Pericardial Disease

Question 1

Pericardial contains 2 layers

Answer 1

1. Fibrous layer

2. Serous layer

Question 2

Serous layer is divided into

Answer 2

1. Visceral layer and parietal layer

Question 3

Which layer adheres to the heat surface? What about the one that adheres to the fibrous layer?

Answer 3

Heart structure- visceral

Fibrous layer- parietal

Question 4

Function of the pericardium

1. Maintains _________ thus limiting acute expansion of chambers ‘
2. Creates a closed chamber with sub atmospheric pressure that aids
3. How does it protect the heart from infections?
4. What else

Answer 4

1. Ventricular compliance
2. Aids atrial filling and lowers trans mural pressure
3. Barrier
4. Anatomically fixes the position of the heart within the chest activity

Question 5

What do we see in EKG with pericarditis that is different in other diseases

Answer 5

Diffuse ST segment elevation and PR segment depression

Question 6

Pericardial effusion with unstable hemodynamics

Answer 6

Pericardial tamponade

Question 7

Pericardial tmaponade ekg findings

Answer 7

Low voltage, electrical alternans

Question 8

Water bottle chest x-ray

Answer 8

Pericardial effusion

Question 9

Becks triad

Answer 9

1. Hypotension
2. Elevated jugular venous pulse
3. Muffled heart sounds

Question 10

what happens to the pressure during inspiration in the pericardium

Answer 10

drops leading to a fall in right heart pressure and increased venous return to right heart

Question 11

pericardial diseases

Answer 11

1. congenital absence
2. pericardial cyst
3. inflammatory disorders
4. pericardial hemorrhage
5. neoplasms

Question 12

inflammation of the pericardium

Answer 12

pericarditis

Question 13

pericarditis ausculation

Answer 13

pericardial friction rub- scratchy, high-pitched sound

Question 14

treatment of pericarditis

Answer 14

Nonsteroidal antiinflammatory agents, colchicine

Question 15

pericardial tamponade

Answer 15

excess pericardial fluid - pericardial effusion

Question 16

pericardial tamponade can be caused by

Answer 16

pericarditis, malignancy or hemorrhage

Question 17

EKG finds in pericardial tamponade

Answer 17

low voltage, electrical alternans

Question 18

what do we see in the echo of a pericardial tamponade

Answer 18

• exaggerated respiratory variation of intracardiac flows, cardiac chamber collapse, dilated inferior vena cava

Question 19

signs of a pericardial tamponade

Answer 19

1. pulsus paradoxus
2. Beck’s triad
3. tachypnea
4. tachycardia

Question 20

pericardial tamponade hemodynamics:

1. CVP: sharp ___ descent (atrial relaxation) and a blunted ____ descent (restricted emptying of right atrium due to RV diastolic resistance to filling)
2. equalization of
3. decreased (2)
4. exaggerated respiratory variation in __________

Answer 20

1. sharp x and blunted y descent
2. equalization of diastolic intracardiac and intrapericardial pressures
3. decreased (1) CO and (2) stroke volume
4. trnasvalvular flows

Question 21

what is the outcome of pulsus paradoxus

Answer 21

decreased left heart filling during inspiration

Question 22

Pulsus paradoxus

1. _____ drop in systolic blood pressure with inspiration
2. inspiratory increase in venous return to right heart
3. increased pericardial pressure leads the right heat unable to
4. right ventricle expands at the expense of the left thereby sifting the septum to the
5. pulmonary venous bed remains
6. reduction in

Answer 22

1. > 10 mmHg
2. intacts
3. expand
4. shift to left
5. remains compliant
6. reduction in LV filling

Question 23

puslus paradox may be absent in some cases of tamponade

Answer 23

yep such as localized effusion or ASD

Question 24

pulsus paradox can also be seen in

Answer 24

RV infarction, PE

Question 25

treatment of pericardial effusion

Answer 25

1. pericardiocentesis
2. surgical drainage
3. pericardial window if recurrent

Question 26

constrictive pericarditis

Answer 26

pericadial inflammation with thickened noncompliant pericardium

Question 27

common causes of constrictive pericarditis

Answer 27

1. post-cardiac surgery

2. infection

Question 28

signs of constrictive pericarditis

Answer 28

1. elevated JVP
2. prominent y descent
3. kussmaul’s sign
4. pericardial knock
5. sys. venous congestion

Question 29

constrictive pericarditis DX:

1. CXR
2. echo
3. CT scan
4. MRI

Answer 29

1. CXR- pericardial calcification
2. echo- interventricular septal shift
3. CT- pericardial thickening
4. MRI- thickening and shift

Question 30

constricitive hemodynamics

1. prominent ____ descent of right atrial pressure due to rapid early diastolic flow from high pressure right atrium to the right ventricle
2. filling pressures are
3. equalization of
4. sign

Answer 30

1. y descent
2. elevated filling pressures
3. equalizations of pressures in all 4 chambers
4. square root sign- dip and plateau

Question 31

constrictive pericarditis treatment

Answer 31

1. diuretics

2. surgery for refractory symptoms