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Clin med Cardiology Exam 2 > pericardial heart disease > Flashcards

pericardial heart disease Flashcards

1
Q

What is the most common cause of Acute pericarditis?

A

Infection (90%, MC viral – Coxsackie)

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2
Q

What are other causes of acute pericarditis?

A
  • Idiopathic (prob postviral)
  • Acute MI or Post MI syndrome (Dressler’s syndrome)
  • Metastatic Neoplasm (lymphoma, breast, lung)
  • Blunt Trauma
  • Drug Induced
  • Endocrine (Myxedema)
  • Uremia (metabolic d/o) – d/t elevated BUN & metabolic acidosis
  • Autoimmune d/o (SLE, rheum arthritis, Reiter syndrome)
  • Iatrogenic (radiation therapy → cancer, cardiac surgery, catheter)
  • Bacterial, Fungal, Parasitic (underdeveloped countries)
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3
Q

Who is at risk of getting pericarditis?

A

20-50 yo, M > F

~ 5% Chest Pain complaints in the ER = acute pericarditis— why is this fact important?

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4
Q

What is the clinical presentation of acute pericarditis?

A
  • MC = severe chest pain that worsens with breathing (inspiration) & lying down
  • Pain localized to the retrosternal & left precordial area radiating to trapezius ridge and neck
  • Chest pain is positional: relieved w/ sitting up and leaning forward
  • Pericardial friction rub: high pitched, heard along left sternal boarder (best heard w/ pt sitting up during expiration – closer to chest)
  • Few days of low grade fever (100F), myalgias, malaise, weakness, anxiety, restlessness, dysphagia, sinus tachycardia
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5
Q

what are complications with acute pericarditis?

A 
cardiac tamponade (15%)
-pericardial effusion (any cause of acute pericarditis that can lead to exudation of fluid into pericardial space)
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6
Q

How long is acute pericarditis

A

<6weeks inflammation

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7
Q

How long is sub-acute pericarditis

A

6wks-6months

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8
Q

How longs is chronic pericarditis

A

> 6months

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9
Q

what is recurrent pericarditis

A

Intermittent (symptom free intervals)
Incessant (recurs w/ anti-inflammatory cessation) Effusive-constrictive pericarditis
Effusion in pericardial space with constriction by the thickened pericardium

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10
Q

what are the types of pericardial effusions

A

fibrous
effusive
constrictive

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11
Q

Fibrous pericarditis is classified as?

A

dry, no effusions

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12
Q

Effusive pericarditis is classified as?

A 
purulent exudate (serous)
hemorrhagic exudate (serosanguineous)
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13
Q

what is constrictive pericarditis?

A
  • Impedes diastolic filling
  • Occurs after acute pericarditis —Can be a late complication of acute pericarditis
  • Can lead to Tamponade
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14
Q

what are the clinical pericardial heart disease? signs and symptoms?

A 
few days with low grade fever
Myalgias
Malaise, weakness
Anxiety, restlessness
dysphagia 
Followed with sudden onset of severe anterior chest pain that worsens with breathing and lying down
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15
Q

What will you pick up on exam for a person with pericardial disease?

A

Low grade fever, sinus tachycardia
Pericardial friction rub along left sternal boarder High pitched
Heard better sitting up/leaning forward at end of expiration/left sternal border
(85%) and are heard intermittently in those who do have one.

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16
Q

what will you see on EKG testing

A 
ST elevations, PR depressions
EKG changes due to epicardial (visceral pericardium) inflammation 
No Q waves
Q waves = infarction
ST elevation = ischemia/inflammation
17
Q

what will you see on an echocardiogram?

A

pericardial effusion

Assesses for tamponade and degree of chamber compressions

18
Q

what will you see on lab tests?

A

Serum troponin
-slightly elevated, will normalize after 1-2 weeks
Troponin: I/T if elevated can imply myocardial inflammation
Inflammatory process
-ESR
-CRP
Serum BUN
->60mg/dl
CBC
↑WBC w/ purulent exudate and infectious causes

19
Q

What are the chest pain characteristics that are more specific to heart disease?

