Pericardial Disease Flashcards
Treatment for chylopericardium
Diet with medium chain triglycerides first
Occurs from disruption of thoracic duct periop
If persistent surgery needed
Constrictive pericarditis
dilated IVC
Mitral inflow E peak wave fall of >25% on inspiration
Expiratory flow reversal hepatic veins
Ventricular interdependence
RV pressure increases, LV pressure decreases during inspiration
Pericarditis recurrence
Induced by steriod therapy
Colchicine REDUCES pericarditis recurrence
Pulsus Paradoxus
> 10mm drop in SBP with inspiration
can also occur with COPD, PTX, OSA (all cause swings in intrathoracic pressure)
Cardiac tamponade hemodynamics
JVP
Kusmal’s sign - inspiratory increase in JVP
Loss of Y descent on RA tracing
Pulsus Paradoxus
SLE
pericarditis
Diffuse ST elev (concave up)
PR depression except AVR (PR elev and ST dep)
check TTE
Cardiac Tamponade by Echo
>30% Mitral flow variation >60% Tricuspid flow variation IVC diliations (inc'd central venous pressure Right heart diastolic collapse
Tamponade
ECG
low votage
Electrical alternans
Tamponade
tachycardia Jugular distension PEA arrest Pulsus paradoxus >10 with inspiration loss of y-descent (no filling of RV) ventricular interdependence (dec SV with inspiration -> inc'd flow into RV -> septum bulges into LV)
Constrictive pericarditis
impaired filling pressures, reduced ventricular fxn
inc’d pericardial thickness not required
fatigue, edema, +kusmal, JVD, abdomenal swelling
RHF
Risk factors - CT based surgery, mantle radiation, recurrent percarditis
Mantle radiation can cause ostial CAD and valvular dz
Sx pericardial effusion/tamponade would have pulsus paradoxus
Acute pericarditis
ibuprofen 1-2 wks
colchicine 8-12 wks
Myxedema pericardial effusion
high triglyceride
Tuberculosis pericardial effusion
Adenosine deaminase >40, elevated protein, elevated LDH
Pericardiocentesis
if unsure of where needle is - transduce needle…
Etiology of pericardial effusion
pericarditis myxedema (thyroid) Dresslers Radiation uremia malignancy infections (TB) autoimmune conditions medications (hydralazine)