Pericardial Diseases

Question 1

What are the 3 types of effusions?

Answer 1

Serous, Bloody or Purulent

Question 2

Differentiate Chronic effusions from Acute

Answer 2

Chronic effusions accumulate slowly and have a slow onset of symptoms (CHF). Acute effusions accumulate quickly (Cardiac Tamponade, Ruptured MI)

Question 3

What are some common causes of effusions?

Answer 3

CHF (Serous), Malignancy, Ruptured MI (Blood), Aortic Dissecition (Blood)

Question 4

How do most cases of Pericarditis happen?

Answer 4

Secondary to viral infection

Question 5

What are the 5 types of Acute Pericarditis?

Answer 5

Serous, Fibrinous, Purulent, Hemorrhagic, and Caseous

Question 6

What can cause Acute Serous Pericarditis

Answer 6

Non-infectious inflammatory diseases (SLE, scleroderma, uremia)

Question 7

Discuss Acute Fibrinous Pericarditis

Answer 7

1. Most frequent type
2. Caused by MI, Dressler syndrome and radiation
3. Dry granular appearance
4. BREAD AND BUTTER

Question 8

Discuss Acute Purulent Pericarditis

Answer 8

1. Caused by bacteria (pneumonia)
2. Seeding from blood or lymph
3. Red, granular surface w/ exudate

Question 9

What is the most common origin of Acute Hemorrhagic Pericarditis

Answer 9

Malignancy!

Question 10

Discuss Acute Caseous Pericarditis

Answer 10

1. TB until proven otherwise

2. Spread from tracheobroncial lymph nodes.

Question 11

Discuss Adhesive mediastinopericarditis

Answer 11

1. Pericardial sac is obliterated and stuck to its surronding surfaces.
2. Causes Cardiac hypertrophy, retraction of rib cage and pulsus paradoxus

Question 12

Discuss Constrictive Pericarditis

Answer 12

The heart is encased in a fibrous scar. This limits diastolic expansion, CO, and heart sounds.

Question 13

Discuss Myxoma

Answer 13

1. Most common primary tumor
2. Solitary tumors that arise in the atrial septum
3. Gelatinous mucopolysaccharide ground substance.

Question 14

How is Myxoma diagnosed and treated?

Answer 14

Echocardiography; Treated with surgery.

Question 15

Discuss the genetic component of Myoxma

Answer 15

Autosomal Dominant; Mutation in PRKAR1 gene.

Will present with multiple myomas, spotty skin pigmentation and endocrine hyperactivity

Question 16

Discuss Fibromas

Answer 16

1. Most commonly affects infants and children
2. Arises in ventricles and IVS
3. Infiltrates and replaces myocardium and lumen
4. Fibrous, white and whorled appearance.

Question 17

Discuss Papillary Fibroelastoma

Answer 17

1. Arises from valves
2. Fine filamentous projections “SEA ANEMONE”
3. Core connective tissue with mucopolysaccharide matrix covered with endothelium.

Question 18

Discuss Rhabdomyoma

Answer 18

1. Most frequent pediatric heart tumor
2. Defects in TSC1/2 genes causing myocyte overgrowth
3. SPIDER CELLS: Cytoplasm with thin septae extending from nucleus to CM.
4. Gray with tan appearance