A 
Not related to exertion
Does not respond to NTG (nitroglycerine)
Sharp, severe, constant, retro-sternal CP that radiates to the trapezius ridge (very characteristic)
Worst with inspiration and supine
Stabbing, pleuritic CP
20
Q

What will you see on a CXR with pericardial heart disease?

A

water bottle heart silhouette
CXR Can show possible cause: TB, cancer, fungus, PNA
200cc (7 oz) of fluid must accumulate before silhouette enlarges 2L

21
Q

what is pericardiocentesis used for?

A 
Obtain exudate (effusion) for culture and histology
Biopsy pericardium for suspected metastasis or primary neoplasm
22
Q

What are the DDx’s you should be thinking of along with pericardial heart disease?

A

MI
-present Q wave, inverted Twaves, responds to NTG, CP no change with respiration, modest rise in CK, pain lasts minutes
PNA
-fever, cough, neg ECG, positive CXR
PE
-CP not positional in nature, no friction rub,
Pneumothorax
-pleuritic, non-positional CP. unilateral decreased BS, CXR pos for pneumothorax
Costochrondritis
-reproducible pain with costochondral palpation, negative ECG, CXR

23
Q

what is the 1st line treatment for pericardial heart Dz?

A

1st line: ASA (2-4g/day) or NSAIDS + colchicine–prevents fibrosis
1-2 weeks NSAIDs
3 months Colchicine
PPI

24
Q

What do you add to the treatment regiment if patients do not respond to NSAID?

A

Prednisone (40-80mg/day)
In pts w/o purulent bacterial exudate
Prednisone can increase recurrence
1-2 weeks

25
Q

How would you go about determining whether to give systemic antibiotics?

A

get paricardiocentesis After blood and pericardial effusion culture & sensitivities are obtained
Get ID consult
Give IV Vancomycin plus ceftriazone or gentamicin (one example)

26
Q

what is the purpose of a pericardiocentesis?

A

Decompression of ventricular pressure from pericardial effusion
Prevention of tamponade progression, death
Must decompress large effusion (can be purulent or malignant)

27
Q

When do you do a pericardiectomy?

A

For recurrent pericarditis
Constrictive pericarditis with adhesions
Resistant to medical treatment

28
Q

what is the admission criteria for a person with pericardial heart disease?

A

fever 38°C or 100°F

29
Q

What is a cardiac tamponade?

A

compression of the heart due to fluid accumulation within the pericardium

30
Q

what determines the complications of pericardial tamponade?

A

rate of effusion accumulation
pericardium expandability
-In myxedema, Uremia, malignancy– effusion accumulates slowly = chronic tamponade
May not be acutely symptomatic
Will see symptoms after 2Ls of fluid accumulation

31
Q

What is the pathophysiology of tamponade?

A

-All cardiac chambers are compressed due to ↑intrapericardial Pressure

32
Q

what is beck’s triad?

A

Hypotension
Distant to absent heart sounds
JVD

33
Q

what is the definition of pulsus paradoxus?

A

Abnormally large ↓ in SPB (>10 mmHg) with inspiration

Is a Consequence of ventricular interdependence during inspiration

34
Q

what causes pulsus paradoxus?

A

Right ventricle bulges into left ventricle during diastole (filling)
There’s ↓ left ventricular filling/EDV → ↓ stroke volume and ↓ SBP with inspiration

35
Q

Which pulses can be used to measure pulsus paradoxus?

A

Brachial, radial, femoral

36
Q

How is Pulsus paradoxus best measured?

A

Best to observe rise and fall of Pt’s chest while taking the BP

37
Q

how is pulsus paradoxus calculated?

A
  • Feel radial pulse—if pulse amplitude decreases with inspiration (observe chest movements) suggestive of severe Pulsus Paradoxsus
  • Calculate difference between 1st korotkoff SBP sound during expiration and when SBP is heard throughout the respiratory cycle.

Clin med Cardiology Exam 2 (6 decks)

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