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S2B4: MEDI > Pericardial Disease > Flashcards

Pericardial Disease Flashcards

1
Q

What time period indicats acute pericarditis? What are the types?

Why time period indicates subacute pericarditis? What are the types?

What time period indicates chronic percarditis? What are the types?

A
  • Acute pericarditis (<6 weeks)
    • fibrinous
    • effusive (serous or sanguineous)
  • Subacute pericarditis (6 weeks to 6 months)
    • effusive-constrictive
    • constrictive
  • Chronic pericarditis > 6 months
    • constrictive
    • effusive
    • adhesive (nonconstrictive)
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2
Q

What are the 3 differentials to consider for pericarditis?

A
  1. Infectious pericarditis
  2. Noninfectious pericarditis
  3. Pericarditis presumable related to hypersensitivity or autoimmunity
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3
Q

What etiological causes are you considering when screening for viral pericarditis?

A
  • infectious pericarditis
    • viral (Coxsackievirus A and B, echovirus, mumps, adenobirus, hepatitis, HIV)
    • pyogenic (pneumococcus, streprococcus, staphylococcus, neisseria, Legionella)
    • Tuberculosis
    • Fungal (histoplasmosis, coccidiodomycosis, Candida, blastomycosis)
    • other infections (syphilic, protozoal, parasitic)
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4
Q

What are the 14 causes you are considering when screening for noninfectius pericarditis?

A
  • Noninfectious pericarditis (more common than infectious)
    1. acute myocardial infarction
    2. uremia
    3. neoplasia
      1. primary tumors
      2. metastatic tumors to pericardium
    4. myxedema
    5. cholesterol
    6. chylopericardium
    7. trauma
      1. penetrating chest wall
      2. nonpenetrating
    8. aortic dissection (with leakage into pericardial sac)
    9. post-radiation
    10. familial mediterranean fever
    11. familial pericarditis
      1. mulbery nanism
    12. acute idiopathic
    13. Whipples disease
    14. Sarcoidosis
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5
Q

What causes are you considering when the pericarditis is presumably related to hypersensitivity or autoimmunity reactions?

A
  • pericarditis presumably related to hypersensitivity or autoimunity
    • rheumatic fever
    • Collagen vascular disease (lupus, rheumatoid arthritis, ankylosing spondylitis
    • drug-induced (procainamide, hydralazine, phentoin, isoniazid, minoxidil, anticoagulants, methysergide)
    • post cardiac injury
      • post myocardial infarction
      • postpericardiotomy
      • post-traumatic
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6
Q

Identify the indicated features of the pericardium

A
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7
Q

What are the 9 majore causes of pericardial disease?

A
  1. idiopathic
  2. infectious
  3. radiation
  4. neoplastic
  5. cardiac
  6. trauma
  7. autoimmune
  8. drug
  9. metabolic
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8
Q

What diagnostic studies would be use to detect pericardial effusion?

A
  • Chest X-Ray
    • Normal if effusion is small
    • if >250mL, the heart changes shape
      • “water bottle heart”
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9
Q

Radiation can lead to what type of pericarditis?

The amount of radiation is directly proportional to what variable??

A

restrictive pericarditis (acts like tamponade, but no fluid)

directly related to the amout of effusion

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10
Q

What are the most common causes of neoplastic pericardial effusion?

A
  • Metastatic
    • lung, breast, Hodgkin’s, leukemia, lymphoma
  • Primary (rare)
    • rhabdomyosarcoma, teratoma, fibroma, lipoma
  • Paraneoplastic
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11
Q

What is hemorrhagic pericarditis?

When does hemorrhagic pericarditis most commonly occur?

A

blood in the pericardium

  • Commonly after cardiac surgery
  • Malignancy
  • Tuberculosis
  • Systemic anticoagulation
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12
Q

Most common cause of pericarditis in:

young, otherwise healthy people?

A

Lupus

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13
Q

Most common cause of pericarditis in:

fever, cytopenias

A

viral

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14
Q

Most common cause of pericarditis in:

elderly, with history of cancer

A
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15
Q

Most common cause of pericarditis in:

MI about a month ago

A

Dressler’s

will take about a month for fluid to accumulate after a MI

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16
Q

Most common cause of pericarditis in:

CKD, not on dialysis

A

uremic

17
Q

Which types of pericardial effusions hurt?

Which types do not hurt?

A

Infectious and inflammatory hurt

uremic and malignant don’t hurt

18
Q

What cause of pericarditis is common elsewhere in the world, but uncommon in the US?

A

tuberculosis

19
Q

What testing woudl we order of pericardial fluid?

A
  • culture(s), gram-stain
  • Viral PCR/viral culture
  • cell count
  • Protein
  • LDH Glucose
20
Q

Fill out the provided table

How would you describe the characteristics of exudative fluid vs. transudative fluid?

A
  • Transudative
    • serous, watery, thin, hypocellular compared to exudative
  • Exudative
    • high protein, thick, puss, more LDH relative to blood, low glucose
21
Q

THe pericardium is contiguous with what spaces?

Why is this important?

A

pericardium is contiguous withthe retropharyngeal space (between the alar fascia and prevertebral fascia)

Abcess can track

22
Q

Describe the diagnostic approach you would take if someone showed up with a painful pericardial effusion.

A
  1. Echocardiogram
    • may find pericardial effusion
  2. If reason to believe TB, perform a PPD
  3. Connective tissue screen
    1. ANA (antinuclear antibody–autoimmune disorder0, rheumatoid factor
    2. SED rate (looking for body-wide inflammation)
  4. If fluid, not uncommon to see mild elevations in cardiac enzymes: troponin (released when heart is damaged), total CPK(injury/stress), CPK-MB (found primarily in the heart)
  5. Search for cancer
    1. lung & breast
  6. Do a chest X-ray and breast exam
23
Q

Pericardial friction rub is present in what percent of acute pericarditis?

In what position is this most prominent?

A

85%

End-expiration, leaning forward, upright position

Heart sounds may be distant

24
Q

What are the 5 treatments for pericarditis?

A
  • Treat underlying cause
    • lupus, cancer, sarcoidosis, uremia
  • NSAIDS
    • ketorolac, naproxyn, ibuprofen, indomethacin
  • Aspirin
  • Colchicine
  • Limited by renal / GI safety - steroids also effective
25
Q

What are symptoms that would suggest cardiac tamponade?

If cardiac tamponade is suspected, what should you do?

A
  • hypotension
  • tachycardia (before hypotension)
  • Jugular venous distent
  • Right ventricular compression on echo
  • IVC distension on echo, without respiratory phasic collapse
  • may occur with only minimal effusion
  • don’t wait for the echo - get help immediately
26
Q

This echo is performed from what view?

Identify the indicated features

A

Parasternal long axis view

27
Q

What finding on an ECG is suspect for pericarditis?

A

universal ST elevation

28
Q

What finding on an ECG is suspect for pericarditis?

A

electrical alternans

29
Q

In what situations would you perform a pericardiocentesis?

In which situations would you not?

A

Attempt if patient is unstable & tamponading

NOT if patient is stable

30
Q

When performing a pericardiocentesis with the assistance of an ECG, what does the elevated ST indicate?

A

that the needle is touching the heart and you need to back it up

S2B4: MEDI (6 decks)

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