Pericardial Heart Disease

Question 1

What are the 4 types of pericarditis?

Answer 1

Chronic
Fibrous
Effusive
Constrictive

Question 2

Describe a fibrous pericarditis.

Answer 2

Dry with no effusion

Question 3

Describe an effusive pericarditis.

Answer 3

Purulent or hemorrhagic exudate

Question 4

Describe a compressive pericarditis.

Answer 4

Compressive syndrome
The pericardium adheres to the heart
Can cause tamponade

Question 5

A patient presents with a low grade fever, myalgias, weakness, anxiety, and dysphagia. She says that she also has sudden-onset, severe chest pain, which did not resolve when you gave her nitroglycerine. Exam reveals sinus tachycardia. What do you suspect? What underlying causes do you suspect?

Answer 5

Pericarditis
Viral (MC), idiopathic, metastatic tumor, acute MI/post-MI syndrome, trauma, bacterial, fungal, or parasitic

Question 6

A patient presents with sudden-onset chest pain, which he describes as sharp, severe, and constant. He says it radiates to his trapezius ridge, and that it is worse when he’s sitting or breathing in. Exam reveals a low-grade fever. What diagnostic tests should you run to confirm your diagnosis?

Answer 6

ECG
Echo
CXR
Chest CT
Pericardiocentesis
Labs (Serum troponin, erythrocyte sedimentation rate, CRP, BUN, CBC)

Question 7

When should you hospitalize a pt for pericarditis?

Answer 7

Fever (100F)
Leukocytosis
Cardiac Tamponade
Large pericardial effusion
Immunocompromised
Acute Trauma
Doesn't respond to Tx
Increased cardiac troponin levels

Question 8

A pt presents with chest pain that radiates to the trapezius ridge and doesn’t resolve with nitroglycerine. He has a low-grade fever. His serum troponin is elevated, his BUN is > 60 mg/dL, and WBC is elevated. How would you treat this pt?

Answer 8

ASA or NSAID + colchicine
Prednisone
Systemic Abx
Pericardiocentesis

Question 9

A patient presents with hypotension, distant heart sounds, and JVD. What is the pathology behind this pt’s disease?

Answer 9

Cardiac Tamponade
Increased intrapericardial fluid
Pericardial elastic limit is met/exceeded
Increased intrapericardial volume –> decreased chamber size –> decreased diastolic compliance –> decreased venous return
Ventricular interdependence

Question 10

A pt presents with hypotension, absent heart sounds and JVD. What is the most likely diagnosis?

Answer 10

Cardiac Tamponade

Question 11

On exam you find that your patient’s systolic BP decreases by 15 mmHg during inspiration. He has audible heart sounds but absent radial pulse. What is the most likely etiology?

Answer 11

Pulses Paradoxus
Caused by ventricular interdependence
RV bulges into the LV during inspiration
Decreased LV filling –> decreased SV –> decreased SBP w/ inspiration

Question 12

A pt presents with audible heart sounds but absent pulses. You want to check to see if she has pulsus paradoxus. What should you do to diagnose it?

Answer 12

Measure her brachial, radial, or femoral pulse
Watch her chest rise and fall while taking her BP
Calculate the difference between SBP during inspiration and expiration; if difference > 10 mmHg then the pt has pulses paradoxus