pericardial diseases

Question 1

what are the common causes of acute pericarditis?

Answer 1

• acute inflammation of the pericardium accompanied by pericardial effusion
• caused by virus, TB, SLE, uremia, drugs like isoniazid, hydralazine, post-MI inflammation, radiation, heart surgery

Question 2

What are the main differences between pericardiits and MI on EKG

Answer 2

• pericarditis shows ST elevation in most leads and PR depression
• However, full MI work-up needed if ST elevation is seen on EKG

Question 3

How is pericarditis treated?

Answer 3

pericardiocentesis for large effusions, NSAIDs for pain, colchicine to prevent recurrence d/t viral or idiopathic causes
can lead to chronic constrictive pericarditis if untreated

Question 4

What is beck triad?

Answer 4

distant heart sounds, hypotension, and distended neck veins- think of cardiac tamponade and perform pericardiocentesis

Question 5

What are common causes of chronic constrictive pericarditis? what are physical exams and lab results?

Answer 5

radiation or heart surgery
often have heart failure, increased JVD with inspiration (aka kussmaul sign), afib is common
cardiac cath shows equal pressure in all chambers

Question 6

treatment of chronic constrictive pericarditis

Answer 6

nsaids, cochicine, corticosteroids; surgical excision of pericarditis (though this has high mortality)

Question 7

How do you interpret studies of pericardial fluid?

Answer 7

• transudates if low in protein and specific gravity less than 1.012; common
• if exudate, do tests for neoplasm, fibrotic disease, and TB

Question 8

What are common underlying causes of cardiac tamponade?

Answer 8

acute percardiits, chest trauma, LV rupture after MI or dissecting aortic aneurysm