Pericardial Diseases

Question 1

what cells produce the fluid in the pericardial cavity?

Answer 1

epithelial cells

Question 2

name three purposes of pericardial sac

Answer 2

keeps heart in place
serves as physical obstruction to infection from lungs
limits expansion of the heart size

Question 3

what are the two most common causes of acute pericarditis?

Answer 3

viral and idiopathic

Question 4

name four types of infections that can lead to acute pericarditis

Answer 4

virus
bacterial
TB
connective tissue disorders

Question 5

what is the cause of post MI pericarditis immediately following an MI

Answer 5

inflammation from myocardium extends into the pericardial space

Question 6

what is the cause of dressler syndrome following an MI? when does this occur?

Answer 6

thought to be autoimmune

at least 2 weeks after MI

Question 7

what is fibrinous pericarditis?

Answer 7

when fibrin leaks out with inflammatory vasodilation and fibrin sets up shop in the pericardial space

Question 8

what are four common causes of fibrinous pericarditis?

Answer 8

Virus
MI
Uremia
SLE

Question 9

what is purulent pericarditis?

Answer 9

inflammatory migration of PMNs into the pericardial space

Question 10

what is the usual cause of purulent pericarditis?

Answer 10

bacterial infections

Question 11

what is tuberculous pericarditis?

Answer 11

when there is a tuberculosis infection that leads to granulomma formation in the pericardial cavity

Question 12

name the four types of acute pericarditis based on pathology

Answer 12

serous
tuberculous
fibrinous
purulent

Question 13

when you have pericarditis…what are the two options for long term development?

Answer 13

will either heal or scar and lead to constrictive pericarditis

Question 14

name four symptoms of acute pericarditis

Answer 14

fever, chest pain thats worse when sitting up, non productive cough, dyspnea

Question 15

what is something you can auscultate with acute pericarditis?

Answer 15

a friction rub from the parietal and visceral rubbing

Question 16

what are the two important EKG findings early on with acute pericarditis?

Answer 16

concave ST segment elevation

PR interval depression

Question 17

what is the main treatment for acute pericarditis?

Answer 17

NSAIDs…specificall ibuprofen

Question 18

describe what causes constrictive pericarditis

Answer 18

chronis inflammation of the pericardium leads to calcification and thickening of the pericardial sac…this limits the expansion of the ventricles

Question 19

what is unique about the filling of the heart in restrictive pericarditis?

Answer 19

you will have a rush of filling in early diastole because as you get to mid/late the ventricles will start to be compressed by the pericardial sac

Question 20

what is a common infectious pericarditis to lead to constrictive pericarditis?

Answer 20

tuberculous pericarditis

Question 21

what are the signs/symptoms of constrictive pericarditis?

Answer 21

those of right heart failure…peripheral edema, ascites, fatigue

Question 22

name one thing you can auscultate with constrictive pericarditis

Answer 22

pericardial knock…3rd heart sound

Question 23

in pericarditis, is the jugular venous pressure increased decreased or stay the same?

Answer 23

increased or elevated

Question 24

what is Kussmauls sign?

Answer 24

when JVP remains elevated even with inspiration

Question 25

name two things that will happen with JVP in constrictive pericarditis

Answer 25

X and Y wave descents are steeper | elevated JVP throughout

Question 26

define cardiac tamponade

Answer 26

extreme form of pericardial constraint that is present throughout diastole, not just in mid to late like constrictive pericarditis

Question 27

what really causes cardiac tamponade?

Answer 27

accumulation of fluid in the pericardial sac leads to greater ventricular interdependence

Question 28

why can you see cardiogenic shock in cardiac tamponade?

Answer 28

negative intrathoracic pressure can be transmitted to the heart...so you get more venous return and as RV fills it bulges into LV since it cannot bulge out...this decreases LV volume and leads to diminished cardiac output

Question 29

what is becks triad for cardiac tamponade

Answer 29

hypotension, diminished heart sounds, elevated JVP

Question 30

what is the abnormality in JVP with cardiac tamponade? why?

Answer 30

blunted Y descent this is because the Y descent is when ventricles are filling and this is problematic in cardiac tamponade

Question 31

what is pulsus paradoxus? why is it seen in cardiac tamponade?

Answer 31

when there is a larger decrease in pulse pressure than 10mmHg with inspiration...in cardiac tamponade the RV will shove on the LV leading to a lesser pulse with inspiration

Question 32

what will you see on EKG with cardiac tamponade? 2 things

Answer 32

tachycardia | electrical alternans

Question 33

what is electrical alternans? why is it seen in cardiac tamponade?

Answer 33

when QRS complexes change amplitude...seen because of the heart swinging in the pericardial fluid

Question 34

two treatments for cardiac tamponade

Answer 34

removal of fluid from pericardial sac and give fluid to maintain CO also will do surgical repair if needed

Question 35

what is the treatment of cardiac tamponade called

Answer 35

catheter pericardiocentesis