28

Right art and ventricle due to less thickness

Question 29

What is pulsus paradoxus?

Answer 29

Fall of systolic blood pressure of greater than 10mmHg with inspiration

Question 30

Tamponade causes what change in the jugular venous curve?

Answer 30

Loss of the y descent

Question 31

3 ECG findings of pericardial tamponade?

Answer 31

Sinus Tachycardia Low voltage Electrical Alternans on ECG

Question 32

Right heart cauterization does what for those with pericardial tamponade?

Answer 32

Equalization of pressures

Question 33

Appropriate initial management of patient with pericardial tamponade?

Answer 33

``` IFV to increase right ventricular volume Avoid diuretics Vasopressors Pericardiocentesis Pericardial window procedure ```

Question 34

Constrictive pericarditis causes what?

Answer 34

Chronic thickening/scarring of pericardium that impairs diastolic filling of LV and RV

Question 35

Effect of constrictive pericarditis on early diastole?

Answer 35

Unimpaired

Question 36

Constrictive Pericarditis etiology?

Answer 36

Idiopathic or viral

Question 37

Physical findings in Constrictive pericarditis?

Answer 37

Elevated JVP with prominent X and Y descents Kussmaul's sign: Increase JVP on inspiration Pericardial knock Systemic congestion

Question 38

Chest X-ray will show what in chronic pericarditis?

Answer 38

Calcification

Question 39

Therapy for chronic pericarditis?

Answer 39

Diuretics | Pericardial stripping