Pericardial Heart Disease & Tamponade Flashcards
define pericardial heart disease
inflammation and effusion of pericardium
normal amount of pericardial fluid
15-50mL
etiology of pericardial heart disease
- MC: viral (coxsackie A+B)
- 2nd MC: idiopathic/recurrent viral dz
categories of pericardial heart disease per chronicity
- acute = less than 6wks
- subacute = 6wks to 6mo
- chronic = greater than 6wks
- recurrent
What are the 3 subtypes of chronic pericardial heart disease?
- constrictive
- effusive
- adhesive
What are the two types of recurrent pericardial heart disease?
- intermittent (asx intervals)
- incessant (resistant to anti-inflam tx)
epidemiology of pericardial heart disease
- 20-50 y/o
- males more than females
categories per pathology
- fibrous
- effusive
- constrictive
What types of exudate can effusive pericarditis have?
- purulent
- hemorrhagic
Which types of pericarditis do not have fluid?
- fibrous
- constrictive
Which types of pericarditis can lead to tamponade?
- effusive
- constrictive
describe constrictive pericarditis
- aka compressive syndrome
- occurs after acute
- impedes diastolic filling not contraction
What are the 4 P’s of pericarditis? (i.e. for signs and symptoms)
- persistent
- pleuritic
- postural pain
- pericardial friction rub
S+S of pericarditis
- low grade fever
- sudden onset, severe anterior chest pain, worsens with breathing + supine; present when sitting + leaning forward
- sinus tachycardia
- pericardial friction rub @ LSB + @ end of expiration
- pain does NOT respond to NTG
diagnostics of pericarditis
- EKG
- labs
- CXR
- pericardiocentesis
- Echo
EKG results of pericarditis
seen in all leads but esp V1-6
- ST elevations
- PR depressions
- no Q waves
CXR results of pericarditis
- “water bottle” silhouette
Echo results of pericarditis
- “swinging heart” = pericardial effusion
What labs are ordered for pericarditis and what do they look for?
- CRP, ESR, and incr. WBC = systemic inflam
- troponin + BUN = MI ddx
tx for pericarditis
- ASA or NSAIDs + colchicine
- prednisone + colchicine for severe
- systemic abx, ID consult, + culture
- pericardiocentesis
- pericardectomy for recurrent
What are the criteria to admit pericarditis?
- fever 100+ x 7d
- leukocytosis (WBC over 11k)
- cardiac tamponade
- 20+mm effusion
- immune suppressed
- trauma
- does not respond to NSAIDs x7d
- incr. troponin –> myopericarditis
What do complications of pericarditis depend on?
- rate of effusion
- pericardium expandability
pathophysiology of tamponade
incr. intracardial pressure leads to:
- compressed/decr. chambers
- decr. diastolic compliance
- decr. venous return (i.e. +JVD)
==> decr. contraction
clinical features of tamponade
- Beck’s Triad (JVD, hypotension, distant/absent heart sounds)
- tachycardia
- tachypnea
define pulsus paradoxus
- more than 10mmHG decr in SBP with inspiration
pathophysiology of pulsus paradoxus
- ventricular interdependence: RV fills more/faster which pushes in on LV inhibiting LV filling ==> decr. LV EDV == decr SV + decr SBP
treatment of pulsus paradoxus
- monitorJVP
- paradoxical pulses
- serial echos
- pericardiocentesis
30 y/o M presents with T = 99.3, severe ant chest pain which worsens when he attempts naps & sleep. leather on leather heard at LSB, Echo = swinging heart, CXR = water ballon silhouette. What is the etiology of his dz? What is the dz? What is the tx?
- MC = viral, 2nd MC = idiopathic/recurrent
- pericarditis
- ASA or NSAIDs+ colchicine
45 y/o M presents with BP = 102/54, HR = 158, RR = 25, JVD, and absent heart sounds. What else do you check for on exam? What is the dx? What is the tx? What are the pts s+s that clue you into the dx?
- pulsus paradoxus
- cardiac tamponade
- monitor + pericardiocentesis
- Beck’ Triad = JVD, hypotension, distant/absent heart sounds
