Pericardial Dz Flashcards
Acute pericarditis
- what is this?
- causes
- clinical findings (sx and PE)
- Dx findings
What is this:
-sudden inflammation of the pericardium from a variety of conditions.
Causes:
- infectious**
- Metastatic Neoplasm
- Medications (Procainamide & hydralazine)
- Bacterial
- Systemic dz
- Radiation
- Dressler Syndrome
Clinical findings:
- chest pain
- dyspnea
- febrile
- Pericardial friction rub
Dx Findings:
- Leukocytosis
- elevated sed rate (ESR)
- Troponin (will remain steady, whereas in MI it will spike up and then go down over the next 24hrs)
- CXR
- EKG
Acute Pericarditis EKG findings
- PR depressions
- ST elevations
- on the same lead
Acute Pericarditis Tx
- Treat underlying cause*
- NSAID and Aspirin
- Colchicine
- Systemic Corticosteroids ( severe sx, refractory, autoimmune disorders)
When to hospitalize Acute Pericarditis
- fever and leukocytosis
- evidence of cardiac tamponade
- anticoagulation
- failure to respond within 7 days to NSAID therapy
Chronic/Recurrent Pericarditis
- what is this?
- common cause
- clinical findings
- Imaging
- Treatment
- predictor of recurrence
What is this:
-syndrome in which acute pericarditis recurs after the agent causing the acute attack has been treated or disappears. Usually occurs 6weeks-18mo after acute attack.
Most Common cause
-autoimmune
Clinical Findings:
- pleuritic chest pain +/- exertion
- Dyspnea
- Imaging:
- EKG
- Echocardiogram
- CXR
Tx:
- Combo of NSAIDS and Colchicine
- Glucocorticoids
- Activity restrictions
- pericardiectomy
Predictor of recurrence:
-glucocorticoids use initially for acute pericarditis
Pericardial effusion
- what is this?
- causes
- what is the normal fluid volume in the pericardial sac?
- 4 types of pericardial fluid
What is this:
-abnormal accumulation of fluid in the pericardial sac
Cause:
- develops during any inflammatory pericardial dz
- disturbance in the equilibrium between the production and reabsorption of pericardial fluid.
Volume:
-15-50ml of fluid is the usual amount of fluid within the pericardium.
Types:
- transudative(CHF)
- exudative(TB)
- Hemorrhagic
- Malignant
Pericardial effusion
- sx
- imaging
- tx
sx:
- +/- pain
- dyspnea
- cough
- pericardial rub
Imaging:
- CXR: enlarged cardiac sillhouette, “Water bottle heart”
- EKG: electrical alternans with sinus tachycardia
- echo: imaging of choice
Tx:
- treat underlying cause
- small effusion can be followed
- large effusions and tampanode drainage is done through pericardiocentesis
- pericardiectomy
Cardiac Tamponade
- what is this?
- causes
- signs and sx
- Imaging
- Tx
What is this:
-increase pressure on the heart muscle when the pericardial space fills up with fluid faster than the pericardial sac can stretch. *increased pressure causes elevation of intrapericardial pressure which restricts venous return and ventricular filling.
Cause:
- inflammatory processes
- disturbance between production and reabsorption of pericardial fluid
- Left ventricular free wall rupture
- Hemorrhagic pericarditis
Signs and sx:
- cough
- dyspnea
- tachycardia
- tachypnea
- pulsus paradoxus
- Becks Triad: hypotension, JVD, Muffled heart sounds.
Imaging:
- EKG; electrical alternans
- Echo: test of choice
Tx:
- urgent pericardiocentesis
- recurrent flud may require pericardial window or partial pericardiectomy
Constrictive pericarditis
- what is this
- causes
- signs and sx
- Imaging
- Tx
What is this:
-inflammation that leads to the pericardium becoming fibrotic, thickened, and adherent and restricts diastolic fillings and produces chronically elevated venous pressure.
Causes:
- radiation
- cardiac surgery
- viral pericarditis
- idiopathic
Signs and Sx:
- slowly progressive dyspnea
- fatigue and weakness
- chronic edema
- elevated jugular venous pressure
- Kussmauls sign
Imaging:
- CXR; egg shell around the heart.
- Echo* (Test of choice)
- Cardiac Cath
tx:
- diuretics DOC
- surgical removal (pericardectomy)
Pericardiocentesis
-procedure
- pt supine with HOB 30-60 degrees
- Ultrasound guidance
- 5th-6th intercostal space at the left sternal border at the cardiac notch of the left lung OR at the infrasternal angle.
