Pericardial Diseases

Question 1

Sinuses

Answer 1

Oblique - behind the heart

Transverse - around the great vessels

Question 2

Pericarditis categories

Answer 2

Acute
Incessant - 4-6 weeks but less than 3 mos
Chronic - over 3 mos
Recurrnet - sx free interval over 4 weeks

Question 3

Hx of acute pericarditis

Answer 3

Sharp pain
Positional - worse laying down and better siting up
Pleuritc

Question 4

Physical acute pericarditis

Answer 4

Maybe fever or tachy

Rubb at LLSB

Question 5

ECG acute pericarditis

Answer 5

SInus tachy

Diffuse PR dep and ST elevation
PR and ST revert to normal
T wave inversion
T wave back to normal

Question 6

Acute percarditis imaging

Answer 6

Echo…not specific

Cardiac MRI can detect acute inflammation

Question 7

Dx of pericarditis

Answer 7

Pleurutic
Pericardial rub
ECG change
Effusion

Supportinong - inflammatory markers nad inflammation by imaging

Question 8

Tx of acute pericaridtis

Answer 8

Aspirin 3-5 weeks
Colchicine - 3 mos
Prednisoone if refrasctory

Question 9

Colchicine

Answer 9

Inhibits MT formation

Question 10

Recurrent pericarditis tx

Answer 10

NSAIDS til sx gone
Colchicine for 6 mos
Immunosuppressants

Question 11

Pericardial effusion Onset and size

Answer 11

Acute, subactue, chonic (3 mo)

Mild under 10, Moderate 10-20, large

Question 12

ECG of pericardial effusion

Answer 12

.5mV or less on limb leads and under 1.0 on precordal

Electrical aternans

Question 13

Percardiocentesis

Answer 13

For both dx AND tx

Question 14

Tamponade physical

Answer 14

Clear lungs***
Pulsus paradoxus - dec SBP during inspiration due to dec LV filling

BEcks triad

Question 15

Cardiac tamponade echo

Answer 15

Pericardial effusion
RA collapse 
RV diastolic collapse 
INsp change in tricuspid flow 
Exp change in mitral flow

Question 16

Tamponade tx

Answer 16

IV fluids and pericardiocetesis

Question 17

COnst pericarditis

Answer 17

Transient
Effusive - improvement with pericardiocentesis
Chronic - 3-6 mos

Question 18

Const pericarditis pathophys

Answer 18

Pericardium is inflamed and adheres to epicardium

Can become thickened and calcified

Stiff pericardium prevents expansion (diastolic dysfunciton)

Filling pressure backs up causing peripheral edema but NOT pulmonary edema

BC diastolic dysfuncition - dyspnea on exertion

Question 19

COnst pericarditis insp and exp

Answer 19

Insp - septum will move to left ventricle to accomodate inc filling in RV

Exp - septum moves to the right to accomodate inc filling in the left

Question 20

Const pericarditis dx

Answer 20

Echo
MRI
Catherization

Need to see ventricular interdependne

Question 21

Const tx

Answer 21

Pericardial stripping or pericardiectomy

Avoid phrenic nerve
s
HEart should “pop out”