PERICARDIAL DISEASES Flashcards
how much fluid does the pericardial cavity normally hold
20-50mL of pericardial fluid
what is the normal pericardial pressure
-4mmHg to +4mmHg, varies w/ respirations
similar to pleural pressure
functions of the pericardium
- prevent infection
- lubrication of the heart
- facilitation of cardiac motion w/in the pericardial sac
- protection of the heart from displacement, maintains optimum shape of heart
- applies compensatory hydrostatic pressure to heart to compensate for alterations in gravitational force
acute pericarditis: definition & causes
definition = inflammation of the pericardium
causes
- infection (viral, bacterial, fungal, TB)
- MI (Dressler’s syndrome)
- trauma
- metastatic dz
- drugs
- radiation
- systemic dz (RA, SLE, scleroderma)
diagnostic features of acute pericarditis
- sudden onset severe CP exaggerated by inspiration
- diffuse ST prolongation, shortened PR interval, T wave inversion
- pericardial friction rub
pericardial effusion: definition & causes
accumulation of pericardial fluid in the pericardial cavity
causes:
- idiopathic
- neoplastic
acute vs. gradual pericardial effusion
acute = cardiac tamponade rapidly results (no time for accommodation) - 100-200mL can cause effects
gradual = pericardium stretches to accommodate even up to 1000mL w/out significant pressure increase
diagnosis = echo
cardiac tamponade
increase in pericardial pressure that impairs diastolic filling of the heart
**medical emergency
s/s cardiac tamponade
- increased CVP
- pulsus paradoxus
- equalization of cardiac filling pressures
- hypotension
- decreased CO, SV
- decreased EKG voltage
- activation of SNS
- tachypnea
- JVD
- muffled heart sounds
tx of cardiac tamponade
removal of fluid
- pericardiocentesis
- subxiphoid pericardiostomy
- thoracic pericardiostomy (open or thoroscopic)
anesthetic management of cardiac tamponade
- expand intravascular volume
- increase contractility (isoproterenol)
- correct metabolic acidosis
- use local, or ketamine
constrictive pericarditis: definition & causes
fibrous scarring & adhesions of the pericardial cavity that creates a rigid, stiff shell around the heart (limits filling)
causes
- idiopathic
- previous cardiac surgery
- TB
- exposure to radiotherapy
s/s constrictive pericarditis
- increased CVP, PCWP
- decreased CO
- fatigue
- atrial dysrhythmias
- edema, ascites, hepatomegaly, JVD
- pulsus paradoxus
constrictive pericarditis tx
surgical stripping & removal of adherent constricting pericardium (pericardiectomy)
anesthetic management of constrictive pericarditis
- minimize changes to HR, SVR, preload, contractility (ketamine, etomidate, pancuronium)
- avoid bradycardia
- maintain intravascular volume to avoid hypotension
- large bore IVs
- aline
- assess for the need for blood transufsions
