Pericardial Diseases Flashcards
most common pericardial disease
acute pericarditis
define acute pericarditis (AP) and its common causes
inflammation of pericardium, usually viral or idiopathic, lots of other possibilities (post MI, TB, bacterial, uremia, PE, dresslers, drugs)
serous pericarditis
increased serous fluid from mesothelium
serofibrinous/fibrinous
inflammatory vasodilation, leakage of plasma proteins like fibrinogen
Bread and Butter, caused by virus, MI, SLE
suppurative/purulent pericarditis
inflammatory migration of PMNs
caused by bacteria
TB pericarditis
granuloma formation, caused by mycobacteria
signs/Sx of AP
prodrome of fever, malaise, myalgia
radiating chest pain, may be pleuritic, better sitting up than supine,
dyspnea, cough
AP physical exam
friction rub- heard at left sternal border, pretty specific scratching sound
heard during atrial systole, ventricle systole, and rapid ventricular filling
AP on ECG
4 stages: diffuse concave ST elevation and PR depression, then just PR depression, then T wave inverstion, then normal T waves
can also be low voltage and/or tachy
3 other findings w/ AP
maybe pericardial effusion, some myocarditis, signs of inflammation- WBC, ESR, CRP
managment of AP
hospitalize w/ unknown etiology, fear of effusion/tamponade, high risk
Tx w/ NSAIDs
AP outcomes
usually self limited, sometimes chronic or recurrent
some risk of constrictive pericarditis
define constrictive pericarditis
chronic inflamed pericardium- calcification and thickening
patho of CP
inhibits transmission of pressure into pericardial space, limits ventricle compliance (during mid to late diastole, still rapid early filling)
etiologies of CP
idopathic, viral, post op or radiation, infection- esp TB or purulent pericarditis, malignancy, trauma
hemodynamic change in heart w/ CP
more interdependence b/w ventricles, impact each other
H and P for CP
Right HF signs and Sx- peripheral edema, ascites, fatigue
JVD, hepatomegaly, pleural effusion
pericardial knock, like an S3
Kussmaul’s sign
increased JVP w/ inspiration (opposite of normal), occurs in CP because heart cannot accept increased preload during inspiriation, this pressure pushed to jugular vein
CP effect on the JVP curve
prominent y descent, from the drop in JVP during ventricular relaxation
Tx for CP
pericardiectomy- strip the pericardium, risky procedure w/ good outcomes in only 60%
define cardiac tamponade
extreme pericardial constraint throughout cycle, from buildup of fliuid under pressure
etiologies of tamponade
acute: trauma, rupture, procedure complication
subacute: neoplastic, uremic, viral, idopathic
pathophys of tamponade
increased pericardial pressure compresses all chambers (even more interdependence)
inspiratory negative prssure is transmitted to heart (unlike CP), leads to: increased venous return, filling RV causes septum to bulge into LV cavity (cant expand outward), impaired LV filling and reduced CO
Sx of tamponade
Sx of fatigue, hypotension, confusion, agitation
what determines hemodynamic stability during tamponade?
rapidity of fluid accumulation, not amount of fluid
physical exam findings w/ tamponade
Beck’s triad: JVD, muffled heart sounds, hypotension
pulsus paradoxus!
sinus tachy (compensate for low CO), cool extremities from increased SVR as CO decreases
tamponade impact on JVP curve
blunted y descent- impaired ventricular filling causes pressure buildup in JVP
define pulsus paradoxus
exaggerated decrease in systolic pressure w/ inspiration- caused by RV bulging into LV (as a result of increased preload w/ limits on heart expansion)
normally would see slight decrease
how to measure pulsus paradoxus
record pressure at which first sound is heard during expiration, then continue to deflate and record until sound w/ both inspiration and expiration- calculate the difference
ECG findings w/ tamponade
electrical alternans- beat to beat alteration in QRS amplitude from swinging of heart in pericardial fluid
specific, not sensitive
Dx of tamponade
physical exam, ECG,
mainly Echo
tx for tamponade
urgent removal of fluid w/ pericardiocentesis, can proceed to surgical drainage
