Pericardial Disease Lecture Powerpoint Flashcards
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- Infectious pericarditis is usually ___ in origin
- Idiopathic pericarditis is the _____ type
- Inflammatory pericarditis is usually due to _____
- Constrictive pericarditis is due to _______
Viral
Most common
Autoimmunity
Fibrosis
If you diagnose pericarditis in a female, think about…
….other connective tissue disorders as the origin (RA, sarcoidosis, lupus)
Pericarditis signs and symptoms (3)
- sharp chest pain relieved by sitting and leaning forward
- rhythmic pericardial friction rub usually at the left lower sternal border not associated with respiratory rate
- Retrosternal pain radiating to neck, shoulders, back
Pericarditis has the potential to sequellae into ____ requiring ____
cardiac tamponade, pericardiocentesis of fluid
Becks triad for acute cardiac tamponade
- low arterial bp
- increased central venous pressure
- distant heart sounds (muffled)
Kussmaul’s sign
A rise in JVD with inspiration causing the jugular vein to rise up due to increased filling pressures, sometimes related to pericardial constriction, other times indicative of inferior wall MI
Best diagnostic test for pericrditis and finding on that test indicating positive result
EKG - diffuse ST elevation across all leads except AVR (fuck AVR man it don’t do shit)
Chest x ray findings for pericarditis
“water bottle” heart (can’t tell where the pericardium ends and where the heart begins but the shape is helpful to diagnose)
Neoplasm causing rapid inflammatory pericarditis is at elevated risk for ___, why?
tamponade, there is decreased time for pericardial sac to adjust to volume changes resulting in increased risk of tamponade occurring
Post MI pericarditis
Occurs 2-5 days*** (diff from dressler syndrome) after infarction due to inflammatory response to necrosis, will see symptoms of both post MI and pericarditis despite self resolving after period of time sometimes requiring pain management for small pericardial effusions
Dressler’s syndrome will have ___ pericardial effusions, and how often does it cause tamponade? When does it occur?
Large, rare, occurs weeks to months*** after MI or open heart surgery
1 cause of constrictive pericarditis
Cardiac surgery
Chest X ray is particularly useful at visualizing ____ pericarditis
Constrictive (can see the calcifications)
Treatment for constrictive pericarditis
-Pericardiectomy
Myocarditis common causes (4)
- rare but seen in young men with unexplained new onset of cardiac abnormalities
- viral
- bacterial (immunocompromised)
- fungal (immunocompromised)
Most common viral cause of myocarditis
-coxsackie virus B
Common causes of bacterial and fungal myocarditis (3 of each)
- chlamydia
- mycoplasma
- sreptococcus
- Aspergillus
- candida
- cryptococcus
Common environmental exposures resulting in myocarditis (3)
- chemo
- heavy metals
- alcohol
Myocarditis signs and symptoms (2)
- recent URI history
- cardiomegaly on CXR with pulmonary edema (diff from pericarditis)
When I say diffuse ST segment elevation you say ___. When I say nonspecific ST segment changes you say ____
pericarditis, myocarditis
1 diagnostic study of myocarditis
Cardiac MRI
Elevated BNP levels indicates…
….presence of heart failure
Acute vs subacute/chronic signs of myocarditis
- Acute includes fever and signs of CHF,
- subacute/chronic will see cardiomegaly (indistinguishable from dilated cardiomyopathy) without signs of HF
Myocarditis treatment (3)
- diuretics
- dobutamine or dopamine (inotropic agents)
- ACE inhibitors
Bed rest and myocarditis
-Not recommended to remain in bed but do not recommend exercise or exert self
Myocarditis will NOT see development of ____ on an EKG, differentiating it from MI
Q waves
Myocarditis prognosis
Good for acute cases treated early and mild cases
Acute episodes of pericarditis are usually treated with ____, while chronic episodes might be treated with ___
NSAIDs, prednisone
Constrictive pericarditis
Thickened, fibrotic adherant pericardium due to injury (surgery) or infection that causes restricted diastolic filling
