pericardial diseases Flashcards
1
Q
What is the pericardium?
A
- tough double layered fibroserous sac that covers the heart
pericardial sac has 2 layers: - serous layer (inner layer) - parietal pericardium and the visceral pericardium (also called epicardium)
- fibrous layer (outermost layer)
2
Q
Fxns of the pericardium?
A
- stabilizes the heart in the mediastinum
- protects heart from infections
- lubricates the heart
3
Q
What is acute pericarditis?
causes?
A
- sudden inflammaton of the pericardium from a variety of conditions
- causes:
infectious (most common)
metastatic neoplasm (lung/breast) - medication: procainamide and hydralazine
- bacterial
- systemic diseases (RA, lupus, hyperuremia)
- radiation
- dressler syndrome (post MI)
4
Q
Clinical findings on acute pericarditis?
A
- chest pain (Gets better when pt leans forward)
- dyspnea
- often febrile
- pericardial friction rub is characteristic
5
Q
Dx findings of acute pericarditis?
A
Run CBC, ESR, CXR, and echo
- leukocytosis
- eleveted ESR
- troponin (high, mimics MI, but won’t decrease like an MI, plateaus)
- CXR
- EKG: new widespread ST segment elevation, and PR depression in same leads (w/ both of these EKG can be more than 98% sensitive)
6
Q
Tx of acute pericarditis?
A
- tx underlying cause
- NSAID and aspirin
- colchicine (hyperuremia - gout)
- systemic corticosteroids:
severe sxs, refractory, auto-immune disorders
7
Q
- major early complication of acute pericarditis?
A
- cardiac tamponade
8
Q
When should you hospitalize an acute pericarditis pt?
A
- fever and leukocytosis
- evidence of cardiac tamponade
- anticoag
- failure to respond within 7 days to NSAID therapy
9
Q
What is chronic or recurrent pericarditis?
A
- syndrome in which acute pericarditis recurs after the agent causing the acute attack has been tx or disappears
- usually occurs 6 weeks to 18 months after the acute attack
- most cases are autoimmune
- not associated with myocardial systolic dysfunction and HF sxs
10
Q
Clinical findings in chronic or recurrent pericarditis?
A
- pleuritic chest pain, +/- exertion
- dyspnea
11
Q
Predictor for recurrence of pericarditis?
A
- if glucocorticoid use initially in acute pericarditis
12
Q
Imaging for chronic pericarditis?
A
- EKG
- echo
- CXR
- labs - ESR and CRP will be elevated
13
Q
Tx for chronic or recurrent pericarditis?
A
- combo therapy: NSAIDs and colchicine
- glucocorticoids (taper off and sxs come back)
- activity restrictions
- pericardiectomy (last option - poor wound healing b/c of chronic steroid use)
14
Q
Pericardial effusions?
causes?
A
- abnormal accum of fluid in the pericardial sac
- causes:
disturbance in equilibrium b/t production and reabsorption of pericardial fluid - develops during any inflammatory pericardial disease
- 15-50 ml of fluid is usual amt of fluid within the pericardium
- the rate of fluid production will determine any hemodynamic effects
15
Q
4 types of pericardial effusions?
A
- transudative (CHF)
- exudative (inflammatory response - infection)
- hemorrhagic
- malignant
16
Q
Signs and sxs of pericardial effusion?
A
- +/- pain
- dyspnea
- cough
- pericardial rub may be present
17
Q
imaging for pericardial effusion?
A
- CXR: shows enlarged cardiac silhouette (water bottle heart)
- EKG: electrical alternans with sinus tachycardia
- echo: imaging of choice
18
Q
Tx of pericardial effusions?
A
- tx underlying cause
- small effusions can be followed
- with large effusions and tamponade drainage is done through pericardiocentesis
- pericardiectomy reqd for recurrences
19
Q
What is cardiac tamponade?
A
- increase pressure on the heart muscle when the pericardial space fills up with fluid faster than pericardial sac can stretch
- increase pressure causes elevation of intrapericardial pressure which restricts venous return and ventricular filling
20
Q
Etiology of cardiac tamponade?
A
- same as pericardial effusion (transudative, exudative, malignant, hemorrhagic)
- LV free wall rupture
- hemorrhagic pericarditis
21
Q
Signs and sxs of cardiac tamponade?
A
- dyspnea and cough common
- tachycardia
- tachypnea
- pulsus paradoxus
- becks triad:
hypotension, JVD, muffled heart sounds
22
Q
Imaging for dx cardiac tamponade?
A
- EKG: electrical alternans
- echo: test of choice
- tx: urgent pericardiocentesis
- recurrent fluid may require paricardial window or partial pericardiectomy
23
Q
What is constrictive pericarditis?
A
- inflammation that leads to pericardium becoming fibrotic, thickened, and adherent and restricts diastolic fillings and produces chronically elevated venous pressures
24
Q
Causes of constrictive pericarditis?
A
- radiation
- cardiac surgery
- viral pericarditis
- idiopathic
25
signs and sxs of constrictive pericarditis?
- slowly progressive dyspnea
- fatigue and weakness
- chronic edema
- elevated JVP
- kussmaul sign: on inhalation JV doesn't diappear
26
Imaging for constrictive pericarditis?
- CXR: egg shell around heart on lateral view
- Echo
cath: assess pressures
27
Tx of constrictive pericarditis?
- initial tx: diuretics
- surgical removal (pericardiectomy): morbidity and mortality are high (up to 15% - NSAIDs, diuretics, and steroids b/f surgery)
28
What is a pericardiocentesis?
- pt positioned supine with head of bed raised at 30-60 degree angle
- usually done with US guidance
- 2 locations used: 5th-6th ICS at left sternal border at cardiac notch of left lung (parasternal approach), and infrasternal angle (subxiphoid approach)
