Pericardial Disorders

Question 1

How much fluid is normally present in the pericardium?

Answer 1

30-50 mL

Question 2

What is a pericardial effusion?

Answer 2

when the parietal pericardium distends from an increase in the volume of pericardial fluid.

Question 3

What is a hemopericardium?

Answer 3

when blood passes into the pericardial sac, possibly due to a dissecting aorta or trauma.

Question 4

What is a purulent pericarditis?

Answer 4

inflammation of the pericardial space characterized by gross pus in the pericardium.

Question 5

What makes pericardial fluid accumulation more significant/symptomatic?

Answer 5

the more rapidly it accumulates

Question 6

What is cardiac tamponade?

Answer 6

compression of atria and ventricles, restricting cardiac filling due to RAPID pericardial effusion.

Question 7

What is pericarditis?

Answer 7

pericardial inflammation due to cardiac disorders, thoracic or systemic disorders, metastases, or cardiac surgery. This can lead to varying degrees of pericardial effusion.

Question 8

Is primary pericarditis common?

Answer 8

NO, but when it does occur it is almost always viral in origin.

Question 9

Is pericarditis more often acute or chronic?

Answer 9

acute, but when chronic it is due to TB (affects lungs and is thus in close proximity to the pericardium) or fungal infections.

Question 10

What are the different types of acute pericarditis?

Answer 10

serous (yellowish fluid), fibrinous (proteinaceous), purulent (pus), hemorrhagic (blood), caseous (from TB)

Question 11

What are the causes of pericarditis?

Answer 11

CARDIAC RIND (pneumonic):
Collagen vascular diseases
Aortic aneurysm
Radiation
Drugs
Infection
Acute renal failure
Rheumatic fever
Injury
Neoplasm
Dressler syndrome

Question 12

**Is serous pericarditis usually infectious or noninfectious?

Answer 12

NONINFECTIOUS (RF, SLE, scleroderma, UREMIA (high levels of waste products in the blood)) and fluid accumulates SLOWLY, due to increased permeability of vessels due to inflammation). This rarely organizes (causes fibrosis) and does not constrict.

Question 13

What may accompany a serous pericarditis?

Answer 13

viral myocarditis

Question 14

What is the most frequent type of pericarditis?

Answer 14

fibrinous and serofibrinous= serous fluid mixed with a fibrinous exudate. Usually due to acute MI.

Question 15

What is Dressler syndrome?

Answer 15

late pericarditis that develops 2 weeks to several months post MI (may have an autoimmune etiology).

Question 16

How does fibrinous differ from serofibrinous pericarditis?

Answer 16

fibrinous= surface is dry with fine granular roughening.
serofibrinous= increased inflammatory component causes  greater and thicker fluid, thicker and cloudy from an increase in WBC and fibrin.

Question 17

How do organisms reach the pericardium in purulent or suppurative pericarditis?

Answer 17

1. direct extension from neighboring inflammation
2. seeding from the blood
3. lymphatic extension
4. direct induction during surgery
   * organization is more common, leading to constrictive pericarditis :(

Question 18

Is resolution of purulent of suppurative pericarditis common?

Answer 18

NO :(

Question 19

**What can lead to a hemorrhagic pericarditis?

Answer 19

• malignant tumor
• bacterial infections
• bleeding disorders
• TB
• following cardiac surgery

Question 20

What is characteristic of chronic pericarditis?

Answer 20

fibrous thickening of serosal membranes called soldier’s plaque. In severe cases, organization can cause complete obliteration of the pericardial sac leading to adhesive pericarditis= stringy type of adhesion between the visceral and parietal pericardium.

Question 21

What is adhesive mediastinopericarditis?

Answer 21

pericardial sac is obliterated leading to a great strain on cardiac function. Increased workload leads to right ventricular hypertrophy and dilation (mimicking cardiomyopathy).