Pericardial Diseases

Question 1

The visceral pericardium is also called what?

Answer 1

Epicardium

Question 2

Where is the insertion of the pericardium?

Answer 2

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

Question 3

What is the normal amount of serous fluid?

Answer 3

20-50ml

Question 4

What are the functions of the pericardium?

Answer 4

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

Question 5

What is epicardial fat also referred to as?

Answer 5

Anterior fat pad

Question 6

What can a fat pad mimic?

Answer 6

Pericardial effusion

Question 7

What is tamponade?

Answer 7

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

Question 8

What does pericarditis restrict?

Answer 8

Diastolic function

Question 9

What is a consequence of having pericardial effusion?

Answer 9

Reduction of SV by restrictive filling

Question 10

What are infectious causes of pericardial effusion?

Answer 10

Viral, bacterial, parasitic

Question 11

What are inflammatory causes of pericardial effusion?

Answer 11

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

Question 12

What are anasarca causes of pericardial effusion?

Answer 12

Liver failure, right heart failure, chemotherapy

Question 13

What are malignant causes of pericardial effusion?

Answer 13

Primary cardiac tumor, neoplastic invasion, metastases

Question 14

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

Answer 14

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

Question 15

What will be seen on the ECG with pericardial effusion?

Answer 15

Low voltage ECG, electrical alternans

Question 16

What is electrical aternans?

Answer 16

Caused by the heart swinging in pericardial fluid

Question 17

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

Answer 17

When there is higher intrapericardial pressures than diastolic intracardiac pressures

Question 18

When the pericardial pressure is > RAP what will fall?

Answer 18

Mean arterial pressure and cardiac output

Question 19

What would constitute a physiologic pericardial effusion?

Answer 19

2-5mm space in systole

Question 20

What would constitute a mild pericardial effusion?

Answer 20

<0.5-1cm space posteriorly in systole and diastole

Question 21

What would constitute a moderate pericardial effusion?

Answer 21

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

Question 22

What would constitute a large pericardial effusion?

Answer 22

> 2cm ant and post space ins systole and diastole

Question 23

What are the differences between pericardial and pleural effusions?

Answer 23

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

Question 24

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

Answer 24

Anechoic space between epicardium and pericardium in diastole

Question 25

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

Answer 25

Inspiration: to the left Expiration: to the right

Question 26

What happens to the right heart with pericardial tamponade?

Answer 26

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

Question 27

What happens to the left heart with pericardial tamponade?

Answer 27

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

Question 28

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

Answer 28

Tamponade

Question 29

Both RV and RA collapse is seen in what circumstance?

Answer 29

When intracardial pressure has risen above the RV diastolic pressure

Question 30

What are acute causes of pericardial tamponade?

Answer 30

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

Question 31

What are the subacute and chronic causes of pericardial tamponade?

Answer 31

Idiopathy, viral pericarditis, metastatic disease, radiation

Question 32

What is indicative of pericardial tamponade on ECG?

Answer 32

Electrical alternans

Question 33

What is Beck's triad?

Answer 33

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

Question 34

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

Answer 34

Increased RV volume and decreased LV volume

Question 35

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

Answer 35

Decreased

Question 36

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

Answer 36

≥25-30%

Question 37

MV inflow does what with inspiration with pericardial tamponade?

Answer 37

Decreases

Question 38

TV inflow does what with inspiration with pericardial tamponade?

Answer 38

increases

Question 39

What is haemopericardium?

Answer 39

Collection of blood in the pericardial sac

Question 40

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

Answer 40

Diastolic filling is reduced as parietal pericardium is not compliant