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)
