Pericardial Disease Flashcards
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:
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
etiologies of pericarditis
- idiopathic
- post-viral
- post MI
- autoimmune
- uremia
- radiation
- drugs
- malignancy
Two ECG changes that would indicate pericarditis
- ST elevation that is concave upwards
- PR depression
pericarditis complications includes pericardial ___ or ___ as well as recurrences
pericardial tamponade or constriction
3 main treatments for pericarditis
- high dose ASA
- NSAIDS
- colchicine (reduces recurrence)
PLUS TREAT UNDERLYING CONDITION IF PRESENT
An abnormal accumulation of pericardial
fluid is known as ___ ___
pericardial effusion
most common malignancy to cause pericardial effusion
- lung cancer, breast cancer and lymphoma
etiologies of pericardial effusion
during pericardial effusion, when are you most likely to witness intrapericardial pressure increase?
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.
Pericardial Effusion symptoms
Symptoms • None • Dyspnea • +/- chest pain • Edema
How does pericardial effusion affect:
- heart rate?
- BP?
- JVP?
- Heart sounds?
HR= tachycardia
BP= low BP+ pulsus paradoxus. Jvp = elevated
heart sounds = quiet
Becks triad for pericardial effusion
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.
Why is JVP elevated in pericardial effusion?
- 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.
gold standard test for pericardial effusion
- ECHOCARDIOGRAM
- PE
- CT/MRI and cxt may help rule things out
pericardial sac is fluid filled– pericardial effusion
tamponade symptoms:
what is pulsus paradoxus
Drop in blood pressure on inspiration of >
10 mmHg.
would would you see on ECG if someone had pericardial tamponade?
- sinus tachycardia but LOW VOLTAGE.
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
Etiologies of pericardial disease
symptoms that would indicate pericardial constriction
- low cardiac output: fatigue, dysnea, exercise intolerance
- elevated right sided filling pressure– edema, ascites
outline the normal JVP contours
pericardial tamponade, effusion, constriction?
contriction. the walls of the pericardium are stiff–almost look calcified
