Pericardial Processes/Tamponade Flashcards
What are the causes of acute pericarditis?
It is often due to a viral illness, but may often occur 1-3 days
after a myocardial infarction.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 144.
What are the symptoms of acute pericarditis?
Chest pain, pericardial friction rub, and a series of changes on
the ECG.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 144.
What is the volume of fluid that the pericardium can
normally hold?
15-50 mL
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 145
What are the treatments for acute pericarditis?
Non-steroidal anti-inflammatory drugs such as aspirin and
ketorolac are often used to treat the inflammation and oral
analgesics such as codeine may be used to treat the pain.
Corticosteroids are used in the treatment of pericarditis that
does not respond to these treatments.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 145.
What is Dressler’s syndrome?
Dressler’s syndrome is a form of pericarditis seen following
myocardial infarction.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 144
What are the symptoms of postcardiotomy
syndrome?
Postcardiotomy syndrome exhibits symptoms similar to acute
pericarditis. Causes include infection, autoimmune processes,
blunt or penetrating trauma, and occurs in 10-40% of patients
who have had cardiac bypass graft surgery involving
pericardiotomy. It occurs more frequently in pediatric patients.
It is not very common in cardiac transplant surgery and this is
believed to be due to immunosuppressant therapy. Cardiac
tamponade is rare in this syndrome.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 145.
What are the ECG changes seen with acute
pericarditis?
The ECG changes seen in acute pericarditis occur in four
stages. In stage I, there is diffuse ST segment elevation and
depression of the PR segment. In stage 2, the ST and PR
changes normalize. In stage 3, the T wave inverts, and in stage
4, the T waves normalize.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 144-145.
What factors tend to worsen and relieve acute
pericarditis?
Deep inspiration worsens the pain. It is often relieved by sitting
forward.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 144-145.
Does acute pericarditis alter cardiac function?
If no other associated pericardial disease is present, acute
pericarditis does not alter cardiac function.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 145.
What induction agents and adjuncts are most useful
for the patient with cardiac tamponade undergoing
general anesthesia?
Induction is typically carried out with ketamine because it
increases heart rate, contractility, and systemic vascular
resistance. A benzodiazepine is often combined with it. The
anesthetic may be maintained with nitrous oxide and fentanyl
combined with pancuronium, which is useful for its vagolytic
effects.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 148.
What is the difference between a pericardial effusion
and pericardial tamponade?
Pericardial effusion is the collection of fluid in the pericardial
cavity. Percardial tamponade occurs when the fluid collects to
a significant enough volume that cardiac contraction is impaired.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 145-146.
What are the causes of pericardial effusion?
It may occur from almost any pericardial disease process such
as infection, trauma, metastatic disease, mediastinal disease,
radiation, rheumatoid arthritis, systemic lupus erythematosus,
and scleroderma. About 20% of cases are idiopathic.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 145.
How does the volume of fluid necessary to produce
pericardial tamponade differ between acute and
chronic pericardial effusion?
An acute influx of as little as 100 mL into the pericardium can
produce a symptomatic tamponade. In chronic pericardial
effusion, symptoms may not become severe until the volume is
in excess of 2 liters.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 146.
How is right atrial pressure related to the severity of
cardiac tamponade?
As the pericardial pressure increases, the right atrial pressure
increases with it. Thus, the right atrial pressure becomes an
accurate reflection of the pericardial pressure. It is at the point
where the pericardial and right atrial pressures become equal
and the patient may begin to exhibit signs and symptoms of
tamponade.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 146.
What are Kussmaul’s sign and pulsus paradoxus?
Kussmaul’s sign is the distention of jugular veins during
inspiration. Pulsus paradoxus is a decrease in systolic blood
pressure greater than 10 mmHg during inspiration. Both of
these signs are consistent with a diagnosis of cardiac
tamponade.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 146
