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PHASE 2 cardio conditions > pericarditis > Flashcards

pericarditis Flashcards

1
Q

define pericarditis

A

Acute inflammation of the pericardium with or without effusion

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2
Q

what is the pericardium

A

a fibroserous, fluid-filled sack that surrounds the muscular body of the heart and the roots of the aorta, pulmonary vessels and the superior and inferior vena cava.

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3
Q

what are the 2 main layers of pericardium

A

external fibrous layer

internal serous layer

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4
Q

describe the external fibrous layer

A
  • Continuous with central tendon of diaphragm
  • Fibrous pericardium made up of tough connective tissue and is relatively non-distensible
  • Rigid structure prevents overfilling of the heart
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5
Q

describe the internal serous layer

A

Divided into:
- Outer parietal layer that lines the internal surface of the fibrous pericardium
- Internal visceral layer that forms the outer layer of the heart (epicardium)

Each layer is made up of mesothelium

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6
Q

what is in between outer and inner pericardium layers

A

pericardial cavity

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7
Q

what does pericardial cavity contain

A

50 mL of lubricating serous fluid

serves to minimise friction generated as the heart contracts

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8
Q

4 functions of pericardium

A
  1. Fixes the heart in the mediastinum and limits its motion
  2. Prevents overfilling of heart.
  3. Lubrication from the thin film of fluid between the two layers of serous pericardium reduces friction
  4. Protection from infection – the fibrous pericardium serves as a physical barrier between the muscular body of the heart and adjacent organs prone to infection
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9
Q

does pericarditis occur more in men or women

A

men

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10
Q

pathology of pericarditis

A
  1. acute inflammation of pericardium
  2. pericardial vascularisation and infiltration with polymorphonuclear leukocytes
  3. A fibrinous reaction frequently results in exudate and adhesions within the pericardial sac
  4. a serous or haemorrhagic effusion may develop
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11
Q

causes of pericarditis

A
  1. idiopathic
  2. infection
  3. MI
  4. autoimmune
  5. dressler syndrome
  6. uraemia
  7. trauma
  8. malignancy
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12
Q

which infections can cause pericaditis

A

Viral– HIV, Coxsackie B, echovirus
Bacterial – TB
Fungal – Histoplasma spp.

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13
Q

what immune conditions can cause pericarditis

A

Sjogren’s
RA
SLE

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14
Q

what is dresslers syndrome

A

inflammation of pericardium after MI damaging it

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15
Q

which malignancies cause pericarditis

A

breast, lung, leukaemia and lymphoma

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16
Q

symptoms of pericarditis

A

Central chest pain
- Severe
- Sharp and pleuritic (without constricting crushing character of ischaemic pain)

Dyspnoea

Hiccups – phrenic involvement

Fever

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17
Q

signs of pericarditis

A
  • Pericardial friction rub (scratching sound) heard by auscultation
  • Chest pain worse on inspiration and lying flat
  • Relieved by sitting forward
  • May radiate to neck and shoulders
  • Raised JVP
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18
Q

investigations for pericarditis

A
  1. ECG - diagnostic
  2. bloods
  3. echocardiogram
  4. chest x ray
19
Q

what would pericarditis ecg show

A

Concave (saddle-shaped) ST segment elevation in all leads (global ST elevation)

PR depression

20
Q

what bloods to do for pericarditis

A

Cardiac enzymes
ESR
C-reactive protein
FBC

21
Q

what would chest x ray of pericarditis show

A

Bottle-water shaped silhouette

May show cardiomegaly in cases of effusion

22
Q

management of pericarditis

A
  1. NSAIDS and gastric protection
  2. Colchicine
  3. Pericardiocentesis
  4. rest
  5. Treat underlying cause if there is one
23
Q

what to use if patient resistant to NSAIDS

A

Systemic corticosteroids

24
Q

what does colchicine do

A

inhibits migrations of neutrophils to site of inflammation to reduce risk of occurrence

25
what is pericardiocentesis
drainage of fluid if there is cardiac tamponade or symptomatic pericardial effusion
26
complications of pericarditis
1. pericardial effusions 2. cardiac tamponade 3. chronic constrictive pericarditi
27
what are pericardial effusions
Accumulation of fluid in the pericardial sac can also be caused by Hypothyroidism
28
what is cardiac tamponade
When there is enough pericardial effusion in the pericardium that it restricts diastolic ventricular filling (ability for heart to expand) and causes reduced BP and CO
29
what is chronic constructuve pericarditis
persistent inflammation of acute pericarditis causes the heart to be encased with a rigid fibrotic pericardial sac which prevents adequate diastolic filling of the ventricles
30
signs and symptoms of pericardial effusion and tamponade
- Effusion obscures apex beat, and heart sounds are soft - Hypotension - Tachycardia - Elevated JVP – rises with inspiration (Kussmaul’s sign) - Pulsus paradoxus
31
what is pulsus paradoxus
A fall in BP of more than 10mmHg on inspiration Caused by increased venous return to the right side of the heart during inspiration The increased RV volume therefore occupies more space within the rigid pericardium and impairs LV filling
32
investigations for pericardial effusion and tamponade
echocardiography chest x ray ecg
33
what would echocardiography for periocardial effusion and tamponade show
diagnostic, shows echo-free space around heart
34
what would chest x ray for periocardial effusion and tamponade show
globular heart
35
what would ecg for periocardial effusion and tamponade show
shows low voltage complexes with sinus tachycardia
36
how to diagnose pericardial effusion
CXR – large heart ECG – low voltage QRS complexes and sinus tachycardia Echocardiogram
37
how to diagnose cardiac tamponade
CXR – large heart Beck’s triad - Falling BP - Rising JVP - Muffled heart sounds ECG Echocardiogram
38
management of pericardial effusions and cardiac tamponade
Most pericardial effusions resolve spontaneously Tamponade requires emergency pericardiocentesis If effusion recurs, excision of pericardial segment allows fluid to be absorbed through plural and mediastinal lymphatics
39
are most pericarditis cases idiopathic
yes or or they result from intrapericardial haemorrhage during heart surgery
40
signs and symptoms of constrictive pericarditis
Similar features of right sided HF - Jugular venous distension - Dependent oedema - Hepatomegaly - Ascites Kussmaul’s signs – JVP rises paradoxically with inspiration Pulsus paradoxes AF Pericardial knock caused by rapid ventricular filling
41
investigations for constructive pericarditis
CXR – shows normal heart and pericardial calcification CT or MRI – diagnostic, shows pericardial thickening and calcification Echocardiography
42
treatment for constructive pericarditis
surgical excision of pericardium
43

PHASE 2 cardio conditions (20 decks)

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