Pericardial diseases Flashcards
1
Q
Label the image
A
2
Q
What are the three layers of the pericardium?
A
- Fibrous Pericardium
- Serous Parietal Pericardium
- Serous Visceral Pericardium
3
Q
What is the pericardial/ epicardial fat?
A
Layer of fat anterior of the heart
4
Q
What does the Pericardial/ epicardial fat do? What does it mimic? What does it look like on U/S?
A
- Protects heart from blunt force trauma
- May mimic pericardial effusion
- Echogenic
5
Q
Pericardial cysts are usually what kind of finding?
A
Incidental
6
Q
Where are percardial cysts found?
A
Adjacent to the RT heart
7
Q
Pericardial cysts are better evaluated with what modality?
A
On CT/MR
8
Q
What is a pericardial effusion?
A
Increased amount of fluid within the pericardial space
9
Q
What is pericardial effusion usually caused by?
A
Irritation/ injury to pericardium
10
Q
What is Tamponade?
A
Marked or fast increased in fluid accumulation
11
Q
What does tamponade cause in terms of pressure?
A
Significant increase in intrapericardial pressure above intracardiac pressure, this compresses the heart and impairs its ability to fill
12
Q
What is pericarditis?
A
Inflammation of the pericardial surfaces
13
Q
What does pericarditis restrict?
A
Diastolic function
14
Q
What are signs and symptoms of pericardial effusions? 3
A
- Chest pain (hurts more when patients lie flat)
- SOB/ Dyspnea
- Possible Tamponade/ constrictive pericarditis S/S
15
Q
What does pericardial effusions look like on ECG?2
A
- Low voltage ECG (suggest large effusion)
- Electrical alternans
16
Q
What is electrical alternans caused by?
A
Swinging heart
17
Q
What does pericardial effusions look like on X-ray?
A
Enlarged cardiac silhouette or CXR
18
Q
What is the role of echo with Pericardial effusion? 6
A
- Spatial orientation
- Potential collapse of cardiac chambers
- Differentiation of pleural fluid
- Size of effusion
- Clear space or echoes within fluids
- Pericardial thickness
19
Q
What are two ways to describe Pericardial effusion?
A
- Location
- Chamber collapse
20
Q
How do we see circumferential pericardial effusions? 3
A
- Use SAX to see all around the heart
- Fluids tend to be dependent (posteriorly at first)
- Fluid will extend to the AV groove, Anterior to DA
21
Q
What does Loculated pericardial effusions look like?
A
May have separate areas of effusions separated by adhesions
22
Q
In terms of loculated pericardial effusions, microbubbles are used to show what?
A
Localized high interpericardial pressure
23
Q
What does pericardial effusions look like? 4 (where is it located)
A
- Anterior to descending aorta
- May sit anterior or posterior to the heart and can be circumferential
- Tapers at AV sulcus
- No respiratory change in size
24
Q
What does Pleural effusions look like? 4
A
- Only posterior to heart
- Posterior to descending aorta
- Changes with respiration
- Does not cause RV or RA collapse
25
Label the image
26
What are the classification of pericardial effusions? 4
1. Physiologic
2. Mild
3. Moderate
4. Large
27
Are Trace effusions Normal or Abnormal?
Normal
28
What does this image identify?
Notice the difference in size between systole/ diastole on the M-mode trace
29
Where does pericardial effusions occur in M mode?
An anechoic space between epicardium and pericardium
30
When would we measure pericardial effusions?
Diastole
31
What does pericardial effusions look like on M-mode?
Posterior wall lifts off the pericardial boarder in Systole as PW contracts (PLAX/PSAX)
32
Measuring Pericardial effusions when leads to over estimates?
During systole
33
In terms of pericardial effusions long standing effusions may have what?
Fibrinous strands that can be seen by echo
34
What does this image demonstrate?
Pericardial effusion
35
What does this image demonstrate?
Pericardial effusion
36
What does this image demonstrate?
Thin vs thick pericardium
37
What do we use doppler for in terms of pericardial effusions?2
1. Diastolic function assessment
2. Changes in LV and RV filling with respiration
38
In terms of looking at diastolic function assessment for Pericardial effusions what do we look at?
Impact of PE on LV and RV filling
39
What are some things we consider when looking at changes in LV and RV filling with Respiration? 3
1. Using MV and TV inflow profiles
2. Constrictive pericarditis vs restrictive cardiomyopathy
3. Tamponade VS constrictive pericarditis
40
What are some imaging considerations with PE?
2D errors
41
What are some 2D errors we see when imaging Pericardial effusions? 2
1. Gains to high
2. Image depth too shallow ( we may miss effusion)
42
What do we assess for in terms of pericardial effusion in terms of 2D?
Pseudoaneurysms of the LV
43
What 3 things are commonly mistaken for pericardial effusions on 2D?
1. Anterior epicardial fat
2. Dilated coronary sinus
3. Large pleural effusion
44
What does this image demonstrate in terms of Pericardial effusion?
