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DMST 367 Echo 3 > Pericardial diseases > Flashcards

Pericardial diseases Flashcards

1
Q

Label the image

A
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2
Q

What are the three layers of the pericardium?

A
  1. Fibrous Pericardium
  2. Serous Parietal Pericardium
  3. Serous Visceral Pericardium
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3
Q

What is the pericardial/ epicardial fat?

A

Layer of fat anterior of the heart

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4
Q

What does the Pericardial/ epicardial fat do? What does it mimic? What does it look like on U/S?

A
  1. Protects heart from blunt force trauma
  2. May mimic pericardial effusion
  3. Echogenic
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5
Q

Pericardial cysts are usually what kind of finding?

A

Incidental

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6
Q

Where are percardial cysts found?

A

Adjacent to the RT heart

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7
Q

Pericardial cysts are better evaluated with what modality?

A

On CT/MR

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8
Q

What is a pericardial effusion?

A

Increased amount of fluid within the pericardial space

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9
Q

What is pericardial effusion usually caused by?

A

Irritation/ injury to pericardium

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10
Q

What is Tamponade?

A

Marked or fast increased in fluid accumulation

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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

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12
Q

What is pericarditis?

A

Inflammation of the pericardial surfaces

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13
Q

What does pericarditis restrict?

A

Diastolic function

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14
Q

What are signs and symptoms of pericardial effusions? 3

A
  1. Chest pain (hurts more when patients lie flat)
  2. SOB/ Dyspnea
  3. Possible Tamponade/ constrictive pericarditis S/S
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15
Q

What does pericardial effusions look like on ECG?2

A
  1. Low voltage ECG (suggest large effusion)
  2. Electrical alternans
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16
Q

What is electrical alternans caused by?

A

Swinging heart

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17
Q

What does pericardial effusions look like on X-ray?

A

Enlarged cardiac silhouette or CXR

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18
Q

What is the role of echo with Pericardial effusion? 6

A
  1. Spatial orientation
  2. Potential collapse of cardiac chambers
  3. Differentiation of pleural fluid
  4. Size of effusion
  5. Clear space or echoes within fluids
  6. Pericardial thickness
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19
Q

What are two ways to describe Pericardial effusion?

A
  1. Location
  2. Chamber collapse
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20
Q

How do we see circumferential pericardial effusions? 3

A
  1. Use SAX to see all around the heart
  2. Fluids tend to be dependent (posteriorly at first)
  3. Fluid will extend to the AV groove, Anterior to DA
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21
Q

What does Loculated pericardial effusions look like?

A

May have separate areas of effusions separated by adhesions

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22
Q

In terms of loculated pericardial effusions, microbubbles are used to show what?

A

Localized high interpericardial pressure

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23
Q

What does pericardial effusions look like? 4 (where is it located)

A
  1. Anterior to descending aorta
  2. May sit anterior or posterior to the heart and can be circumferential
  3. Tapers at AV sulcus
  4. No respiratory change in size
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24
Q

What does Pleural effusions look like? 4

A
  1. Only posterior to heart
  2. Posterior to descending aorta
  3. Changes with respiration
  4. Does not cause RV or RA collapse
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25
Q

Label the image

A
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26
Q

What are the classification of pericardial effusions? 4

A
  1. Physiologic
  2. Mild
  3. Moderate
  4. Large
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27
Q

Are Trace effusions Normal or Abnormal?

A

Normal

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28
Q

What does this image identify?

A

Notice the difference in size between systole/ diastole on the M-mode trace

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29
Q

Where does pericardial effusions occur in M mode?

A

An anechoic space between epicardium and pericardium

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30
Q

When would we measure pericardial effusions?

A

Diastole

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31
Q

What does pericardial effusions look like on M-mode?

A

Posterior wall lifts off the pericardial boarder in Systole as PW contracts (PLAX/PSAX)

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32
Q

Measuring Pericardial effusions when leads to over estimates?

A

During systole

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33
Q

In terms of pericardial effusions long standing effusions may have what?

A

Fibrinous strands that can be seen by echo

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34
Q

What does this image demonstrate?

A

Pericardial effusion

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35
Q

What does this image demonstrate?

A

Pericardial effusion

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36
Q

What does this image demonstrate?

A

Thin vs thick pericardium

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37
Q

What do we use doppler for in terms of pericardial effusions?2

A
  1. Diastolic function assessment
  2. Changes in LV and RV filling with respiration
38
Q

In terms of looking at diastolic function assessment for Pericardial effusions what do we look at?

A

Impact of PE on LV and RV filling

39
Q

What are some things we consider when looking at changes in LV and RV filling with Respiration? 3

A
  1. Using MV and TV inflow profiles
  2. Constrictive pericarditis vs restrictive cardiomyopathy
  3. Tamponade VS constrictive pericarditis
40
Q

What are some imaging considerations with PE?

41
Q

What are some 2D errors we see when imaging Pericardial effusions? 2

A
  1. Gains to high
  2. Image depth too shallow ( we may miss effusion)
42
Q

What do we assess for in terms of pericardial effusion in terms of 2D?

A

Pseudoaneurysms of the LV

43
Q

What 3 things are commonly mistaken for pericardial effusions on 2D?

A
  1. Anterior epicardial fat
  2. Dilated coronary sinus
  3. Large pleural effusion
44
Q

What does this image demonstrate in terms of Pericardial effusion?

A

In parasternal the beam transects the descending aorta, mistaken for posterior effusion

45
Q

What is a hemopericardium?

