Pericardial Disease Flashcards
Layers of pericardium
Fibrous pericardium, serous parietal, and serous visceral
Normal amount of pericardial fluid
5-10 ml
What is the most common disorder involving the pericardium?
Acute pericarditis- inflammation of the pericardial sac
Acute pericarditis causes
Infection, autoimmune, CT disease, Neoplasms, radiation, chemo, cardiac surgery, post MI
Example of post-MI pericarditis
Acute pericarditis, Dressler’s syndrome- acute illness occurring weeks to months after an MI
Major clinical manifestation of acute pericarditis
Pleuritic Chest pain- sharp and pleuritic, often sudden in onset and over anterior chest, also pericardial friction rub
What would you suspect if you heard superficial scratchy or squeaking sound with diaphragm over Left sternal border
Pericardial friction rub- a major characteristic of acute pericarditis
Male patient 40 years old presents with pleuritic chest pain, described as sharp and sudden.” With stethoscope, you hear a squeaking sound over the left sternal border. Cardiac biomarkers are elevated, including troponin I and T. ECG shows ST elevation and PR depression. CXR and Echocardiography are normal. You check WBC, ESR, and Serum C-reactive protein, tuberculin test, and antinuclear antibody titer. What do you suspect?
Acute pericarditis
When would echocardiography not be normal in acute pericarditis?
if associated pericardial effusion. Definitely order if cardiac tamponade suspected
What organism is most often responsible for bacterial pericarditis?
Staph aureus
You suspect acute pericarditis in patient but are unsure of whether it is bacterial or viral. Why is it important to differentiate?
Affects treatment options. Viral usually resolves within 1 month with bed rest and analgesics. Bacterial pericarditis- requires decompression of the pericardial space, IV Abx therapy for 1 month, supportive therapy
Why should hemorrhagic pericarditis with effusion accumulation secondary to trauma be drained?
Because of risk of subsequent development of constrictive pericarditis
Different types of recurrent pericarditis include
Rheumatolic, Uremic pericarditis, neoplastic pericarditis
Rheumatologic pericarditis tx
corticosteroids and/or salicylates
Urmic pericarditis tx
dialysis, pericardiotomy
Neoplastic pericarditis tx
Treat primary disease, pericardiocentesis if indicated
Type of fluid in pericardial effusion
Serous fluid, serosanguinous fluid, blood, pus, chyle
Patient presents with persistent pain in chest. He had viral pericarditis 1 month ago which seems to have resolved. You hear muffled heart sounds and dullness and decreased breath sounds over L posterior lung (Ewart’s sign). You suspect…
Pericardial effusion
What is Ewart’s sign and what is it associated with?
Dullness and decreased breath sounds over posterior L lung due to compression by large pericardial sac- seen in pericardial effusion
Diagnosis of pericardial effusion
History, PE, ECG, CXR. Very similar to pericarditis. Cardiomegaly may occur due to pericardial effusion.
Patient presents with dyspnea, fatigue, cough, and shock. PE shows pulsus paradoxus. ECG- electrical alternans. Beck’s triad also present. Diagnosis?
Cardiac Tamponade
Beck’s triad
Elevated venous pressure, hypotension, quiet heart- seen in cardiac tamponade
Pulsus paradoxus
exaggerated drop in SBP with inspiration
Tx of cardiac tamponade
pericardiocentesis, pericardial window
Tx of constrictive pericarditis
Pericardiectomy
Patient presents with Kussmaul’s sign, dyspnea, ascites, edema, and pericardial KNOCK. Diagnosis and what do you suspect?
Suspect constrictive pericarditis. Xray- calcified pericardium. CT scan, MRI- thickened pericardium. Pericardial biopsy, cardiac cathetirization- restricted filling pattern in RV
Pericardial KNOCK
Abrupt cessation of early diastolic inflow. often best heart during inspiration.
What is classic in constrictive pericarditis
Pericardial Knock
What type of pericarditis is very similar to Restrcitive cardiomyopathy?
Constrictive pericarditis
Abnormal diastolic filling pattern in both constrictive pericarditis and cardiac tamponade. Reasons..
Cardiac tamponade- increased accumulation of fluid in pericardial sac causes increased intra-pericardial pressure which causes less diastolic filling. In constrictive pericarditis, pericardium becomes fibrous, thickened so ventricles are unable to open up as much
Tx of constrictive pericarditis vs. cardiac tamponade
constrictive pericarditis- pericardioectomy. cardiac tamponade- pericardiocentesis, pericardial window
Patient just had a MI. Is now experiencing pericardial friction rub, pleuritic pain, fever. What do you suspect?
Dressler’s syndrome (Post-MI pericarditis)
You are trying to figure out if patients sharp chest pain is due to pericarditis. What do you ask them?
Does you pain improve when you sit up and lean forward? Does it improve upon inspiration? If yes, then diagnosis more favored.
