Pericardial Diseases Flashcards

1
Q

most common pericardial disease

A

acute pericarditis

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2
Q

define acute pericarditis (AP) and its common causes

A

inflammation of pericardium, usually viral or idiopathic, lots of other possibilities (post MI, TB, bacterial, uremia, PE, dresslers, drugs)

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3
Q

serous pericarditis

A

increased serous fluid from mesothelium

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4
Q

serofibrinous/fibrinous

A

inflammatory vasodilation, leakage of plasma proteins like fibrinogen

Bread and Butter, caused by virus, MI, SLE

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5
Q

suppurative/purulent pericarditis

A

inflammatory migration of PMNs

caused by bacteria

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6
Q

TB pericarditis

A

granuloma formation, caused by mycobacteria

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7
Q

signs/Sx of AP

A

prodrome of fever, malaise, myalgia

radiating chest pain, may be pleuritic, better sitting up than supine,

dyspnea, cough

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8
Q

AP physical exam

A

friction rub- heard at left sternal border, pretty specific scratching sound

heard during atrial systole, ventricle systole, and rapid ventricular filling

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9
Q

AP on ECG

A

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

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10
Q

3 other findings w/ AP

A

maybe pericardial effusion, some myocarditis, signs of inflammation- WBC, ESR, CRP

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11
Q

managment of AP

A

hospitalize w/ unknown etiology, fear of effusion/tamponade, high risk

Tx w/ NSAIDs

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12
Q

AP outcomes

A

usually self limited, sometimes chronic or recurrent

some risk of constrictive pericarditis

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13
Q

define constrictive pericarditis

A

chronic inflamed pericardium- calcification and thickening

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14
Q

patho of CP

A

inhibits transmission of pressure into pericardial space, limits ventricle compliance (during mid to late diastole, still rapid early filling)

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15
Q

etiologies of CP

A

idopathic, viral, post op or radiation, infection- esp TB or purulent pericarditis, malignancy, trauma

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16
Q

hemodynamic change in heart w/ CP

A

more interdependence b/w ventricles, impact each other

17
Q

H and P for CP

A

Right HF signs and Sx- peripheral edema, ascites, fatigue

JVD, hepatomegaly, pleural effusion

pericardial knock, like an S3

18
Q

Kussmaul’s sign

A

increased JVP w/ inspiration (opposite of normal), occurs in CP because heart cannot accept increased preload during inspiriation, this pressure pushed to jugular vein

19
Q

CP effect on the JVP curve

A

prominent y descent, from the drop in JVP during ventricular relaxation

20
Q

Tx for CP

A

pericardiectomy- strip the pericardium, risky procedure w/ good outcomes in only 60%

21
Q

define cardiac tamponade

A

extreme pericardial constraint throughout cycle, from buildup of fliuid under pressure

22
Q

etiologies of tamponade

A

acute: trauma, rupture, procedure complication
subacute: neoplastic, uremic, viral, idopathic

23
Q

pathophys of tamponade

A

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

24
Q

Sx of tamponade

A

Sx of fatigue, hypotension, confusion, agitation

25
what determines hemodynamic stability during tamponade?
rapidity of fluid accumulation, not amount of fluid
26
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
27
tamponade impact on JVP curve
blunted y descent- impaired ventricular filling causes pressure buildup in JVP
28
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
29
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
30
ECG findings w/ tamponade
electrical alternans- beat to beat alteration in QRS amplitude from swinging of heart in pericardial fluid specific, not sensitive
31
Dx of tamponade
physical exam, ECG, mainly Echo
32
tx for tamponade
urgent removal of fluid w/ pericardiocentesis, can proceed to surgical drainage