In parasternal the beam transects the descending aorta, mistaken for posterior effusion
45
What is a hemopericardium?
Collection of blood in the pericardial sac
46
What does these images demonstrate?
Hemopericardium
47
Tamponade usually occurs with what?
Rapid fluid accumulation
48
Where is pressure higher with tamponade?
Higher pressure in intrapericardial cavity
49
What happens during cardiac tamponade?
Impairs the cardiac chamber filling, thus impairing the SV and CO
50
What is the outcomes for Tamponade?
Potentially life threatening depending on amount of fluid and time of accumulation
51
How common is subacute and chronic tamponade?
Common
52
How common is acute tamponade?
Less common
53
What are causes of pericardial tamponade? 3
1. Pericarditis
2. Metastatic disease
3. Radiation therapy
54
What are causes of acute tamponade?
Trauma
55
What is often seen with tamponade?
Fibrin strands
56
What happens in the right heart with Tamponade? 2
1. RA systolic collapse
2. RV diastolic collapse
57
What happens as a result of right chamber collapse during tamponade? 3
1. RV filling is impaired
2. Reciprocal RV/LV respiratory changes producing **septal shifting**
3. SVC and IVC become dilated
58
What are some 2D features of tamponade?4
1. RA systolic collapse
2. RV diastolic collapse
3. Reciprocal changes in ventricular volume with respiration variation
4. Septal shifting
59
What does this image demonstrate?
IVC plethora
60
What is the criteria for pericardiocentesis? 3
1. Large effusion
2. Tamponade
3. Fluid analysis
61
What is the pericarditis?
Inflammation of the pericardial sac/ lining
62
What are subsequent results of pericarditis? 2
1. Fibrosis and thickening
2. Purulent (infected)
63
What the etiology for pericarditis? 4
1. Acute infection
2. Post- surgical
3. Post MI: dressler's syndrome
4. Chronic pericardial effusion
64
What is constrictive pericarditis? 2
1. Parietal pericardium is not compliant
2. RV and LV restrictive diastolic filling
65
What is another name for constrictive pericarditis?
Stuck pericardium
66
What does this image demonstrate?
The difference between tamponade and constrictive pericarditis
67
What diastolic dysfunction is associated with constrictive pericarditis?
Grade 3 DD
68
Why can't the heart expand as much with constrictive pericarditis?
Increased fluid in the pericardial sac
69
In term of constrictive pericarditis, when pericardial fluid regresses what happens? 2
1. Fluid resolution
2. Residual fibrin deposition
70
What are the clinical signs of pericarditis?2 (what do we hear with auscultation)
Through auscultation from
1. Pericardial friction rub
2. Pericardial knock
71
What does pericardial friction rubs sound like?
Sandpaper
72
What is pericardial knocks associated with?
Constrictive pericarditis
73
What is pericardial friction rubs a symptom of?
Diastolic murmur
74
What are symptoms of Pericarditis? 2
1. Chest pain
2. Kussmaul's signs
75
What does the ECG look like with pericarditis?
Diffuse ST segment elevation
76
What are some 2D findings for constrictive pericarditis? 3
1. **Thickened, echogenic pericardium**
2. Fibrotic strands or clot
3. IVC dilated and non-collapsing
77
What does this image demonstrate?
Constrictive pericarditis
78
What does this image demonstrate?
The railroad appearance of constrictive pericarditis in M mode
79
What does constrictive pericarditis look like with M mode?
Posterior LV wall stuck to the pericardium
80
What are some doppler findings of Constrictive pericarditis?4
1. Increased MV E/A ratio
2. Decreased MV deceleration time
3. Decreased IVRT
4. IVC plethora
81
What is the difference between normal normal TDI and Constrictive pericarditis TDI?
Lateral tissue doppler velocity is less than the medial TDI
82
What happens to the LV/RV/ IVS during constrictive pericarditis with inspiration?
1. Decreased LV filling
2. Increased RV filling
3. IVS shift toward sleft
83
What happens with Expiration with constrictive pericarditis in terms of the LV/RV/IVS?
1. Increased LV filling
2. Decreased RV filling
3. IVS shift towards right
84
What are some similarities of Constrictive pericarditis and Restrictive cardiomyopathy? 3
1. Increased MV E/A ratio
2. Decreased MV deceleration time
3. Normal LV size and function
85
What are some differences between CP and RCM in terms of the atria?
CP: normal atrial size
RCM: enlarged atria
86
What are some differences between CP and RCM in terms of the pericardium?
CP: thickened/ bright pericardium
RCM: average E' greatly decreased
87
In terms of CP and RCM, what are the differences between E'?
CP: lateral E' less than septal E', average e' may be normal
RCM: average e' greatly decreased
88
In terms of CP and RCM, what is the differences between TR/MR?
CP: Infrequent TR/MR
RCM: Common TR/MR
89
In terms of CP and RCM, what is the differences with respiration?
CP: MV >25%, TV >50%
RCM: no variation with respiration
90
