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MRCP PART ONE CARDIOLOGY > Pericardial disease > Flashcards

Pericardial disease Flashcards

1
Q

Constrictive pericarditis

  • causes
  • mechanism
  • clinical features
  • differential diagnosis
  • how do we differentiate
  • tests
  • treatment
A
  • Unknown (uk),TB,following any type of pericarditis (haemopericardium,rheumatic pericarditis,viral)
  • fibrosis and calcification of the pericardium–>decreased expansion of pericardium–>impaired venous return
  • rise JVP,kussmul’s breathing(paradoxically increase JVP with inspiration),diffuse apex beat,quiet heart sounds,S3,diastolic pericardial knock,ascites,hepatosplenomegaly,oedema
  • differentiate from cardiac temponade (JVP,pulses paradox us,kussmul’s breathing),restrictive pericarditis (CT/MRI)
  • CXR:small heart+/-pericardial calcification,echo-cardiac catheterization
  • treated by surgical resection
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2
Q

How Do you differentiate cardiac temponade from constrictive pericarditis?

A

JVP. Y descent absent X and Y descent
Pulses paradoxus. Specific. Less specific
Kussmul’s breathing. Rare. Present

Note:TEMponade=TEMpeX

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3
Q

Pericardial effusion

  • causes
  • clinical features
  • ECG changes
  • treatment
A

-pericarditis,myocardial rupture (haemopericardium-stab wounds,surgical,post MI),aortic dissection,pericardium filling with pus,malignancy
-dyspnoea,raised JVP(prominent X descent),bronchial breathing at left base (Ewart’s sign:left effusion compressing left lower lobe),hiccough (phrenic nerve),nause (diaphragm),muffled heart sounds
-Diagnosis:CXR-enlarged globular heart if effusion>300ml,ECG-low voltage QRS complexes,electrical alternans,echo-echo free zone around heart
-pericardiocentasis (therapeutic/diagnostic)-culture,cytology
-

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4
Q

What are the treatment for different types of pericarditis?

A 
Pericarditis-Ibuprofen
Recent MI-Aspirin
Rheumatic fever-Aspirin
Dressler's syndrome (post MI)-steroids
Recurrence-Colchicine
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5
Q

Cardiac Temponade

  • mechanism
  • clinical features
  • differential diagnosis
  • how do we differentiate
  • tests
  • treatment
A

Fatal*

  • pericardial effusion that raises intrapericardial pressure,reducing ventricular filling and reducing CO
  • diagnostic:Beck’s triad-raised JVP,fallin pressure,muffled heart sounds,(refer pericardial effusion)
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6
Q

Acute Pericarditis

  • clinical features
  • Test
A
  • central chest pain worsening on inspiration or lying flat,relieved by sitting forward.pericardial friction rub,+/-fever,+/-pericardial effusion/cardiac temponade
  • ECG : conceived (saddle shaped)ST elevation , PR depression,T inversion (D/D:MI-no q wave)
  • cardiac enzymes may be raised
  • CXR:cardiomegaly may indicate paricardial effusion–>echo

Cause include hypothyroidism

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7
Q

Jugular venous examination finding in cardiac temponade

A

Blunted or absent y descent

TEMponade=TEMpaX

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8
Q

Harmodynamic finding in cardiac temponade

A

Equalization of LV and RV pressure (cardiac catheterization)

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9
Q

If patient has CA breast,what cardiac issues should you think of?

A

Cardiomegaly,Constrictive pericarditis or temponade

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10
Q

Where can pericarditis pain radiate to?

A

Trapezius

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11
Q

What is the yield of serological studies in acute pericarditis?

A

Low

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12
Q

COPE trial result for acute pericarditis

A

Colchicine reduce recurrent rate vs placebo

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13
Q

2 side effects of colchicine

A

Diarrhea

Bone marrow depression

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14
Q

Can colchicine be given in renal or hepatic dysfunction?

A

No

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15
Q

In what cases are colchicine side effects pronounced?

A

Interaction with CYP3A4 drug (CCB,Amino,Cyclosporine)

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16
Q

What do you see on mitral and tricuspid inflow velocities on Echo (E wave) in constrictive pericarditis?

A

Respiratory flow variation

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17
Q

On echo in constrictive pericarditis,what is the septum doing?

A

Diastolic bounce

18
Q

What do the atria look like on echo in constrictive pericarditis?

A

Dilated despite TR/MR

19
Q

What is a normal pericardial thickness?

What is the abnormal pericardial thickness?

A

2 mm

> 4mm

20
Q

Ventricular interdependence

A

Constrictive pericarditis

21
Q

What is the PASP usually in constrictive pericarditis? Restrictive pericarditis?

(PASP=pulmonary arterial systolic pressure)

A

Constrictive <50

Restrictive >80

22
Q

The number one reason to suspect constriction

A

LV/RV interdependence

23
Q

What pattern will MV inflow have on echo in constrictive pericarditis?

A

Restrictive pattern

24
Q

3 factors that deme a worse prognosis s/p pericardiectomy for constriction?

A

Age, NYHA class,post radiation as cause

25
Q

First line agents to treat acute pericarditis

A

NSAIDS (GI cover), Colchicine

26
Q

Diagnostic criteria for post pericardiotomy syndrome

A 
2 of the following:
Pleuritic chest pain
Friction rub
Pleural effusion
New or worsening pericardial effusion
Fever >1 week post op
27
Q

Definition of myoperucarditis

A

Elevation of cardiac enzymes or new LV dysfunction

28
Q

What population is more prone to get myopericarditis?

A

Male age<40

29
Q

Definition of pulses paradoxus (temponade)

A

Inspiratory decrease in SBP>10

30
Q

What causes false positive result for pulsus paradoxus,making you think that there is temponade?

A

COPD,PE,Constrictive pericarditis

P * 3

31
Q

What causes false negative to constrictive pericarditis?

A

LVH,AI,ASD,VENTricular localized effusion,severe hypotension

32
Q

Treatment t of temponade

A

IVF,I tropes/vasopressors if hypotension persists, pericardiocentasis,avoid vent

33
Q

What is appearance of Y descent in constrictive pericarditis?

A

Prominent

34
Q

Increased RAP,prominent Y descent,tachycardia

Most likely diagnosis?

A

Constrictive pericarditis

35
Q

Description of constrictive pericarditis

A

Obliterated pericardial space and adhesive pericarditis

36
Q

What sxs will patient get in constrictive pericarditis is RA=LA are 10 mmHg?

A

Hepatosplenomegaly, oedema

37
Q

What sxs will patient get in constrictive pericarditis is RA=LA are >18 mmHg?

A

Dyspnoea,orthophosphate

38
Q

What stage of cardiac cycle do restrictive and constrictive CM affect mainly?

A

Diastole

39
Q

What is the systolic function (usually)in restrictive and constrictive pericarditis?

A

Normal

40
Q

What is the kussmaul’s sign?

A

Elevated JVP on inspiration

Seen in constrictive pericarditis

41
Q

What is friedrich’s sign and what dz state it is seen in?

A

Prominen Y descent

Constrictive pericarditis

MRCP PART ONE CARDIOLOGY (1 decks)

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