Pericardial Diseases Flashcards
The visceral pericardium is also called what?
Epicardium
Where is the insertion of the pericardium?
Posteriorly at the IVC and superiorly to the pulmonary and great vessels.
What is the normal amount of serous fluid?
20-50ml
What are the functions of the pericardium?
Limits over distention, distributes diastolic pressure, reduces friction, infection barrier
What is epicardial fat also referred to as?
Anterior fat pad
What can a fat pad mimic?
Pericardial effusion
What is tamponade?
Marked or fast increase in fluid accumulation around the heart that compresses the heart
What does pericarditis restrict?
Diastolic function
What is a consequence of having pericardial effusion?
Reduction of SV by restrictive filling
What are infectious causes of pericardial effusion?
Viral, bacterial, parasitic
What are inflammatory causes of pericardial effusion?
Post MI, uremia, radiation therapy, systemic diseases (lupus, scleroderma)
What are anasarca causes of pericardial effusion?
Liver failure, right heart failure, chemotherapy
What are malignant causes of pericardial effusion?
Primary cardiac tumor, neoplastic invasion, metastases
What are some signs and symptoms that are seen with a pericardial effusion?
Chest pain (more when they are laying flat), SOB, increased JVP, friction rub in diastole, muffled heart sounds
What will be seen on the ECG with pericardial effusion?
Low voltage ECG, electrical alternans
What is electrical aternans?
Caused by the heart swinging in pericardial fluid
What causes a diastolic collapse of the right heart with pericardial effusion?
When there is higher intrapericardial pressures than diastolic intracardiac pressures
When the pericardial pressure is > RAP what will fall?
Mean arterial pressure and cardiac output
What would constitute a physiologic pericardial effusion?
2-5mm space in systole
What would constitute a mild pericardial effusion?
<0.5-1cm space posteriorly in systole and diastole
What would constitute a moderate pericardial effusion?
1-2cm posterior space in systole and diastole/anteriorly
What would constitute a large pericardial effusion?
> 2cm ant and post space ins systole and diastole
What are the differences between pericardial and pleural effusions?
Pericardial: anterior to descending Ao ALWAYS, no resp. Change in size
Pleural: only posterior to heart, change with respirations, does not cause RV or RA collapse
Where do you measure a pericardial effusion on M-Mode?
Anechoic space between epicardium and pericardium in diastole
With a pericardial effusion, where does the septum shift during inspiration and expiration?
Inspiration: to the left
Expiration: to the right
What happens to the right heart with pericardial tamponade?
RA systolic collapse, RV diastolic collapse, RV filling impaired, increased TV flow and decreased MV flow producing septal shifting, dilated SVC and IVC
What happens to the left heart with pericardial tamponade?
Impaired LV diastolic filling, volume changes with respiration, SV and BP drop, tachycardia compensates for low blood volume
If systolic RV collapse is seen, what is this a sign of?
Tamponade
Both RV and RA collapse is seen in what circumstance?
When intracardial pressure has risen above the RV diastolic pressure
What are acute causes of pericardial tamponade?
Trauma, Ao dissection, Dressler’s syndrome, myocardial rupture post MI, iatrogenic
What are the subacute and chronic causes of pericardial tamponade?
Idiopathy, viral pericarditis, metastatic disease, radiation
What is indicative of pericardial tamponade on ECG?
Electrical alternans
What is Beck’s triad?
- Low arterial BP
- Distended neck veins
- Distant, muffled heart sounds
With inspiration with pericardial tamponade, describe the volume of the RV and LV:
Increased RV volume and decreased LV volume
With expiration with pericardial tamponade, describe the volume of the RV
Decreased
MV E velocities will have what percentage of change with pericardial tamponade?
≥25-30%
MV inflow does what with inspiration with pericardial tamponade?
Decreases
TV inflow does what with inspiration with pericardial tamponade?
increases
What is haemopericardium?
Collection of blood in the pericardial sac
What happens to RV and LV diastolic filling with constrictive pericarditis?
Diastolic filling is reduced as parietal pericardium is not compliant
