Pericardial disease Flashcards
What are the four clinical syndromes of pericardial disease?
Pericarditis
Pericardial effusion
Pericardial tamponade
Constrictive pericarditis
What is the structure overlying the heart below?
What the alleged functions of the structure (3). True/False: people can be born without it and live just fine
The structure has 2 sacs, namely ___ and ___
Pericardium
Alleged functions of the structure (3):
Fixes heart within mediastinum and limits motion
Prevents extreme dilatation
Acts as barrier to spread of infection
True apparently: people can be born without it and live just fine
The structure has 2 sacs, namely inner (visceral pericardium) and outer fibrous layer
**note that intrapericardial pressure increases by 5mmHg and decreases by 5mmHg during expiration and inspiration, respectively
The most common causes of acute pericarditis can be grouped as __ and __
The most common causes of acute pericarditis can be grouped as infectious and non-infectious
The most common infectious cause of acute pericarditis is ___
Others are ___ (hint: both bacterial)
The most common infectious cause of acute pericarditis is viral infection
Others are TB and pyogenic bacteria
Two of the most common viral cause of pericarditis are ___ and ___
Others are (4) ___
Two of the most common viral cause of pericarditis are echovirus and Coxsackie B virus
Others are Influenza, HIV, Hep B and Infectious mononucleosis (EBV)
Why are viral titers not helpful for determining cause of pericarditis?
By the time the results come back, the symptoms would have ablated
Describe the pathology (development of disease appearance) of pericarditis
Serofibrinous pericarditis: deposition of plasma proteins like fibrinogen covering the heart surface resulting in a rough and shaggy (bread and butter ) appearance
What is the pathology below?
Acute pericarditis
What are the pathologies below?
Left: viral pericarditis
Right: Fibrous strands that develop as tissue starts to heal
What are 4 clinical features of acute pericarditis?
Pleuritic Chest Pain (sharp pain that worsens with inspiration, may radiate to the back, relieved by sitting up, leaning forward)
Fever
Pericardial friction rub: “ 3 components” like creaking leather”
ECG abnormalities
A pericardial friction rub can be heard on auscultation as 3 sounds, namely __
A pericardial friction rub can be heard on auscultation as 3 sounds, namely high pitched and scratchy as, vs and vd sounds heard best with pt leaning forward (heard in atrial systole, ventricular systole and ventricular diastole)
What does the ECG for a pt with pericarditis look like? (2)
The ECG will have diffuse ST elevations (meaning that the elevations are everywhere in the EKG reading) and occassional PR depressions
A 56 year old male pt presents with chest pain worsening with breathing, and is relieved by sitting up and leaning forward. The pain radiates to the back and scapula. Upon auscultation, high pitched and scratchy as, vs and vd sounds are heard w/ the pt leaning forward. EKG reveals the reading below. Echo is normal. Lab tests are positive for TB.
What is the syndrome?
Pericarditis: EKG = diffuse ST elevations, +ve TB test, pattern of radiating, pleuritic chest pain
What is the treatment of pericarditis? (3)
Why would you avoid anti-coagulants in this pt?
It’s generally self-limiting (goes away in about 1-3 weeks)
Other Rx: bed rest and NSAIDs for pain relief
Avoid anticoagulants because they can cause pericardial bleeding
___ can cause pericarditis esp in immunocompromised pts due to reactivation
TB can cause pericarditis esp in immunocompromised pts due to reactivation
What are the causes of purulent pericarditis? (5)
Perforating trauma
Post surgical contamination
Extension of intracardiac infection
Extension of pneumonia
Hemathogenous spread
The bugs that most commonly cause purulent pericarditis are ___ (3)
The bugs that most commonly cause purulent pericarditis are:
Staph
Pneumococcus
Gram negative rods
What is the pathology below?
Bacterial pericarditis - shaggy fibropurulent exudate
The treatment for purulent pericarditis is ___
The treatment for purulent pericarditis is catheter drainage and antibiotics
(for TB cause - give anti-TB meds)
