Pericardial Dz Flashcards
What is the hallmark of chronic progressive constrictive pericarditis?
Thickened and calcified adherent pericardium
What are the signs and symptoms of constrictive pericarditis?
Nonspecific s/s like dyspnea on exertion, fatigue, and peripheral edema + Kussmaul’s sign (failure to decrease or a paradoxical increase in JVP during inspiration) + pericardial knock on auscultation
What do you see in constrictive pericarditis with respiration?
Similar to tamponade; Inspiration = increased right-sided filling leading to ventricular interdependence and decreased SBP; Expiration = increased left-sided filling leading to increased SBP and SV
What happens if you positive pressure ventilate constrictive pericarditis?
You see the opposite of normal, spontaneous respirations
What do you see on CVP tracing with constrictive pericarditis?
Prominent systolic x wave and a rapid y-descent (early diastolic filling)
What do you see with pulmonary and hepatic venous flows for constrictive pericarditis?
Predominant diastolic flows and reversal during atrial contraction
What is the classic ventricular pressure tracing finding for constrictive pericarditis?
The square root sign; signifies rapid early diastolic flow followed by equalization of pressures within chambers (all elevated)
What do you see on TEE for constrictive pericarditis?
Thickening pericardium (>4mm) and hyperechogenic (80% of cases) + exaggerated interventricular dependence + restrictive ventricular filling pattern (E/A>2) + transmitral E wave decreases >25% with inspiration + transtricuspid E wave decreases >40% with expiration + medial mitral annular e’>8cm/s + medial mitral annular e’ > lateral mitral annular e’ (annulus reversus) + hepatic antegrade flow is higher in diastole (expiratory reversal of diastolic flow)
Why is there an increased risk of bleeding during pericardiectomy?
Inflammatory scar tissue and adhesions + liver congestion + splenic congestion (platelet sequestration)
What can you see post-op after pericardiectomy?
Persistent constrictive physiology within 14 days of surgery + diastolic abnormalities in up to 60% of patients
How do you tell the difference between a restrictive cardiomyopathy and constrictive pericarditis?
- Myocardial relaxation is impaired in RCM (abnormal elastic properties of the myocardium itself) but normal in CP
- CP has exaggerated interventricular dependence
- Imaging (thickened pericardium >4mm in 80% of patients)
- Both have a restrictive filling pattern but only CP has respiratory variation
