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Cardiology > Pericardial Diseases > Flashcards

Pericardial Diseases Flashcards

1
Q

Whats the visceral layer of the pericardial sac called?

A

Epicardium

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2
Q

What makes up the pericardial sac?

A

Fibrous Pericardium and Parietal leyer of the serous pericardium

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3
Q

Functions of the pericardium?

3

A
  1. Stabilizes heart in mediastinum
  2. Protects heart from infections
  3. Lubricates the heart
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4
Q

What is acute pericarditis?

A

Sudden inflammation of the pericardium from a variety of conditions

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5
Q

Causes of acute pericarditits?

7

A
  1. Infectious (most common)
  2. Metastatic neoplasm (lung/breast)
  3. Medication
  4. Bacterial
  5. Systemic diseases
  6. Radiation
  7. Dressler syndrome
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6
Q

What are medications that cause acute pericarditis? 2

A

Procainamide & hydralazine

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7
Q

Clinical findings for acute pericarditis?
4
(whats the most characteristic?)

A
  1. Chest pain
  2. Dyspnea
  3. Often febrile
  4. Pericardial friction rub is characteristic*****
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8
Q

Diagnostic findings for acute pericarditis?

5

A
  1. Leukocytosis
  2. Elevated erythrocyte sedimentation rate (ESR)
  3. Troponin
  4. Chest X-ray
  5. EKG
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9
Q

What will you see on the EKG for acute pericarditis?

2

A
  1. New widespread ST-segment elevation, and

2. PR-segment depression in the same leads

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10
Q

With both ST elevation and PR depression, sensitivity on EKG can be > ___%?

A

98%

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11
Q

Acute pericarditis treatment?
4

Whats the major early complication to look out for? 1

A
  1. Treat the underlining cause
  2. NSAID and Aspirin (2 weeks)
  3. Colchicine (3 months)
  4. Systemic corticosteroids
  5. Major early complication is tamponade
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12
Q

When would we treat acute pericarditis with systemic corticosteriods? 3

A
  1. Severe symptoms
  2. Refractory
  3. Auto-immune disorders
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13
Q

When should we hospitalize with acute pericarditis?

4

A
  1. Fever and leukocytosis
  2. Evidence of cardiac tamponade
  3. Anticoagulation
  4. Failure to respond within 7 days to NSAID therapy
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14
Q

Chronic or Recurrent pericarditis

is what?

A

Syndrome in which acute pericarditis recurs after the agent causing the acute attack has been treated or disappears

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15
Q
  1. When does Chronic or Recurrent pericarditis usually occur?
  2. Most cases are caused by what?
  3. What is it not associated with? 2
A
  1. Usually occurs 6 weeks to 18 months after the acute attack
  2. Most cases are autoimmune.
  3. Not associated with
    - -myocardial systolic dysfunction
    - -heart failure symptoms
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16
Q

Chronic or Recurrent pericarditis:

Clinical findings? 2

What is a predictor for recurrence? 1

Imaging? 3

A

Clinical Findings

  1. Pleuritic chest pain, +/- exertion
  2. Dyspnea

Predictor for recurrence
1. Glucocorticoid use initially for acute pericarditis

Imaging

  1. EKG
  2. Echocardiogram
  3. Chest X-ray
17
Q

Chronic or Recurrent pericarditis
Treatment?
4

A
  1. Combo therapy
    - -NSAID’s and Colchicine
  2. Glucocorticoids
  3. Activity restrictions
  4. Pericardiectomy
18
Q
  1. Pericardial Effusions are what?
  2. What are the causes? 2
  3. Whats the normal amount of fluid in the pericardium?
  4. What will determine any hemodynamic affects of the pericardial effusion?
A
  1. Abnormal accumulation of fluid in the pericardial sac
  2. Causes
    - -Disturbance in the equilibrium between the production and reabsorption of pericardial fluid
    - -Develops during any inflammatory pericardial disease
  3. 15-50ml of fluid is the usual amount of fluid within the pericardium
  4. The rate of fluid production will determine any hemodynamic effects

If it happens over time, there could be up to a liter of fluid because it can stretch. If it happens acutely they will have pain and more symptoms!

