Pericardial Dz Flashcards
How fluid does pericardium have?
15-50ml
What is pericarditis?
inflammation of the pericardium
What are the different classifications of pericarditis?
-acute (6mo)
What are the different etiologies?
- infectious
- nonfectious
What is infectious?
- viral: most likely; post URI
- bacterial: sepsis
- mycotic: impaired immune system; T cells so increased rate in HIV patients
What is noninfectious?
- MI
- Neoplastic
- myxedmea: hypothyroidism
- DRESSEL SYDNROME
- autoimmunity: lupus
- meds; hydralazine
What is Dressel’s syndrome?
- d/t injury to HEART or PERICARDIUM
- 2wks after MI
- TRIAD:
1) low fever
2) pleuritic chest pain: sharp
3) pericardial effusion - autoimmune: heals on it’s own
What is acute pericarditis?
80% are idiopathic/viral
Who does acute pericarditis affect?
young adults
Tx of acute pericarditis?
- self limiting
- bed rest
- NO anticoagulants b/c it can x and increase risk of bleeding
- watch out for pericardial effusion if it gets worse
- if pt insistent:
- -First line:
- —NSAIDs (idiopathic, viral, autoimmune)
- — ASA
- – colchicine (works well w/ gout)
How long does acute pericarditis last?
4 days to 4 wks
What do you have to watch out for in acute pericarditis?
increased inflammation can lead to pericardial effusion
PE of acute pericarditis?
- severe, sharp chest pain
- -worse w/ cough
- -better w/ sitting up
- PERICARDIAL FRICTION RUB
- -high pitched, scratching upon inspiration
- -heard better in L decubitus
Lab for acute pericarditis?
-increased ERS
EKG for acute pericarditis?
- WIDE ST segment
- inverted T
- PR depressed
PE of pericardial effusion
- distant heart sounds
- +/- pericardial friction rub (it may be filled with too much water)
- dullness under scapula (b/c it’s filled with water in the HEART not lungs)
CXR of pericardial effusion?
water bottle shape (heart is in a WATER bag)
EKG of pericardial effusion?
- PR depressed
- small R wave –> large R wave –> small R wave
Echo for pericardial effusion?
GOLD STANDARD
- estimates amount of fluid
- where the fluid is localized
- how much water is pressing on the heart
What is cardiac tamponade?
- fluid/blood building up between heart and endocardium
- 911 EMERGENCY
- reduces CO
Cx of cardiac tamponade?
- neoplastic inflitration of pericardium/lungs
- dissecting aortic aneurism
- idiopathic pericarditis
PE of cardiac tamponade for acute?
acute:
- dyspnea (b/c not enough CO)
- cold clammy hands (b/c not enough perfusion)
PE of cardiac tamponade for slow?
slow:
- may look like RHF
- JVD
- dyspnea
PE of cardiac tamponade in general?
- weak pulses
- tachycardia (b/c of low SV so it tries to perfuse by beating faster)
- FALLING ARTERIAL BP
- INCREASED VENOUS PRESSURE
- PARADOXICAL PULSE (when they breathe in, there’s no pulse heard/felt)
Tx of cardiac tamponade?
- pericardiocentesis
- can be used at tx AND diagnostic
- has needle/aspiration and catheter
Send diagnostic pericadiocentesis to lab to check for..?
- viral
- culture
- tumor cells
What is chronic constrictive pericarditis?
the pericardial cavity that has granulation and scarring
Cx of chronic constrictive pericarditis?
healing processes from acute fibrinous pericarditis (ie) TB
PE of chronic constrictive pericarditis?
- SOB
- weakness
- fatigue
- wt loss
- looks sick
- MAY look like LIVER CIRRHOSIS but NO distended neck veins
What is test for chronic constrictive pericarditis?
CT/MR
Tx for chronic constrictive pericarditis?
surgery
What can chronic constrictive pericarditis look like?
- pericardial cyst
- tumors
- blood clots
