- involves parietal layer & visceral layer - 15-50mL of intrapericardial fluid - stabilize and restricts chamber dilatation - minimizes friction bw heart and pulmonary pleura, vessels

Pericardial Heart Dz and Tamponade Flashcards by Alicia Wilber

normal pericardium

involves parietal layer & visceral layer
15-50mL of intrapericardial fluid
stabilize and restricts chamber dilatation
minimizes friction bw heart and pulmonary pleura, vessels

How well did you know this?

Not at all

Perfectly

what systemic disorders may cause pericardial heart dz

infection (usually viral)
idiopathic
systemic (metastatic neoplasm ie. breast, lung; rheumatic fever, endocrine - myxedema)
trauma - s/p acute MI (Dressier’s syndrome)
cardiac surgery
mediastinal radiation
uremia

How well did you know this?

Not at all

Perfectly

4 categories of pericardial dz

acute 6mo): constrictive, effusive, adhesive

4. recurrent - intermittent, incessant = effusion in pericardial space with constriction by thickened pericardium

How well did you know this?

Not at all

Perfectly

3 types of pericardial dz

fibrous - dry, no effusions
effusive - purulent exudate
constrictive pericarditis - impededs diastolic filling, occurs after acute pericarditis, can lead to tamponade

How well did you know this?

Not at all

Perfectly

etiology of pericardial heart dz

infectious - 90% viral (coxsackie A&amp;B, Echo virus, Mumps, adenovirus, hepatits, HIV)
idiopathic
metastatic neoplasm
acute MI
post MI syndrome
trauma
endocrine - myxedema
associated with metabolic disorder - uremia
autoimmune dz 
myocarditis
iatrogenic

How well did you know this?

Not at all

Perfectly

what is the definition of pericardial heart dz

inflammation and effusion of the pericardium

-isolated dz or manifestation of a systemic disorder

How well did you know this?

Not at all

Perfectly

bacterial causes of pericardial heart dz

strep, staph, meningococcal, hemophilus, chlamydia, TB, treponema

How well did you know this?

Not at all

Perfectly

fungal cause of pericardial dz

candida

histoplasmosis

How well did you know this?

Not at all

Perfectly

parasitic causes of pericardial heart dz

entamoeba histolytica

echinococcus granulosus

How well did you know this?

Not at all

Perfectly

age of onset for pericardial heart dz

20-50 yo

How well did you know this?

Not at all

Perfectly

men vs women for pericardial heart dz

men>women

How well did you know this?

Not at all

Perfectly

what % of chest pain complaints in ER are acute pericarditis

How well did you know this?

Not at all

Perfectly

cardinal manifestations of acute pericarditis

chest pain
pericardial friction rub
EKG changes
pericardial effusion - with or without tamponade

How well did you know this?

Not at all

Perfectly

clinical presentation of pericardial heart dz

s/s:
few days + with low grade fever
myalgias
malaise
anxiety
dysphagia
sudden onset of severe anterior chest pain that worsens with breathing and lying down
exam: low grade fever, sinus tachycardia &amp; pericardial friction rub along left sternal border

How well did you know this?

Not at all

Perfectly

what is the pericardial friction rub caused by

-how is it heard better

friction bw visceral and parietal pericardial surfaces

scratching, high pitched
heard better sitting up/leaning forward at end of expiration/left sternal border/stethoscope held firmly against chest

How well did you know this?

