Pericardial Diseases Flashcards
Whats the visceral layer of the pericardial sac called?
Epicardium
What makes up the pericardial sac?
Fibrous Pericardium and Parietal leyer of the serous pericardium
Functions of the pericardium?
3
- Stabilizes heart in mediastinum
- Protects heart from infections
- Lubricates the heart
What is acute pericarditis?
Sudden inflammation of the pericardium from a variety of conditions
Causes of acute pericarditits?
7
- Infectious (most common)
- Metastatic neoplasm (lung/breast)
- Medication
- Bacterial
- Systemic diseases
- Radiation
- Dressler syndrome
What are medications that cause acute pericarditis? 2
Procainamide & hydralazine
Clinical findings for acute pericarditis?
4
(whats the most characteristic?)
- Chest pain
- Dyspnea
- Often febrile
- Pericardial friction rub is characteristic*****
Diagnostic findings for acute pericarditis?
5
- Leukocytosis
- Elevated erythrocyte sedimentation rate (ESR)
- Troponin
- Chest X-ray
- EKG
What will you see on the EKG for acute pericarditis?
2
- New widespread ST-segment elevation, and
2. PR-segment depression in the same leads
With both ST elevation and PR depression, sensitivity on EKG can be > ___%?
98%
Acute pericarditis treatment?
4
Whats the major early complication to look out for? 1
- Treat the underlining cause
- NSAID and Aspirin (2 weeks)
- Colchicine (3 months)
- Systemic corticosteroids
- Major early complication is tamponade
When would we treat acute pericarditis with systemic corticosteriods? 3
- Severe symptoms
- Refractory
- Auto-immune disorders
When should we hospitalize with acute pericarditis?
4
- Fever and leukocytosis
- Evidence of cardiac tamponade
- Anticoagulation
- Failure to respond within 7 days to NSAID therapy
Chronic or Recurrent pericarditis
is what?
Syndrome in which acute pericarditis recurs after the agent causing the acute attack has been treated or disappears
- When does Chronic or Recurrent pericarditis usually occur?
- Most cases are caused by what?
- What is it not associated with? 2
- Usually occurs 6 weeks to 18 months after the acute attack
- Most cases are autoimmune.
- Not associated with
- -myocardial systolic dysfunction
- -heart failure symptoms
Chronic or Recurrent pericarditis:
Clinical findings? 2
What is a predictor for recurrence? 1
Imaging? 3
Clinical Findings
- Pleuritic chest pain, +/- exertion
- Dyspnea
Predictor for recurrence
1. Glucocorticoid use initially for acute pericarditis
Imaging
- EKG
- Echocardiogram
- Chest X-ray
Chronic or Recurrent pericarditis
Treatment?
4
- Combo therapy
- -NSAID’s and Colchicine - Glucocorticoids
- Activity restrictions
- Pericardiectomy
- Pericardial Effusions are what?
- What are the causes? 2
- Whats the normal amount of fluid in the pericardium?
- What will determine any hemodynamic affects of the pericardial effusion?
- Abnormal accumulation of fluid in the pericardial sac
- Causes
- -Disturbance in the equilibrium between the production and reabsorption of pericardial fluid
- -Develops during any inflammatory pericardial disease - 15-50ml of fluid is the usual amount of fluid within the pericardium
- 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!
What are the 4 types of pericardial effusion?
- Transudative
- Exudative
- Hemorrahagic
- Malignant
Signs and symptoms
of pericardial effusion?
4
- +/- pain
- Dyspnea
- Cough
- Pericardial rub my be present
What will imaging show us with a pericardial effusion?
3
(Whats the imaging of choice?)
- CXR: shows enlarged cardiac silhouette
- EKG: electrical alternans with sinus tachycardia
- Echo: imaging of choice
Treatment of pericardial effusion?
4
- Treat the underlying cause
- Small effusions can be followed
- With large effusions and tamponade drainage is done through pericardiocentesis
- Pericardiectomy is required for reoccurances
Cardiac tamponade
pathophysiology
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
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.________ ______
- intrapericardial
- venous return
- ventricular filling
Cardiac tamponade etiology?
3
- Same as pericardial effusion (Increased fluid and pressure due to inflammation)
- Left ventricular free wall rupture
- Hemorrhagic pericarditis
Signs and Symtpoms of cardiac tamponade
5
- Dyspnea and cough common
- Tachycardia
- Tachypnea
- Pulsus paradoxus
- Beck’s triad
Whats Beck’s Triad?
- Hypotension
- Jugular venous distention (JVD)
- Muffled heart sounds
Imaging for cardiac tamponade?
2
(test of choice?)
EKG
–Electrical alternans
Echo
–Test of choice
Cardiac tamponade treatment?
2
- Urgent pericardiocentesis
2. Recurrent fluid may require paricardial window or partial pericardiectomy
Constrictive Pericarditis is what?
Causes? 4
Inflammation that leads to the pericardium becoming fibrotic, thickened, and adherent and restricts diastolic fillings and produces chronically elevated venous pressures
Causes:
- Radiation
- Cardiac surgery
- Viral pericarditis
- Idiopathic
Constrictive Pericarditis:
Signs and Symptoms?5
Imaging?3
- Slowly progressive dyspnea
- Fatigue and weakness
- Chronic edema
- Elevated jugular venous pressure
- Kussmaul sign
- CXR
- Echo
- Cardiac cath
Constrictive Pericarditis
Treatment?
2
- Initial treatment with diuretics
- Surgical removal (pericardiectomy)
Morbidity and mortality are high (up to 15%)
Pericardiocentesis
is what?
Draining of the pericardial fluid
- How is the pt positioned in Pericardiocentesis?
- Guided by?
- What locations are used? 2
- Patient positioned supine with the head of the bed raised at a 30-60 degree angle
- Usually done with ultrasound guidence
- 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)
