Pericardial Diseases

Question 1

Which of the following is NOT a clinical presentation Acute Pericarditis?
A. Substernal pain w/ possible radiation to arms, neck, jaw and left trapezius ridge
B. Increased intensity of pain lying flat
C. Decreased intensity with inspiration
D. Decreased intensity when sitting up/leaning forward

Answer 1

C. Increased intensity with inspiration

Question 2

Acute Pericarditis presents with what kind of auscultation?

Answer 2

Pericardial Rub
50% are triphasic: systole, early, late diastole
70%: systolic and late diastolic components
Rest are systolic only.

(Idk how the math adds up…)

Question 3

T/F: Acute pericarditis is a medical emergency

Answer 3

False. Usually benign. BUT acute cardiac tamponade, chronic constrictive or subacute effusive constrictive pericarditis could occur.

Question 4

Name the symptoms of tamponade (3)

Answer 4

Dyspnea
Orthopnea
Decreased blood pressure

Question 5

Which of the following (2) are NOT PE findings of cardiac tamponade?
A. Tachypnea/tachycardia w/ normal - low blood pressure
B. Elevated jugular venous pressure
C. Kussmaul’s sign
D. Paradoxical pulse
E. Pulmonary crackles

Answer 5

C. Kussmaul’s sign seen in chronic pericarditis

E. No pulmonary crackles but friction rub may be present

Question 6

Which of the following are diagnostic of cardiac tamponade?
A. EKG
B. Echocardiogram
C. Chest x-ray
D. Right heart catheterization + pericardiocentesis

Answer 6

B, D
Right heart catheterization + pericardiocentesis critical to diagnosis and treatment in emergency situation

C. CXR: cardiac silhouette usually enlarged but normal does NOT exclude tamponade

Question 7

T/F: Chronic constrictive pericarditis presents predominately with left sided congestion without symptoms of right sided congestion.

Answer 7

False. Vise versa. Predominately right sided.

Question 8

JVP does NOT decrease with inspiration =

Answer 8

Kussmaul’s sign

Seen in chronic constrictive pericarditis

Question 9

Chronic constrictive pericarditis can mimic ____ with what symptoms?

Answer 9

Cirrhosis

Ascites, hepatomegaly, peripheral edema

Question 10

Pericardial knock may be present in what disease?

Answer 10

chronic constrictive pericarditis

Question 11

What is used to diagnosis chronic constrictive pericarditis ?

Answer 11

Cardiac catheterization: shows equilibration of left and right ventricular diastolic pressures

Question 12

T/F: CXR of chronic constrictive pericarditis shows cardiomegaly.

Answer 12

False. Usually small. 50% can show pericardial calcification.

Question 13

Tamponade or Constrictive Pericarditis?

R+L heart have different compliances

Answer 13

Tamponade

Question 14

Tamponade or Constrictive Pericarditis?

Kussmaul’s sign

Answer 14

Constrictive Pericarditis

Question 15

Tamponade or Constrictive Pericarditis?

Paradoxical pulse

Answer 15

Tamponade

Question 16

Tamponade or Constrictive Pericarditis?

Widened pulse pressure

Answer 16

Neither!

Constrictive Pericarditis has narrowed PP

Question 17

Tamponade or Constrictive Pericarditis?

Pericardial pressure = +20, +18 during inspiration

Answer 17

Tamponade

Question 18

Tamponade or Constrictive Pericarditis?

Pericardial pressure = 2 during inspiration

Answer 18

Constrictive Pericarditis