pericardial diseases Flashcards
What is the definition of acute pericarditis?
Inflammation of the pericardial sac.
This condition often presents with chest pain and other symptoms.
What are the idiopathic causes of acute pericarditis?
Post viral; preceded by flulike, respiratory, or gastrointestinal symptoms.
Idiopathic cases often follow viral infections.
List some infectious causes of acute pericarditis.
- Viral (coxsackie, echovirus, adenovirus)
- Bacterial (TB)
- Fungal
- Toxoplasmosis
These infections can lead to inflammation of the pericardium.
What is a complication of acute pericarditis?
Pericardial effusion & cardiac tamponade.
These complications can occur due to fluid accumulation.
What are the clinical features of acute pericarditis?
- Chest pain (retrosternal, radiates to neck and back)
- Fever and leukocytosis
- Friction rub
Chest pain is aggravated by coughing, inspiration, and lying supine, but relieved by leaning forward.
What specific findings can be seen on an ECG for acute pericarditis?
Diffuse ST elevation in all leads and PR depression.
PR depression is more specific for pericarditis.
What is the mainstay treatment for acute pericarditis?
Aspirin or ibuprofen + Colchicine & bedrest.
If there is no response, glucocorticoids may be considered.
What defines constrictive pericarditis?
Heart enclosed by a rigid fibrous pericardial sac leading to reduced diastolic filling of ventricles.
This condition can arise from chronic pericarditis.
What is Kussmaul sign?
JVP increases paradoxically on inspiration.
This is an abnormal response and indicates constrictive pericarditis.
What are the symptoms that resemble right heart failure in constrictive pericarditis?
- Peripheral edema
- Distended JVP
- Ascites
- Hepatomegaly
These symptoms arise due to impaired heart filling.
What diagnostic imaging shows pericardial calcifications in constrictive pericarditis?
Chest X-ray.
It typically shows a normal size heart with calcifications.
What is the initial treatment for constrictive pericarditis?
Diuretics to relieve edema and organomegaly.
This helps to decompress the heart’s filling.
What is a pericardial knock?
An extra heart sound in diastole from ventricular filling.
This can be a clinical feature of constrictive pericarditis.
What advanced imaging can be used to diagnose constrictive pericarditis?
CT/MRI to show pericardial thickening and calcification.
These imaging techniques provide detailed views of the pericardium.
Fill in the blank: The treatment for constrictive pericarditis may include surgical _______.
excision of pericardium.
Surgery may be necessary if other treatments are ineffective.
What is pericardial effusion?
Exudation of fluid into the pericardial space.
What conditions can cause pericardial effusion?
Conditions include:
* Acute pericarditis
* CHF
* Cirrhosis
* Nephrotic syndrome
* Trauma
What physical examination findings are associated with pericardial effusion?
Findings include:
* Muffled heart sounds
* Dullness at the left lung base
What is the procedure of choice for investigating pericardial effusion?
Echo
What does a chest X-ray show in pericardial effusion?
Cardiomegaly without pulmonary vascular congestion and a flask shape appearance.
What is the most common outcome for pericardial effusion?
Most resolve spontaneously.
What is cardiac tamponade?
Rapid accumulation of fluid in the pericardial space that prevents the heart from compensating.
What are the clinical features of cardiac tamponade?
Features include:
* Pulsus paradoxus
* Tachypnea
* Tachycardia
* Hypotension
* Elevated JVP
* Clear lungs
What is Beck’s triad?
Muffled heart sounds, jugular vein distension, hypotension.
What causes cardiac tamponade?
Causes include:
* Penetrating trauma
* Iatrogenic causes (e.g., central line placement, pericardiocentesis)
* Pericarditis
* Post MI
What is the most sensitive and specific noninvasive test for cardiac tamponade?
Echo
What does catheterization show in cardiac tamponade?
Equalization of pressure in all the chambers in diastole.
What is the treatment for hemodynamically unstable patients with cardiac tamponade?
Pericardiocentesis
What should be done in the case of hemorrhagic tamponade due to penetrating trauma?
Emergent surgery.
What is the recommended treatment for a patient with renal failure who is hemodynamically stable?
Dialysis
True or False: Diuretics should be used in cardiac tamponade treatment.
False
What is the hallmark of pulsus paradoxus?
Decrease in pulse during inspiration and increase during expiration.
