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Board Basics Review > Pericardial Tamponade and Constriction > Flashcards

Pericardial Tamponade and Constriction Flashcards

1
Q

presentation of pts w/ chronic cardiac tamponade

A
  • dyspnea
  • fatigue
  • peripheral edema
  • hepatomegaly
  • hepatic dysfunction
  • ascites withOUT pulmonary congestion
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2
Q

dx for chronic cardiac tamponade may be suggested by risk factors for tamponade, which are?

A
  • metastatic LUNG and BREAST cancers (MCC)
  • recent cardiac surgery
  • dissecting aneurysm
  • recent viral or bacterial pericarditis
  • systemic rheumatic disease
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3
Q

PE findings for chronic cardiac tamponade

A
  • JVD
  • pulsus paradoxus
  • tachycardia
  • reduced heart sounds
  • hypotension
  • Kussmaul sign (CVP increases w/ inspiration)
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4
Q

CXR finding for chronic cardiac tamponade

A

enlarged silhouette (“water bottle sign”)

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5
Q

test to confirm

A

echocardiogram

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6
Q

what virtually EXCLUDES a dx of cardiac tamponade?

A

pericardial effusion

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7
Q

thickened, fibrotic, and adherent pericardium that strains ventricular diastolic expansion, leading to impaired filling

A

constrictive pericarditis

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8
Q

often a sequela of acute pericarditis

A

constrictive pericarditis

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9
Q

cardiac auscultatory exam of constrictive pericarditis

A
  • loud S3 (pericardial knock)

- friction rub

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10
Q

long-standing constrictive pericarditis may be a/w

A

liver failure and cirrhosis

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11
Q

imaging findings supporting dx of constrictive pericarditis

A
  • calcified pericardium on XR (specific, but not sensitive)
  • pericardial thickening on CT or MRI
  • abnormal diastolic motion on echo
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12
Q

acute management of cardiac tamponade

A
  • volume resuscitation

- vasopressors

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13
Q

tx for pericardial fluid

A

percutaneous pericardiocentesis or surgery

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14
Q

what meds should be avoided in chronic constrictive pericarditis?

A

diuretics, avoid if possible

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15
Q

most effective tx for chronic constrictive pericarditis

A

pericardiectomy

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16
Q

when is pericardiectomy unnecessary, and when is it unwarranted?

A
  • unnecessary in pts w/ early dz (NYHA functional class 1)

- unwarranted in pts w/ advanced dz (NYHA functional class 4)

17
Q

DON’T BE TRICKED

in CONSTRICTIVE PERICARDITIS echo will show shifting of ventricular septum to and fro during diastole as a manifestation of the RV and LV competing for a confined space during filling; these findings are NOT seen in what dz?

A

RCM

18
Q

constrictive pericarditis vs restrictive CM:

  • constrictive pericarditis
  • PE: pericardial knock
A

supports dx

19
Q

constrictive pericarditis vs restrictive CM:

  • constrictive pericarditis
  • PE: S3
A

may be present

20
Q

constrictive pericarditis vs restrictive CM:

  • constrictive pericarditis
  • ECG: LBBB or RBBB
A

not helpful

21
Q

constrictive pericarditis vs restrictive CM:

  • constrictive pericarditis
  • CXR: pericardial calcification
A

may be present

22
Q

constrictive pericarditis vs restrictive CM:

  • constrictive pericarditis
  • echo: LVH and atrial enlargement
A

absent

23
Q

constrictive pericarditis vs restrictive CM:

  • RCM
  • PE: pericardial knock
A

unusual but loud S3 may be mistaken for pericardial knock

24
Q

constrictive pericarditis vs restrictive CM:

  • RCM
  • PE: S3
A

supports dx

25
Q

constrictive pericarditis vs restrictive CM:

  • RCM
  • ECG: LBBB or RBBB
A

supports dx

26
Q

constrictive pericarditis vs restrictive CM:

  • RCM
  • CXR: pericardial calcification
A

absent

27
Q

constrictive pericarditis vs restrictive CM:

  • RCM
  • echo: LVH and atrial enlargement
A

present

28
Q

constrictive pericarditis vs restrictive CM:

  • constrictive pericarditis
  • echo: accentuated drop in peak LV filling during inspiration
A

present

29
Q

constrictive pericarditis vs restrictive CM:

  • RCM
  • echo: accentuated drop in peak LV filling during inspiration
A

absent

30
Q

constrictive pericarditis vs restrictive CM:

  • constrictive pericarditis
  • MRI: increased pericardial thickness
A

present

31
Q

constrictive pericarditis vs restrictive CM:

  • RCM
  • MRI: increased pericardial thickness
A

absent

32
Q

constrictive pericarditis vs restrictive CM:

  • constrictive pericarditis
  • right heart catheterization: elevated and equalized diastolic LV and RV pressures (w/i 5 mmHg)
A

present

33
Q

constrictive pericarditis vs restrictive CM:

  • RCM
  • right heart catheterization: elevated and equalized diastolic LV and RV pressures (w/i 5 mmHg)
A

absent

34
Q

constrictive pericarditis vs restrictive CM:

  • constrictive pericarditis
  • BNP level
A

< 100 pg/mL

35
Q

constrictive pericarditis vs restrictive CM:

  • RCM
  • BNP level
A

> 400 pg/mL

Board Basics Review (24 decks)

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