Pericardial Disease Flashcards
Mono layer of mesothelioma cells and collagen and elastin fibers adherent to the pericardial surface of the heart
Visceral pericardium
2mm thick, and largely acellular and contains collagen and elastin fibers
Fibrous parietal pericardium
Fixes the heart within the mediastinum and limits its motion
Pericardium
Pericardial inflammation of no more than 1 to 2 weeks duration that can occur in a variety of diseases but most cases are considered idiopathic
Acute pericarditis
Most idiopathic pericarditis cases are presumed to be
Viral
What are the 4 clinical features of acute pericarditis?
Pleuritic chest pain, pericardial friction rub, fever, and ECG abnormalities
Relieved by sitting forward and worsened by lying down
Pleuritic chest pain
Made up of three components, ventricular systole, early diastolic filling, and atrial contraction
Pericardial friction rub
How do we treat relapsing and recurrent pericarditis?
NSAIDs, colchicine, and prednisone
Up to 60% of infectious etiologies of pericarditis cause a late scarring complication called
-Uncommon after viral pericarditis
Constrictive pericarditis
Most cases of pericarditis respond to treatment with an
NSAID and Colchicine
Should be avoided in treating pericarditis
Glucocorticoids
Idiopathic pericarditis or any infection, neoplasm, autoimmune, or inflammatory process that can cause pericarditis can also cause a
Pericardial effusion
Collection of fluid between visceral and parietal pericardium
Pericardial effusion
Soft heart sounds and reduced intensity of pericardial friction rub are the clinical features of
Pericardial Effusion
Dullness over posterior left lung that is indicative of pericardial effusion
Edward sign
An ECG characteristic of pericardial effusion is
Electrical alternans (an alternating between QRS amplitudes)
When fluid accumulates in the pericardial space under high pressure, compresses the cardiac chambers, and comprises cardiac output
Cardiac Tamponade
The primary effect of high pericardial pressure in cardiac tamponade is to impede filling of the
Right side of the heart
Characterized by elevated and equal interactivity pressures w/ low transmural filling pressures and low cardiac volumes
Cardiac Tamponade
Shows loss of the Y descent of right atrial or systemic venous pressure wave
Cardiac tamponade
Pulses paradoxus is indicative of
Cardiac Tamponade
Normally begins when the tricuspid valve opens, i.e. when blood is not leaving the heart
Y descent
In cardiac tamponade, blood can only enter the heart when blood is also simultaneously
Leaving
Therefore, in tamponade, inflow can not increase until blood is also leaving so we lose
Y descent
Occurs during ventricular ejection
X descent
Thus, in tamponade, because blood is leaving the heart, inflow can increase and thus
X is maintained
The phenomenon of systolic BP declining slightly following inspiration
Pulsus Parodoxus
In cardiac tamponade, both ventricles share a fixed volume due to the external compression by the tense pericardial fluid. This we see an exaggeration of
Pulsus Paradoxus
Can be caused by pericarditis or acute hemorrhage into the pericardium
Cardiac Tamponade
What are the two major features of cardiac tamponade
Beck’s triad and pulsus paradoxus
What is Beck’s triad?
Hypotension, muffled heart sounds, and elevated JVP
To treat cardiac tamponade, we want to perform and urgent or emergency closed
Pericardiocentesis
Until pericardiocentesis can be performed, we want to give IV saline and
Isoproterenol
The end stage of an inflammatory process involving the pericardium, resulting in dense fibrosis, calcification, and adhesion of parietal and visceral pericardium
Constrictive pericarditis
The pathophysiological consequence of constrictive pericarditis is markedly restricted
Filling of Heart
In constrictive pericarditis, almost all filling occurs early in
Diastole
Results in systemic venous congestion which results in hepatic congestion’s, peripheral edema, ascites, anasarca, and cardiac cirrhosis
Constrictive pericarditis
Failure of transmission of changes in intrathoracic pressure to the cardiac chambers is an important contributor to the pathophysiology of
Constrictive Pericarditis
W/ constrictive pericarditis, the decrease in intrathoracic pressure on inspiration is transmitted to the pulmonary veins but not to the
Left side of the heart
In constrictive pericarditis, the high systemic pressures and reduced cardiac output result in the kidneys retaining
Sodium and water
Characterized by reduced CO, elevated systemic venous pressures, pericardial knock, and Kussmaul sign
Constrictive pericarditis
An early diastolic sound heard best at the LLSB and or cardiac apex
Pericardial knock
Inspiration increase in venous pressure
Kussmaul sign
When differentiating between constrictive pericarditis and cardiac tamponade, what is highly indicative of cardiac tamponade?
Pulsus Paradoxus
When differentiating between constrictive pericarditis and cardiac tamponade, what is highly indicative of constrictive pericarditis?
Kussmaul sign
In JVP recordings, the
- ) y descent is lost in?
- ) y descent is normal in?
- ) Tamponade
2. ) Constrictive pericarditis
We also must differentiate between constrictive pericarditis and
Restrictive cardiomyopathy (e.g. amyloid)