19
Q

What are the 4 types of pericardial effusion?

A
  1. Transudative
  2. Exudative
  3. Hemorrahagic
  4. Malignant
20
Q

Signs and symptoms
of pericardial effusion?
4

A
  1. +/- pain
  2. Dyspnea
  3. Cough
  4. Pericardial rub my be present
21
Q

What will imaging show us with a pericardial effusion?
3
(Whats the imaging of choice?)

A
  1. CXR: shows enlarged cardiac silhouette
  2. EKG: electrical alternans with sinus tachycardia
  3. Echo: imaging of choice
22
Q

Treatment of pericardial effusion?

4

A
  1. Treat the underlying cause
  2. Small effusions can be followed
  3. With large effusions and tamponade drainage is done through pericardiocentesis
  4. Pericardiectomy is required for reoccurances
23
Q

Cardiac tamponade

pathophysiology

A

Increase pressure on the heart muscle when the pericardial space fills up with fluid faster than the pericardial sac can stretch
The increase pressure causes elevation of intrapericardial pressure which restricts venous return and ventricular filling

24
Q

Cardiac Tamponade:
Increase pressure on the heart muscle when the pericardial space fills up with fluid faster than the pericardial sac can stretch
The increase pressure causes elevation of 1._________ pressure which restricts 2.______ _______ and 3.________ ______

A
  1. intrapericardial
  2. venous return
  3. ventricular filling
25
Q

Cardiac tamponade etiology?

3

A
  1. Same as pericardial effusion (Increased fluid and pressure due to inflammation)
  2. Left ventricular free wall rupture
  3. Hemorrhagic pericarditis
26
Q

Signs and Symtpoms of cardiac tamponade

5

A
  1. Dyspnea and cough common
  2. Tachycardia
  3. Tachypnea
  4. Pulsus paradoxus
  5. Beck’s triad
27
Q

Whats Beck’s Triad?

A
  1. Hypotension
  2. Jugular venous distention (JVD)
  3. Muffled heart sounds
28
Q

Imaging for cardiac tamponade?
2

(test of choice?)

A

EKG
–Electrical alternans
Echo
–Test of choice

29
Q

Cardiac tamponade treatment?

2

A
  1. Urgent pericardiocentesis

2. Recurrent fluid may require paricardial window or partial pericardiectomy

30
Q

Constrictive Pericarditis is what?

Causes? 4

A

Inflammation that leads to the pericardium becoming fibrotic, thickened, and adherent and restricts diastolic fillings and produces chronically elevated venous pressures

Causes:

  1. Radiation
  2. Cardiac surgery
  3. Viral pericarditis
  4. Idiopathic
31
Q

Constrictive Pericarditis:

Signs and Symptoms?5

Imaging?3

A
  1. Slowly progressive dyspnea
  2. Fatigue and weakness
  3. Chronic edema
  4. Elevated jugular venous pressure
  5. Kussmaul sign
  6. CXR
  7. Echo
  8. Cardiac cath
32
Q

Constrictive Pericarditis
Treatment?
2

A
  1. Initial treatment with diuretics
  2. Surgical removal (pericardiectomy)

Morbidity and mortality are high (up to 15%)

33
Q

Pericardiocentesis

is what?

A

Draining of the pericardial fluid

34
Q
  1. How is the pt positioned in Pericardiocentesis?
  2. Guided by?
  3. What locations are used? 2
A
  1. Patient positioned supine with the head of the bed raised at a 30-60 degree angle
  2. Usually done with ultrasound guidence
  3. Two locations are used
    - –5th -6th intercostal space at the left sternal border at the cardiac notch of the left lung (parasternal approach)
    - –Infrasternal angle (subxiphoid approach)

Cardiology (19 decks)

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