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Cardio > Pericardial Diseases - Exam 1 > Flashcards

Pericardial Diseases - Exam 1 Flashcards

1
Q

What is the role of the pericardium?

A

double-layered sac surrounding the heart that restricts the anatomic position of the heart. Decreases the spread of infections from the lungs and pleural cavities to the heart

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2
Q

a large portion of pericarditis causes are ______. What is the MC?

A

no identifiable cause

viral are the MC cause

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3
Q

When bacterial endocarditis does occur _____ is the likely culprit

A

extension of pulmonary infections

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4
Q

cancer pericarditis is either going to be _____ or ______. Why?

A

lung or breast

they both are in close proximity

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5
Q

name 4 pericardial injuries that can cause pericarditis

A

invasive cardiac procedures

post-pericardiotomy

trauma

radiation

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6
Q

**What is Dressler syndrome? What is the tx?

A

pericarditis that occurs 2 weeks after a MI due to an autoimmune/inflammatory response

usually self limiting

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7
Q

What are the 4 main diagnostic features of pericarditis?

A

chest pain

pericardial friction rub

EKG

pericardial effusion

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8
Q

**What is the cardinal symptom of pericarditis? Where? Is it pleuritic? What makes it worse? better?

A

Chest pain caused by the heart rubbing against the pericardium

Usually precordial or retrosternal with referral to the trapezius ridge, neck, left shoulder, or arm

PLEURITIC

worse: lying flat, swallowing, coughing, body movement

better: sitting up and leaning forward

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9
Q

What is the characteristic heart sound associated with pericarditis?

A

pericardial friction rub

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10
Q

What is a EKG finding that would point to pericarditis?

A

diffuse ST segment elevation (aka ST segment elevation everywhere NOT just in specific boxes that would indicate MI)

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11
Q

What is the diagnostic criteria for acute pericarditis?

A

need at least 2:

Typical chest pain - pleuritic, worse with lying down, improved with sitting/leaning forward

Pericardial friction rub

Characteristic ECG changes

New or worsening pericardial effusion

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12
Q

What is the tx for acute pericarditis? _____ should be used in post-MI cases. ________ is used in severe/refractory cases or when the first line agent is CI

A

Ibuprofen or Indomethacin for 14 days

+/- colchicine as adjuvant

ASA is preferred post-MI

Prednisone

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13
Q

Because the pericardium covers the ascending aorta and arch, _______ can also lead to a pericardial effusion/ tamponade

A

aortic dissection / rupture

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14
Q

What is cardiac tamponade? What does it depend on?

A

increased pressure around the heart

no specific amount of fluid but depends on the RATE of ACCUMULATION

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15
Q

What does cardiac tamponade lead to?

A

the right atria is usually the first to collapse due to increased pressure which leads to reduced cardiac output and potentially cardiogenic shock = medical emergency

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16
Q

What does the presentation of cardiac tamponade depend on? Give both options

A

presentation is based on the size of the effusion

small: asymptomatic or s/s of pericarditis

large: chest pain, fatigue, SOB

aka super bad cardiac tamponade will have s/s of cardiogenic shock

17
Q

**What is Beck’s triad? What is it associated with?

A

Beck’s triad: classic presentation of cardiac tamponade

JVD
Muffled Heart Sounds
Hypotension

18
Q

What is Kussmaul’s sign?

A

increase in JVP on inspiration (instead of the normal decrease)

cardiac tamponade

19
Q

What is pulsus paradoxus?

A

an inspiratory systolic fall in arterial pressure >12 mmHg during normal breathing (check BP with inspiration) – 70-80% of patients

20
Q

What are the 2 highlighted s/s of pericardial effusion?

A

Pericardial friction rub
Narrow pulse pressure

plus look for all the s/s of cardiogenic shock

21
Q

What is the initial test of choice to dx pericardial tamponade? What 3 things should you look for on said test?

