Pericardial Disease

Question 1

pericarditis is the inflammation of the pericardial layers and is characterized by sharp, pleuritic chest discomfort. it is classically improved by ___ ___. On PE, you may hear a:

Answer 1

pericarditis is the inflammation of the pericardial layers and is characterized by sharp, pleuritic chest discomfort. it is classically improved by SITTING UP. On PE, you may hear a: FRICTION RUB

Question 2

etiologies of pericarditis

Answer 2

1. idiopathic
2. post-viral
3. post MI
4. autoimmune
5. uremia
6. radiation
7. drugs
8. malignancy

Question 3

Two ECG changes that would indicate pericarditis

Answer 3

1. ST elevation that is concave upwards
2. PR depression

Question 4

pericarditis complications includes pericardial ___ or ___ as well as recurrences

Answer 4

pericardial tamponade or constriction

Question 5

3 main treatments for pericarditis

Answer 5

1. high dose ASA
2. NSAIDS
3. colchicine (reduces recurrence)

PLUS TREAT UNDERLYING CONDITION IF PRESENT

Question 6

Question 7

An abnormal accumulation of pericardial
fluid is known as ___ ___

Answer 7

pericardial effusion

Question 8

most common malignancy to cause pericardial effusion

Answer 8

• lung cancer, breast cancer and lymphoma

Question 9

etiologies of pericardial effusion

Answer 9

Question 10

during pericardial effusion, when are you most likely to witness intrapericardial pressure increase?

Answer 10

if there is a lack of pericardial compliance. Fluid accumulation will cause pressure to build up.

if there is enough pericardial compliance– ex/ if the accumulation of fluid is slow enough for the pericardium to stretch and get used to the volume, it is less likely to increase pressure.

Question 11

Pericardial Effusion symptoms

Answer 11

Symptoms • None • Dyspnea • +/- chest pain • Edema

Question 12

How does pericardial effusion affect:

1. heart rate?
2. BP?
3. JVP?
4. Heart sounds?

Answer 12

HR= tachycardia

BP= low BP+ pulsus paradoxus.
Jvp = elevated

heart sounds = quiet

Question 13

Becks triad for pericardial effusion

Answer 13

low BP

elevated JVP (. Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity and the increased volume afforded to right ventricular expansion during diastole. Kussmaul sign suggests impaired filling of the right ventricle due to a poorly compliant myocardium or pericardium.)

muffled/quiet heart sounds.

Question 14

Why is JVP elevated in pericardial effusion?

Answer 14

• normally JVP falls on inspiration because the pressures in the thoracic cavity fall when the lungs expand.

if there is pericardial effusion putting pressure on the lungs, there is more pressure on the lungs even during inspiration

thus, the JVP will not fall, it will remain elevated

this is Kaussmans sign

. Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity and the increased volume afforded to right ventricular expansion during diastole. Kussmaul sign suggests impaired filling of the right ventricle due to a poorly compliant myocardium or pericardium.

Question 15

gold standard test for pericardial effusion

Answer 15

1. ECHOCARDIOGRAM
2. PE
   - CT/MRI and cxt may help rule things out

Question 16

Answer 16

pericardial sac is fluid filled– pericardial effusion

Question 17

what is pericardial tamponade?

Answer 17

A pericardial effusion that has
accumulated under pressure, and is
limiting cardiac chamber filling by
compressing the underlying chambers
• Results in low-output, hypotension,
tachycardia, jugular venous distention
• Life-threatening

Question 18

tamponade symptoms:

what is pulsus paradoxus

Answer 18

Drop in blood pressure on inspiration of >
10 mmHg.

Question 19

would would you see on ECG if someone had pericardial tamponade?

Answer 19

• sinus tachycardia but LOW VOLTAGE.

Question 20

treatment for pericardial tamponande

Answer 20

drain all the fluid causing pressure

Question 21

Question 22

this happens when there is compression of the cardiac chambers by a stiff and contracted pericardium. It results in elevated and equal pressures in the cardiac chambers and results in low stroke volume and therefore low cardiac output

Answer 22

Question 23

Etiologies of pericardial disease

Answer 23

Question 24

symptoms that would indicate pericardial constriction

Answer 24

• low cardiac output: fatigue, dysnea, exercise intolerance
• elevated right sided filling pressure– edema, ascites

Question 26

outline the normal JVP contours

Answer 26

Question 27

pericardial tamponade, effusion, constriction?

Answer 27

contriction. the walls of the pericardium are stiff–almost look calcified

Question 28

treatment of pericardial stiffening/constriction

Answer 28

• treat underlying process (ex could be caused by TB or sarcoid)
• pericardial stripping: especitally if it’s getting super fibrotic

Question 29

In a patient presenting with pericardial effusion, which of the following signs would suggest raised intrapericardial pressure?
A. Low JVP

B. Increased BP

C. Low oxygen saturations

D. Pulsus paradoxus

E. S4

Answer 29

A. Low JVP –> would have elevated JVP

B. Increased BP –> low BP because ventricles can’t expand as much as they usually do

C. Low oxygen saturations –> not reliable

D. Pulsus paradoxus YES

E. S4–> no, usually would just have quiet heart sounds

Question 30

In a patient presenting with increased JVP, low BP and quiet heart sounds, which of the following tests would most likely yield a diagnosis?
A. CXR

B. ECG

C. ABG

D. Ddimer

E. Echocardiogram

Answer 30

A. CXR

B. ECG

C. ABG

D. Ddimer

E. Echocardiogram