Pericardial Disease Lecture Powerpoint

Question 1

• Infectious pericarditis is usually ___ in origin
• Idiopathic pericarditis is the _____ type
• Inflammatory pericarditis is usually due to _____
• Constrictive pericarditis is due to _______

Answer 1

Viral
Most common
Autoimmunity
Fibrosis

Question 2

If you diagnose pericarditis in a female, think about…

Answer 2

….other connective tissue disorders as the origin (RA, sarcoidosis, lupus)

Question 3

Pericarditis signs and symptoms (3)

Answer 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

Question 4

Pericarditis has the potential to sequellae into ____ requiring ____

Answer 4

cardiac tamponade, pericardiocentesis of fluid

Question 5

Becks triad for acute cardiac tamponade

Answer 5

• low arterial bp
• increased central venous pressure
• distant heart sounds (muffled)

Question 6

Kussmaul’s sign

Answer 6

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

Question 7

Best diagnostic test for pericrditis and finding on that test indicating positive result

Answer 7

EKG - diffuse ST elevation across all leads except AVR (fuck AVR man it don’t do shit)

Question 8

Chest x ray findings for pericarditis

Answer 8

“water bottle” heart (can’t tell where the pericardium ends and where the heart begins but the shape is helpful to diagnose)

Question 9

Neoplasm causing rapid inflammatory pericarditis is at elevated risk for ___, why?

Answer 9

tamponade, there is decreased time for pericardial sac to adjust to volume changes resulting in increased risk of tamponade occurring

Question 10

Post MI pericarditis

Answer 10

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

Question 11

Dressler’s syndrome will have ___ pericardial effusions, and how often does it cause tamponade? When does it occur?

Answer 11

Large, rare, occurs weeks to months*** after MI or open heart surgery

Question 12

1 cause of constrictive pericarditis

Answer 12

Cardiac surgery

Question 13

Chest X ray is particularly useful at visualizing ____ pericarditis

Answer 13

Constrictive (can see the calcifications)

Question 14

Treatment for constrictive pericarditis

Answer 14

-Pericardiectomy

Question 15

Myocarditis common causes (4)

Answer 15

• rare but seen in young men with unexplained new onset of cardiac abnormalities
• viral
• bacterial (immunocompromised)
• fungal (immunocompromised)

Question 16

Most common viral cause of myocarditis

Answer 16

-coxsackie virus B

Question 17

Common causes of bacterial and fungal myocarditis (3 of each)

Answer 17

• chlamydia
• mycoplasma
• sreptococcus
• Aspergillus
• candida
• cryptococcus

Question 18

Common environmental exposures resulting in myocarditis (3)

Answer 18

• chemo
• heavy metals
• alcohol

Question 19

Myocarditis signs and symptoms (2)

Answer 19

• recent URI history

- cardiomegaly on CXR with pulmonary edema (diff from pericarditis)

Question 20

When I say diffuse ST segment elevation you say ___. When I say nonspecific ST segment changes you say ____

Answer 20

pericarditis, myocarditis

Question 21

1 diagnostic study of myocarditis

Answer 21

Cardiac MRI

Question 22

Elevated BNP levels indicates…

Answer 22

….presence of heart failure

Question 23

Acute vs subacute/chronic signs of myocarditis

Answer 23

• Acute includes fever and signs of CHF,

- subacute/chronic will see cardiomegaly (indistinguishable from dilated cardiomyopathy) without signs of HF

Question 24

Myocarditis treatment (3)

Answer 24

• diuretics
• dobutamine or dopamine (inotropic agents)
• ACE inhibitors

Question 25

Bed rest and myocarditis

Answer 25

-Not recommended to remain in bed but do not recommend exercise or exert self

Question 26

Myocarditis will NOT see development of ____ on an EKG, differentiating it from MI

Answer 26

Q waves

Question 27

Myocarditis prognosis

Answer 27

Good for acute cases treated early and mild cases

Question 28

Acute episodes of pericarditis are usually treated with ____, while chronic episodes might be treated with ___

Answer 28

NSAIDs, prednisone

Question 29

Constrictive pericarditis

Answer 29

Thickened, fibrotic adherant pericardium due to injury (surgery) or infection that causes restricted diastolic filling