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ECHO 325 > Pericardial Diseases > Flashcards

Pericardial Diseases Flashcards

1
Q

The visceral pericardium is also called what?

A

Epicardium

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2
Q

Where is the insertion of the pericardium?

A

Posteriorly at the IVC and superiorly to the pulmonary and great vessels.

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3
Q

What is the normal amount of serous fluid?

A

20-50ml

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4
Q

What are the functions of the pericardium?

A

Limits over distention, distributes diastolic pressure, reduces friction, infection barrier

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5
Q

What is epicardial fat also referred to as?

A

Anterior fat pad

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6
Q

What can a fat pad mimic?

A

Pericardial effusion

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7
Q

What is tamponade?

A

Marked or fast increase in fluid accumulation around the heart that compresses the heart

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8
Q

What does pericarditis restrict?

A

Diastolic function

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9
Q

What is a consequence of having pericardial effusion?

A

Reduction of SV by restrictive filling

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10
Q

What are infectious causes of pericardial effusion?

A

Viral, bacterial, parasitic

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11
Q

What are inflammatory causes of pericardial effusion?

A

Post MI, uremia, radiation therapy, systemic diseases (lupus, scleroderma)

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12
Q

What are anasarca causes of pericardial effusion?

A

Liver failure, right heart failure, chemotherapy

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13
Q

What are malignant causes of pericardial effusion?

A

Primary cardiac tumor, neoplastic invasion, metastases

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14
Q

What are some signs and symptoms that are seen with a pericardial effusion?

A

Chest pain (more when they are laying flat), SOB, increased JVP, friction rub in diastole, muffled heart sounds

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15
Q

What will be seen on the ECG with pericardial effusion?

A

Low voltage ECG, electrical alternans

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16
Q

What is electrical aternans?

A

Caused by the heart swinging in pericardial fluid

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17
Q

What causes a diastolic collapse of the right heart with pericardial effusion?

A

When there is higher intrapericardial pressures than diastolic intracardiac pressures

18
Q

When the pericardial pressure is > RAP what will fall?

A

Mean arterial pressure and cardiac output

19
Q

What would constitute a physiologic pericardial effusion?

A

2-5mm space in systole

20
Q

What would constitute a mild pericardial effusion?

A

<0.5-1cm space posteriorly in systole and diastole

21
Q

What would constitute a moderate pericardial effusion?

A

1-2cm posterior space in systole and diastole/anteriorly

22
Q

What would constitute a large pericardial effusion?

A

> 2cm ant and post space ins systole and diastole

23
Q

What are the differences between pericardial and pleural effusions?

A

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

24
Q

Where do you measure a pericardial effusion on M-Mode?

A

Anechoic space between epicardium and pericardium in diastole

25
Q

With a pericardial effusion, where does the septum shift during inspiration and expiration?

A

Inspiration: to the left
Expiration: to the right

26
Q

What happens to the right heart with pericardial tamponade?

A

RA systolic collapse, RV diastolic collapse, RV filling impaired, increased TV flow and decreased MV flow producing septal shifting, dilated SVC and IVC

27
Q

What happens to the left heart with pericardial tamponade?

A

Impaired LV diastolic filling, volume changes with respiration, SV and BP drop, tachycardia compensates for low blood volume

28
Q

If systolic RV collapse is seen, what is this a sign of?

A

Tamponade

29
Q

Both RV and RA collapse is seen in what circumstance?

A

When intracardial pressure has risen above the RV diastolic pressure

30
Q

What are acute causes of pericardial tamponade?

A

Trauma, Ao dissection, Dressler’s syndrome, myocardial rupture post MI, iatrogenic

31
Q

What are the subacute and chronic causes of pericardial tamponade?

A

Idiopathy, viral pericarditis, metastatic disease, radiation

32
Q

What is indicative of pericardial tamponade on ECG?

A

Electrical alternans

33
Q

What is Beck’s triad?

A
  1. Low arterial BP
  2. Distended neck veins
  3. Distant, muffled heart sounds
34
Q

With inspiration with pericardial tamponade, describe the volume of the RV and LV:

A

Increased RV volume and decreased LV volume

35
Q

With expiration with pericardial tamponade, describe the volume of the RV

A

Decreased

36
Q

MV E velocities will have what percentage of change with pericardial tamponade?

A

≥25-30%

37
Q

MV inflow does what with inspiration with pericardial tamponade?

A

Decreases

38
Q

TV inflow does what with inspiration with pericardial tamponade?

A

increases

39
Q

What is haemopericardium?

A

Collection of blood in the pericardial sac

40
Q

What happens to RV and LV diastolic filling with constrictive pericarditis?

A

Diastolic filling is reduced as parietal pericardium is not compliant

ECHO 325 (19 decks)

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