Pericardial Disease Flashcards
How much serous fluid is usually between the heart and the pericardium
15-50 ml
How much fluid can the pericardium take on without creating too much of a change in the pericardial pressure?
200 ml
Common causes of pericardial effusion
viral myopericarditis, metastatic malignancy, autoimmune disease and renal failure
Symptoms of pericardial effusion
dull constant left chest ache, dyspnea, potential hiccups associated with phrenic nerve irritation, dysphagia (esophageal compression)
Whats wrong with a chest x-ray when diagnosing pericardial effusion
You can’t tell the effusion from cardiomegally. Better to get an echo
What might an electrocardiogram show with pericardial effusion?
decreased voltage of the QRS (a pattern of alternating large and small QRS complexes (electrical alternans)
Hemopericardium
can be caused by cardiac rupture after transmural myocardial infarction (typically around day 5). Frequently happens fast, thats why its fatal
Cardiac Tamponade
a condition of pericardial effusion or blood compressing the heart enough to impair filling and function
Sudden cardiac tamponade leads to
pts having altered mental status, dyspnea, potentially cv collapse and cardiac arrest
Slow Cardiac tamponade signs and symptoms
fatigue, leg edema, dyspnea on exertion
What are the three signs of cardiac tamponade (Beck’s Triad)
JVD, Muffled Heart SOunds, Hypotension
What will echo show
Diastolic collapse of right atrium and right ventricle
Pathologic pericarditis types
Serous, fibrinous, purulent, hemorrhagic, constrictive
Serous pericarditis
pericardium has a smooth surface and scant neutrophils, lymphocytes, and macrophages
Finbrinous pericarditis
Surface is dry, roughened, and shaggy, with more neutrophils, lymphocytes, and macrophages
Purulent Pericarditis
Red granular surface coated with pus, lots of subsurface neutrophils
Hemorrhagic pericarditis is just….
serous, fibrinous, or purulent pericarditis plus hemorrhage
Acute pericarditis
Most common disease of the pericardium…presumed to be viral but rarely proven to be viral, so purists call it idiopathic
Most common viruses associated pericarditis
Coxsackie and echovirus
Most common symptoms of pericarditis?
Sharp, pleuritic chest pain, improved by sitting up and leaning forward
Signs of pericarditis
Pericardial friction rub. ST segment Elevation
Primary pericarditis common or uncommon>
uncommon (usually due to a viral infection if it does occur). Usually it is secondary to MI.
acute viral pericarditis exudate is usually fibrinous imparting an irregular , shaggy, appearance to teh pericardial surface.
truth
Bacterial pericarditis usually has what appearance
pus filled
