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clin med - cardio exam #1 > Pericardial Heart Disease & Tamponade > Flashcards

Pericardial Heart Disease & Tamponade Flashcards

1
Q

define pericardial heart disease

A

inflammation and effusion of pericardium

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2
Q

normal amount of pericardial fluid

A

15-50mL

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3
Q

etiology of pericardial heart disease

A
  • MC: viral (coxsackie A+B)

- 2nd MC: idiopathic/recurrent viral dz

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4
Q

categories of pericardial heart disease per chronicity

A
  • acute = less than 6wks
  • subacute = 6wks to 6mo
  • chronic = greater than 6wks
  • recurrent
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5
Q

What are the 3 subtypes of chronic pericardial heart disease?

A
  • constrictive
  • effusive
  • adhesive
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6
Q

What are the two types of recurrent pericardial heart disease?

A
  • intermittent (asx intervals)

- incessant (resistant to anti-inflam tx)

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7
Q

epidemiology of pericardial heart disease

A
  • 20-50 y/o

- males more than females

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8
Q

categories per pathology

A
  • fibrous
  • effusive
  • constrictive
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9
Q

What types of exudate can effusive pericarditis have?

A
  • purulent

- hemorrhagic

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10
Q

Which types of pericarditis do not have fluid?

A
  • fibrous

- constrictive

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11
Q

Which types of pericarditis can lead to tamponade?

A
  • effusive

- constrictive

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12
Q

describe constrictive pericarditis

A
  • aka compressive syndrome
  • occurs after acute
  • impedes diastolic filling not contraction
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13
Q

What are the 4 P’s of pericarditis? (i.e. for signs and symptoms)

A
  • persistent
  • pleuritic
  • postural pain
  • pericardial friction rub
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14
Q

S+S of pericarditis

A
  • 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
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15
Q

diagnostics of pericarditis

A
  • EKG
  • labs
  • CXR
  • pericardiocentesis
  • Echo
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16
Q

EKG results of pericarditis

A

seen in all leads but esp V1-6

  • ST elevations
  • PR depressions
  • no Q waves
17
Q

CXR results of pericarditis

A
  • “water bottle” silhouette
18
Q

Echo results of pericarditis

A
  • “swinging heart” = pericardial effusion
19
Q

What labs are ordered for pericarditis and what do they look for?

A
  • CRP, ESR, and incr. WBC = systemic inflam

- troponin + BUN = MI ddx

20
Q

tx for pericarditis

A
  • ASA or NSAIDs + colchicine
  • prednisone + colchicine for severe
  • systemic abx, ID consult, + culture
  • pericardiocentesis
  • pericardectomy for recurrent
21
Q

What are the criteria to admit pericarditis?

A
  • 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
22
Q

What do complications of pericarditis depend on?

A
  • rate of effusion

- pericardium expandability

23
Q

pathophysiology of tamponade

A

incr. intracardial pressure leads to:
- compressed/decr. chambers
- decr. diastolic compliance
- decr. venous return (i.e. +JVD)
==> decr. contraction

24
Q

clinical features of tamponade

A
  • Beck’s Triad (JVD, hypotension, distant/absent heart sounds)
  • tachycardia
  • tachypnea
25
Q

define pulsus paradoxus

A
  • more than 10mmHG decr in SBP with inspiration
26
Q

pathophysiology of pulsus paradoxus

A
  • ventricular interdependence: RV fills more/faster which pushes in on LV inhibiting LV filling ==> decr. LV EDV == decr SV + decr SBP
27
Q

treatment of pulsus paradoxus

A
  • monitorJVP
  • paradoxical pulses
  • serial echos
  • pericardiocentesis
28
Q

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?

A
  • MC = viral, 2nd MC = idiopathic/recurrent
  • pericarditis
  • ASA or NSAIDs+ colchicine
29
Q

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?

A
  • pulsus paradoxus
  • cardiac tamponade
  • monitor + pericardiocentesis
  • Beck’ Triad = JVD, hypotension, distant/absent heart sounds

clin med - cardio exam #1 (7 decks)

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