Pericardial Disease

Question 1

Clinical signs of pericardial effusion and hemopericardium

Answer 1

Chronic: seen on Xray as globular enlargement of the heart shadow

Hemoperricardium can cause cardiac tamponade very quickly if there is a ruptured MI or aortic dissection

Question 2

Pathogenesis of pericardial effusion and hemopericardium

Answer 2

Pericardial effusion: filled with serous fluid
Hemoperricardium: filled with blood
Purulent pericarditis: filled with pus

Slow accumulating fluid, pericardium has time to dilate and can become quite large

Question 3

Normal pericardial sac contents

Answer 3

less than 50 mL of thin, clear, straw-colored fluid

Question 4

Clinical signs of acute pericarditis

Answer 4

Fibrinous: pain, fever, possible CHF
Friction rub most striking

Constrictive: heart sounds are muffled, heart can’t increase workload for demands due to its restriction

Question 5

Pathogenesis of serous pericarditis

Answer 5

Rheumatic fever, SLE, scleroderma, tumors, uremia

Bacterial pleuritis may cause sterile serous effusion in pericardium

URI, pneumonia, parotitis may be the primary site of infection

Question 6

Pathogenesis of Fibrinous and serofibrinous pericarditis

Answer 6

most frequent types. Serous fluid with a fibrinous exudate. Acute MI, postinfarction syndrome, uremia, chest radiation, rheumatic fever, SLE, and trauma. Follows routine surgery

Question 7

Pathogenesis of purulent pericarditis

Answer 7

active infection by microbial invasion from direct extension, seeding, lymphatic, direct introduction. Serosal surfaces are reddened, granular, and coated w/ exudate.

Question 8

Pathogenesis of hemorrhagic pericarditis

Answer 8

exudate of blood and fibrinous or suppurative effusion from malignancy to this space. Can also be from infection. W/ bleeding disorder, may follow surgery. Causes a re-operation.

Question 9

Pathogenesis of caseous pericarditis

Answer 9

Tuberculosis in origin. Direct spread from bronchial tree.

Question 10

Serous pericarditis histology

Answer 10

mild inflammatory infiltrate in the epipericardial fat

Question 11

Fibrinous pericarditis morphology

Answer 11

dry surface w/ fine granular roughening

Question 12

Serofibrinous pericarditis morphology

Answer 12

accumulation of larger amounts of yellow to brown turbid fluid

Question 13

Constrictive pericarditis morphology

Answer 13

Organization w/ scarring

encased in a dense, fibrous or fibrocalcific scar. Limits the expansion. Up to a cm thick. Can resemble plaster (concetio cordis)

Question 14

Chronic/healed pericarditis morphology

Answer 14

“soldiers” plaque in the pericardium or mesh like adhesions causing adhesive pericarditis.

Question 15

Adhesive mediastinopericarditis

Answer 15

follow infection, previous cardiac surgery or mediastinal irradiation. Pericardial sac is destroyed. Heart pulls against the pericardium but also the mediastinal structures causing pulsus paradoxus