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Pericardial Disease Flashcards

1
Q

Hemodynamic findings in tamponade

A

Equalization of LV and RV pressures

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2
Q

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

A

CM, constriction or tamponade

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3
Q

Where can pericarditis pain radiate to?

A

Trapezius

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4
Q

What is the yield of serologic studies in acute pericarditis?

A

Low

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5
Q

COPE trial results for acute pericarditis

A

Colchicine reduced recurrence rates vs placebo

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6
Q

2 side effects of colchicine

A

Diarrhea

Bone marrow suppression

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7
Q

Can colchicine be given in renal or hepatic dysfxn?

A

No

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8
Q

In what case are colchicine’s side effects pronounced?

A

Interaction with CYP3A4 drugs (CCB, Amio, cyclosporine)

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9
Q

Steroids should be avoided in acute pericarditis unless …?

A

Contraindications to colchicine
Connective tissue dz
Uremic pericarditis

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10
Q

Diagnostic criteria for post-pericardiotomy syndrome?

A

2 of the following:

Pleuritic CP, friction rub, pleural effusion, new or worsening pericardial effusion, fever > 1wk postop

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11
Q

Definition of myopericarditis

A

Elevation of cardiac enzymes or new LV dysfxn

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12
Q

What population is prone to get myopericarditis?

A

Male age<40

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13
Q

definition of pulsus paradoxus (Tamponade)

A

inspiratory decrease in SBP >10

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14
Q

what causes false positive results for pulsus paradoxus, making you think there is tamponade?

A

COPD, PE, constriction

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15
Q

what causes false negatives for pulsus paradoxus?

A

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

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16
Q

Rx of tamponade

A

IVF, inotropes/vasopressors if hypotension persists, pericardiocentesis, avoid vent

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17
Q

what is appearance of Y-descent in constrictive pericarditis?

A

prominent

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18
Q

inc’d RAP, prominent y-descent, tachycardia. Most likely Dx?

A

constrictive pericarditis

19
Q

description of constrictive pericarditis

A

obliterated pericardial space and adhesive pericarditis

20
Q

top 5 etiologies behind constrictive pericarditis

A

idiopathic, prioir cardiac Sx, pericarditis, mediastinal radiation, CTD

21
Q

what sxs will pt get in constrictive pericaditis if RA = LA are 10mmHg?

A

hepatomegaly, edema

22
Q

what sxs will pt get in constrictive pericaditis if RA = LA are > 18mm Hg?

A

dyspnea, orthopnea

23
Q

what stage of cardiac cycle do restrictive and constrictive CM effect mainly?

A

diastole

24
Q

what is the systolic function (usually) in constriction or restriction?

A

normal

25
Q

what is the Kussmaul sign and what dz state is it seen in?

A
  • elevated JVP on inspiration

- constrictive pericarditis

26
Q

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

A
  • prominent Y descent

- constrictive pericarditis

27
Q

what do you see on mitral and tricuspid inflow velocities on echo (E wave) in constrictive pericaditis?

A

respiratory flow variation

28
Q

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

A

diastolic bounce

29
Q

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

A

dilated despite TR/MR

30
Q

what is an abnormal pericardial thickness?

A

> 4mm

31
Q

ventricualr interdependence

A

constriction

32
Q

what is the PASP usually in constrictive pericarditis? restrictive?

A

constrictive PASP < 50

Restrictive PASP > 80

33
Q

the number one reason to suspect constriction

A

LV/RV interdependence

34
Q

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

A

restrictive pattern

35
Q

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

A

age, NYHA class, post-radiation as cause

36
Q

First line agents to treat acute pericarditis

A

NSAIDs and colchicine

37
Q

when do you give corticosteroids for acute pericarditis? why?

A
  • refractory cases or contraindications to first line therapy
  • b/c of higher rate of recurrent pericarditis
38
Q

dissociation of intra-thoracic and intra-cardiac pressures

A

constrictive pericarditis

39
Q

what is LVEDP-RVEDP in constriction?

A

<5mmHg

40
Q

what is PASP in constriction?

A

<55mmHg

41
Q

RVEDP/RVSP in constriction

A

> 1/3

42
Q

if LVEDP-RVEDP > 5mmHg and RVEDP/RVSP < 1/3 and PASP > 55, is it constriction or restriction?

A

restriction

43
Q

Jugular venous exam finding in tamponade

A

Blunted or absent y descent

` (31 decks)

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