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Cardio > Pericardial Diseases (Newman and Nichols) > Flashcards

Pericardial Diseases (Newman and Nichols) Flashcards

1
Q

What is the mechanism of pulsus paradoxus in pericardial temponade

A

pulse disappears during inspiration

  1. the inter ventricular septum bulges into the left ventricle (the walls of the heart cannot expand)
  2. this inc the LV pressure and dec EDV

SBP and pulse wave amplitude decrease during inspiration

need to wiki this: “abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration”

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2
Q

what happens to a healthy LV when it is filled during diastole?
(Diastolic function of the healthy heart)

A

water balloon:
elastin in LV allows the LV to expand with smow rises in volume and pressure

(abn heart = loss of compliance/elasticity)

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3
Q

What is the normal amt of serous fluid in pericardial sac?

A

15-20 mL

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4
Q

With a sudden inc in serous fluid to 200 mL will the pressure in pericardial space change?

A

no = enough elasticity

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5
Q

With a sudden inc in serous fluid to 200 - 300 mL will the pressure in pericardial space change?

A

yes, sharp rise in pressure

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6
Q

Will a slow increase in 2L of serous fluid cause an increase in the pressur of the pericardial space change?

A

no

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7
Q

What are common causes of pericardial effusion

A

viral myopericarditis (simultaneous infection of heart muscle and pericardial tissue)
metastatic malignancy (lung and breast)
autoimmune disease (lupus)
renal failure
bleeding (hemopericardium)** commonly considered a separate syndrome

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8
Q

What is the test you need to do in the pt that presents with acute pericarditis to determine if it mild or severe?

A

troponin

1/3 of pts with acute pericarditis it is elevated and therefore it s an acute myopericaditis (both heart muscle and pericardium affected) and needs to be hospitalized

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9
Q

What 2 most common cancers causing pericardial effusion

A

lung

breast

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10
Q

T of F: uremia causes pericarditis and pericardial effusion

A

T: something that the kidney is not getting rid of is causing the inflammation

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11
Q

How is pericardial effusion diagnoses?

A

ECG:”
shows as clear halo and can estimate size of effusion and determine if there is tamponade, a functional disturbance (this is describing a CXR)

(chest X-ray
EKG: dec voltage)

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12
Q

WHen is pericardiocentesis performed?

A

pericardiocentesis is low yield for diagnosis of pericardial effusion and reserved for cases when there is tamponade bc this is simultaneous a diagnosis and treatment

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13
Q

Describe plain chest x ray showing pericardial effusion? How can you differentiate this from cardiomegaly?

A

globular cardiac silhouette

do an ECHO**

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14
Q

Blue heart (gross appearance)

A

hemopericardium (what you see and tamponade is the functional syndrome/cause of death)
deoxygenated blood

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15
Q

black heart at autopsy

A

clotted blood within pericardium of hemopericardium

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16
Q

What is a hemopericardium?

A

a structual an anatomical pathologic finding that is rare but comonly fatal

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17
Q

What are the causes of a hemopericadium?

A
  1. cardiac rupture (from transmural MI)
  2. aortic dissection rupture
  3. chest trauma
  4. anticoagulation
  5. leukemia
18
Q

What is the diff between hemopericadium and cardiac tamponade?

A

syndrome vs finding

19
Q

percardial effusion or blood compressing the heart enought to impaired filling and pumping

A

tamponade

20
Q

symptoms of sudden cardiac tamponade?

slow developing tamponade

A

confusion, agitation, dyspnea, collapse, arrest

symp of HF: fatigue, leg edema, dyspnea

21
Q

What is Beck’s Triad? What does the presence of this signify?

A

presence of cardiac tamponade

  1. JVD
  2. muffled heart sounds
  3. hypotension
22
Q

What is an exaggeration of normal decrease in blood pressure with inspiration > 10 mmHg systolic?

A

pulsus paradoxus

23
Q

How is tamponade diagnosed?

A

diastolic collapse of right atrium and right ventricle (on ECHO)

swan-ganz right heart cathetierization to show an increased and equalized right atrial and left atrial pressures

24
Q

What is the treatment of cardiac tamponade?

A

tap it (subxiphoid)

25
Q

What is the difference between serous and fibrinous and purulent AND hemorrhagic pericarditis?

A

serous: smooth surface, usually with effusion of 50 to 200 mL of thin fluid with protein <50% of serum level, scant neutrophils, lymphocytes and macrophages
fibrinous: dry rough, shaggy,surface, more neutrophils, lymphocytes, and macrophages
purulent: red granular surface coated with pus, lots of subsurface neutrophils, up to 500 mL of exudate in pericardium
hemorrhagic: any of the above types with blood

26
Q

dry, rough, an shaggy pericardium

A

fibrous

condensed fibrin

27
Q

microscopic:

dense pink stuff on surface

A

fibrous

28
Q

self limited, usually over 1-3 weeks

caused by coxsackie (grou B) or echovirus

A

viral pericarditis

29
Q

How is viral pericarditis diagnosed?

A

anti-viral titers if at all but usually pts recover on their own

30
Q

What is the diagnostic criteria for acute pericarditis?

A

any 2 of these:

  1. pericardial friction rub (L sternal border)
  2. EKG (widespread ST elevation in 8-12 leads, which is way more than in MI)
  3. pericardial effusion
  4. positional sharp chest pain (worse when lying down and gets better leaning forward)
31
Q

What 2 bugs commonly cause acute pericarditis?

A

staph aureus

strep pneumonia

32
Q

What is the pathogenesis of acute pericarditis due to pyogenic bacteria

A 
1. extension of empyema 
(empyema = purulent infection of pleural space)
2. expension of mycocardial abscess 
3. seeding of pre-existing effusion 
4. hematogenous infection
33
Q

autoimmune pericarditis occurs in __% of pts with lupus and RA as part of a ____

A

30

polyserousitis with simultaneous pleuritis and peritonitis

34
Q

What are hemorrhagic pericarditis assc with

A

metastatic carcinoma
leukemia
TB

35
Q

encasement of the heart om dense fibrous or fibrocalcific scar

A

constrictive pericarditis

36
Q

Why is constrictive peritonitis problematic?

A

prevents hypertrophy or dilation (even when needed)

pathophys similar to tamponade!

37
Q

Tx of constrictive pericarditis?

Cause?

A 
strip it (surgery)
previous purulent or TB pericarditis
38
Q

In diastole, what determines ventricular pressure?

A

intrapericardial pressure

*in tamponade, all of the diastolic pressures in the chambers are equal

39
Q

How does tamponade effect CO?

A

heart cannot fill –> dec EDV which dec CO

40
Q

How is the RV affected during cardiac tamponade?

A

RV cannot expand correctly due to pressure; greater bulging of intraventricular septum into LV

between the RV and the tamponade pressure the LV (vol and) pressure decreases–cannot expand outward

41
Q

Acute pericarditis affects more (men/women); A big sign is that CP is better when:
Upon auscultation, you’ll hear:

A

women
sitting up/leaning fwd
pericardial friction rub

42
Q

Acute pericarditis can evolve to form

A

fibrinous adhesions, organization, fibrous adhesions

“constrictive pericarditis”

Cardio (26 decks)

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