A

Collection of blood in the pericardial sac

46
Q

What does these images demonstrate?

A

Hemopericardium

47
Q

Tamponade usually occurs with what?

A

Rapid fluid accumulation

48
Q

Where is pressure higher with tamponade?

A

Higher pressure in intrapericardial cavity

49
Q

What happens during cardiac tamponade?

A

Impairs the cardiac chamber filling, thus impairing the SV and CO

50
Q

What is the outcomes for Tamponade?

A

Potentially life threatening depending on amount of fluid and time of accumulation

51
Q

How common is subacute and chronic tamponade?

52
Q

How common is acute tamponade?

A

Less common

53
Q

What are causes of pericardial tamponade? 3

A
  1. Pericarditis
  2. Metastatic disease
  3. Radiation therapy
54
Q

What are causes of acute tamponade?

55
Q

What is often seen with tamponade?

A

Fibrin strands

56
Q

What happens in the right heart with Tamponade? 2

A
  1. RA systolic collapse
  2. RV diastolic collapse
57
Q

What happens as a result of right chamber collapse during tamponade? 3

A
  1. RV filling is impaired
  2. Reciprocal RV/LV respiratory changes producing septal shifting
  3. SVC and IVC become dilated
58
Q

What are some 2D features of tamponade?4

A
  1. RA systolic collapse
  2. RV diastolic collapse
  3. Reciprocal changes in ventricular volume with respiration variation
  4. Septal shifting
59
Q

What does this image demonstrate?

A

IVC plethora

60
Q

What is the criteria for pericardiocentesis? 3

A
  1. Large effusion
  2. Tamponade
  3. Fluid analysis
61
Q

What is the pericarditis?

A

Inflammation of the pericardial sac/ lining

62
Q

What are subsequent results of pericarditis? 2

A
  1. Fibrosis and thickening
  2. Purulent (infected)
63
Q

What the etiology for pericarditis? 4

A
  1. Acute infection
  2. Post- surgical
  3. Post MI: dressler’s syndrome
  4. Chronic pericardial effusion
64
Q

What is constrictive pericarditis? 2

A
  1. Parietal pericardium is not compliant
  2. RV and LV restrictive diastolic filling
65
Q

What is another name for constrictive pericarditis?

A

Stuck pericardium

66
Q

What does this image demonstrate?

A

The difference between tamponade and constrictive pericarditis

67
Q

What diastolic dysfunction is associated with constrictive pericarditis?

A

Grade 3 DD

68
Q

Why can’t the heart expand as much with constrictive pericarditis?

A

Increased fluid in the pericardial sac

69
Q

In term of constrictive pericarditis, when pericardial fluid regresses what happens? 2

A
  1. Fluid resolution
  2. Residual fibrin deposition
70
Q

What are the clinical signs of pericarditis?2 (what do we hear with auscultation)

A

Through auscultation from
1. Pericardial friction rub
2. Pericardial knock

71
Q

What does pericardial friction rubs sound like?

72
Q

What is pericardial knocks associated with?

A

Constrictive pericarditis

73
Q

What is pericardial friction rubs a symptom of?

A

Diastolic murmur

74
Q

What are symptoms of Pericarditis? 2

A
  1. Chest pain
  2. Kussmaul’s signs
75
Q

What does the ECG look like with pericarditis?

A

Diffuse ST segment elevation

76
Q

What are some 2D findings for constrictive pericarditis? 3

A
  1. Thickened, echogenic pericardium
  2. Fibrotic strands or clot
  3. IVC dilated and non-collapsing
77
Q

What does this image demonstrate?

A

Constrictive pericarditis

78
Q

What does this image demonstrate?

A

The railroad appearance of constrictive pericarditis in M mode

79
Q

What does constrictive pericarditis look like with M mode?

A

Posterior LV wall stuck to the pericardium

80
Q

What are some doppler findings of Constrictive pericarditis?4

A
  1. Increased MV E/A ratio
  2. Decreased MV deceleration time
  3. Decreased IVRT
  4. IVC plethora
81
Q

What is the difference between normal normal TDI and Constrictive pericarditis TDI?

A

Lateral tissue doppler velocity is less than the medial TDI

82
Q

What happens to the LV/RV/ IVS during constrictive pericarditis with inspiration?

A
  1. Decreased LV filling
  2. Increased RV filling
  3. IVS shift toward sleft
83
Q

What happens with Expiration with constrictive pericarditis in terms of the LV/RV/IVS?

A
  1. Increased LV filling
  2. Decreased RV filling
  3. IVS shift towards right
84
Q

What are some similarities of Constrictive pericarditis and Restrictive cardiomyopathy? 3

A
  1. Increased MV E/A ratio
  2. Decreased MV deceleration time
  3. Normal LV size and function
85
Q

What are some differences between CP and RCM in terms of the atria?

A

CP: normal atrial size
RCM: enlarged atria

86
Q

What are some differences between CP and RCM in terms of the pericardium?

A

CP: thickened/ bright pericardium
RCM: average E’ greatly decreased

87
Q

In terms of CP and RCM, what are the differences between E’?

A

CP: lateral E’ less than septal E’, average e’ may be normal
RCM: average e’ greatly decreased

88
Q

In terms of CP and RCM, what is the differences between TR/MR?

A

CP: Infrequent TR/MR
RCM: Common TR/MR

89
Q

In terms of CP and RCM, what is the differences with respiration?

A

CP: MV >25%, TV >50%
RCM: no variation with respiration

DMST 367 Echo 3 (27 decks)

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