Not at all

Perfectly

diagnostic labs for pericardial heart dz

diffuse/global EKG ST elevations, PR depressions
echo - pericardial effusion
lab - systemic inflammation - CRP, ESR, incr WBC

chest pain characteristics of pericardial dz

pain is postural: lying, coughing, swallowing – relieved by sitting up and leaning forward
not related to exertion
does not respond to NTG (nitroglycerine)
sharp,severe,constant, retro-sternal CP that radiates to the trapezius ridge
stabbing CP

initial workup of pericardial dz

EKG - global ST elevation with PR depression
-represents inflammatory process
NO Q Waves

workup of pericardial dz to differentiate from MI

serum troponin - slightly elevated, will normalize after 1-2wks
inflammatory process - ESR, CRP
serum BUN >60mg/dL uremia
CBC - incr WBC with purulent exudate and infectious causes

imaging for pericardial dz workup

CXR - water bottle heart silhoutte, can show possible cause (TB, fungus, PNA, cancer
echo - shows pericardial effusion, assess for tamponade and degree of chamber compression
chest ct
pericardiocentesis - obtain exudate for culture and histology; biopsy pericardium for suspected metastasis or primary neoplasm

first line tx for pericardial dz

ASA or NSAIDS + colchicine, prevents fibrosis and recurrence

2 weeks NSAIDS, 3 months colchicine, PPI

other treatment for pericardial dz

prednisone in pts w/o purulent bacterial exudate (1-2 weeks)
systemic antibiotics - after blood and pericardial effusion culture , get ID consult, fever and WBC, give IV vanco plus cetriazone or gentamicin)

complication of pericardial heart dz

acute pericarditis

what is the treatment of acute pericarditis

pericardiocentesis - decompression of ventricular pressure from pericardial effusion; prevention of tamponade progression (death), must decompress large effusion
pericardiectomy - for recurrent pericarditis, constrictive pericarditis with adhesions, resistant to medical tx

when to admit pt with pericardial heart dz

1. fever 100 degrees 2. WBC >11,000 3. cardiac tamponade 4. pericardial effusion occupying >20mm intrapericardial space 5. immune suppressed state 6. acute trauma 7. failure to respond to initial 7 day NSAID tx 8. elevated troponin level --> myopericarditis

what is cardiac tamponade

compression of the heart due to fluid accumulation within the pericardium

development of tamponade depends on

1. rate of effusion accumulation 2. pericardium expandability ex. in myxedema, uremia, malignancy - effusion accumulates slowly = chronic tamponade = gives time for pericardium to expand

how much fluid accumulation will cause symptoms

pathophys of tamponade

1. all cardiac chambers are compressed d/t increased intrapericardial pressure 2. normally ther pericardium has fixed elasticity - the heart is therefore sujected to compression with a tamponade 3. once pericardial elastic limit is reached heart chambers compete with intrapericardial pressure 4. incr intrapericardial volume/pressure: decr cardiac chamber size: decr diastolic compliance: decr venous return = +JVD

Beck's triad of pericardial tamponade of clinical features

1. JVD - most common 2. HTN 3. distant heart sounds other: tachycardia, tachypnea, hypotension with onset of shock

what is pulsus paradoxus

abnormally large decrease in SBP (>10mmHg) with inspiration - consequence of ventricular interdependence during inspiration (to fill one ventricular chamber, the other has to fill less - RV bulges into left ventricle during diastole and inspiration - therse's decr LV filling/EDV = decr SV and decr SBP with inspiration

what does clinically detectable pulsus paradoxus suggest

moderate to severe tamponade

what is the paradox in PP

pulses can be absent with audible heart sounds

how to measure PP

- feel radial pulse - if amplitude decreases with inspiration suggestive of severe PP - brachial radial femoral pulses can be used - using the SBP - best to observe rise and fall of pts chest while taking BP

PP measurement with BP

- proceed with usual BP procedure - deflate BP cuff slowly - note SBP on quiet breathing - when 1st Korokoff is heard on expiration (highest) - increased cuff pressure 20 mmHg above SBP - deflate cuff slowly and meaure SBP during slow and deep insp/expir cycles and note when sound are heard during inspir (should be lowest) - subtract SBP during expiration from SBP during inspiration = >10mmHg difference = PP

tx of PP

hemodynamically stable with small cardiac effusion -monitor: JVP, PP, serial echos when tamponade is present -pericardiocentesis