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Cardio > Pericardial Diseases > Flashcards

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
Q

what determines hemodynamic stability during tamponade?

A

rapidity of fluid accumulation, not amount of fluid

26
Q

physical exam findings w/ tamponade

A

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
Q

tamponade impact on JVP curve

A

blunted y descent- impaired ventricular filling causes pressure buildup in JVP

28
Q

define pulsus paradoxus

A

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
Q

how to measure pulsus paradoxus

A

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
Q

ECG findings w/ tamponade

A

electrical alternans- beat to beat alteration in QRS amplitude from swinging of heart in pericardial fluid

specific, not sensitive

31
Q

Dx of tamponade

A

physical exam, ECG,

mainly Echo

32
Q

tx for tamponade

A

urgent removal of fluid w/ pericardiocentesis, can proceed to surgical drainage

Cardio (34 decks)

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