A

Echo TTE

RV Collapse
LV Collapse
Dilated IVC w/out inspiratory collapse

22
Q

**The CXR of cardiac tamponade will often have _______. What does it indicate?

A

water bottle heart

fluid accumulation around the heart

23
Q

**What is the EKG finding associated with pericardial effusion? What is it a result of?

A

ELECTRICAL ALTERNANS is pathognomonic of cardiac tamponade.Characterized by alternating levels of ECG voltage of the p wave, QRS complex, and T waves

This is the result of the heart “swinging” in a large effusion

24
Q

Why would you order a CT in pericardial effusion? What is an advantage?

A

provides anatomic details of the entire pericardium due to its capacity in providing a wide field of view. Advantages include its capacity to detect pericardial calcifications.

25
Q

Why would you order a MRI in pericardial effusion? What type of pt is it NOT good for?

A

provides anatomic details of the pericardium and heart without ionizing contrast or radiation. Sensitive for detecting pericardial effusion and loculated pericardial effusion and thickening

Limited use in patients with arrhythmias

26
Q

What is the management for small effusions? What is considered small?

A

serial echos

Usually <1cm in size

27
Q

What is the criteria for pericardial effusion that requires hospital admission?

A

large effusions >2cm
Fever (>38ºC [100.4ºF]) and leukocytosis
Immunosuppressed state
A history of therapy with V-K antagonists
Acute trauma
Failure to respond within seven days to NSAID therapy
Elevated cardiac troponin, which suggests myopericarditis

28
Q

When would pericardiocentesis be a good management option?

A

For effusions >250 mL, effusions when size increases despite intensive dialysis for 10-14 days, or effusions with evidence of tamponade

considered diagnostic and therapeutic

29
Q

What are the 4 pericardial effusion tx options?

A

Pericardial Diodesis
Pericardiotomy
Pericardial Window
Pericardiectomy

30
Q

What is happening in Pericardial Diodesis (Sclerotherapy)?

A

Installation of chemical in the pericardial space causing sclerosis of the pericardium - essentially eliminates the space between the heart and the pericardium so fluid can no longer accumulate

31
Q

What is happening in a Pericardiotomy?

A

Incision made into the pericardium. Effective (90-97%)

32
Q

What is happening in pericardial window?

A

A surgical procedure to create a fistula - “window” - from the pericardial space to the pleural cavity, allowing the effusion to drain out of the pericardial space into the chest cavity.

Can be performed with a balloon catheter.

33
Q

What is happening in a pericardiectomy?

A

Removal of the pericardium itself. The most effective surgical procedure for managing large effusions, but since it requires general anesthesia and a thoracotomy, only consider if pericardiotomy can’t be performed or has been unsuccessful

34
Q

What is constrictive pericarditis caused by?

A

Inflammation of the pericardium can lead to a thickened, fibrotic, adherent pericardium that restricts DIASTOLIC filling which will present as right sided heart failure

35
Q

____ is the most common cause of constrictive pericarditis in developing countries. **What are the 3 MC causes in developed countries?

A

TB

Radiation
cardiac surgeries
viral pericarditis

36
Q

How will constrictive pericarditis present? What phase of the cardiac cycle is most affected?

A

Progressive dyspnea, fatigue and weakness
Edema, ascites, hepatic congestion
Elevated JVP – Kussmaul sign
Atrial fibrillation is common
(presents like right sided heart failure)

DIASTOLIC function is most affected

37
Q

constrictive pericarditis presents similarly to other heart conditions, need to order ______ to confirm diagnosis.

A

cardiac cath to measure pressures in the right and left ventricle during inspiration and expiration

38
Q

What is the tx for constrictive pericarditis? What is that doesnt work?

A

Diuretics!! loop or aldosterone antagonists

Surgical pericardiectomy is recommended for patients unresponsive to diuretics

39
Q
A

Cardio (20 decks)

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