Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

General med - Cardiovascular > Pericardial effusion > Flashcards

Pericardial effusion Flashcards

1
Q

What is a pericardial effusion

A

Describes a collection of fluid in the pericardial space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of pericardial effusions

A

Transudate(hydropericardium)
Exudate(pyopericardium)
Haemopericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Common causes of large pericardial effusions

A 
Neoplasms 
Tuberculosis 
Uraemic pericarditis 
Myxoedema 
Parasitic infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When are loculated effusions more common

A

When scarring is present(eg, post-surgery, post-trauma, post-purulent pericarditis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of pericardial effusions

A 
Idiopathic 
Infectious pericarditis
MI
AKI/CKD
Malignancy 
Benign tumours 
Hypothyroidism 
Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Drugs associated with pericardial effusions

A 
Hydralazine 
Isoniazid 
Minoxidil 
Phenytoin 
Anticoagulants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of pericardial effusion

A 
Chest pain/discomfort 
Light-headedness/syncope 
Palpitations 
Cough/SOB/hoarseness 
Anxiety and confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Classic triad associated with pericardial tamponade

A

Hypotension
Muffled heart sounds
Jugular venous distention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Signs associated with pericardial effusion

A

Pulsus paradoxus
Percardial friction rub
Tachycardia
Resp signs(tachypnoea, decreased breath sounds and Ewart’s sign)
Hepatosplenomegaly, weakened peripheral pulses, oedema and cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How a pericardial effusion show on an ECG

A

May show raised ST segments with myocardial infarction or pericarditis

Diminished QRS and T-wave voltages, PR-segment depression, ST-T changes, bundle branch block and electrical alternans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a raised carcinoembryonic antigen level in the presence of a pericardial fluid level highly specific for

A

Malignant effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cardiac tamponade vs pericardial effusion

A

Pericardial effusion is an anatomic diagnosis of abnormal pericardial fluid accumulation that has no haemodynamic consequences, whereas cardiac tamponade is a physiologic diagnosis of varying amounts of pericardial fluid that causes haemodynamic consequences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pharmacological management of pericardial effusions

A

Oxygen therapy

Treatment of underlying condition(eg cytotoxic agents for malignancy, or steroids and NSAIDs for RA)

IV fluids if hypovolaemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Surgical interventions for pericardial effusions

A

Pericardiocentesis
Pericardotomy if effusion recurs
Pericardial sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is pericardiocentesis contra-indicated

A

Wounds
Ruptured ventricular aneurysm
Dissecting aortic haematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Examples of sclerosing agents for pericardial sclerosis

A

Tetracycline
Doxycycline
Cisplatin

17
Q

Complications of pericardial sclerosis

A

Severe pain
Fever
Infection
Atrial dysrhythmias

18
Q

Complications of pericardial effusions

A

Pericardial tamponade - can lead to severe haemodynamic compromise and death

Chronic pericardial effusion(effusions lasting longer than 6 months and they are usually well tolerated)

19
Q

Signs of cardiac tamponade

A 
Distended neck veins
Hypotension 
Tachycardia/tachypnoea 
Muffled heart sounds 
Pericardial friction rub 
Hepatomegaly 
Pulsus paradoxus
20
Q

What is beck’s triad

A

Acute tamponade leads to increased jugular venous pressure(JVP) - jugular venous distension, hypotension and diminished heart sounds(rarely seen)

21
Q

What is a good way of distinguishing patients with cardiac tamponade in patients with known pericardial effusion

A

Exaggeration of the normal decrease in systemic blood pressure during inspiration; a pulsus paradoxus greater than 10 mm Hg

This sign is more reliable in patients with high-pressure rather than low-pressure tamponade

22
Q

Ix of choice for cardiac tamponade/pericardial effusion

A

Transthoracic echocardiogram

23
Q

Management of cardiac tamponade

A 
Oxygen 
Volume expansion(small boluses) 
Improve venous return(bed rest with leg elevation) 
Positive inotropic drugs 
Treat underlying cause
24
Q

Example of positive inotropic drug used in cardiac tamponade management

A

Dobutamine

25
Q

Why should positive pressure mechanical ventilation be avoided in cardiac tamponade management

A

May decrease venous return

26
Q

surgical management of cardiac tamponade

A

Pericardiodesis
Corticosteroids, tetracycline or antineoplastic drugs

Pericardio-peritoneal shunt to prevent recurrent tamponade in malignant pericardial effusions

Pericariectomy

27
Q

Symptoms of pericarditis

A

Sharp pleuritic chest pain
Relief of pain with sitting up or leaning forward
Generally constant

28
Q

What is a pericardial rub

A

Superficial scratchy or squeaking sound best heard with the diaphragm over the left sternal border with the patient leaning forward at end-expiration

Indicative of pericarditis

29
Q

How can a pericardial friction rub be distinguished from a pleural rub

A

Ask patient to hold their breath - a pericardial friction rub will still be heard when patient holds breath

30
Q

Causes of acute pericarditis

A 
Idiopathic 
Underlying systemic condition(SLE, RA) 
Viral infections(Coxsackievirus, EBV, CMV) 
Radiotherapy 
Cardiac surgery
31
Q

ECG changes in pericarditis

A

Global upwardly concave ST-segment(J-point) elevations with PR-segment depressions in most leads

32
Q

Use of serum troponin in diagnosis of pericarditis

A

Elevated levels may reflect pericarditis with myocardial involvement but not specific or sensitive

33
Q

Management of suspected pericarditis

A

Triage and consider admission to hospital

Consider pericardiocentesis in suspected tamponade

34
Q

High risk features indicative of a need for inpatient management in pericarditis

A 
High fever(>38 degrees)
Subacute course 
Evidence of large pericardial effusion 
Cardiac tamponade 
Failure to respond within 7 days to NSAID
35
Q

Management of idiopathic or viral(non-purulent) pericarditis

A 
NSAID
PPI
Colchicine 
Exercise restriction 
Corticosteroid
36
Q

Management of purulent pericarditis

A

IV antibiotic therapy(anti-staphylococcal antibiotic plus an aminoglycoside)
Specialist referral

General med - Cardiovascular (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions