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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
Q

what is pericardiocentesis

A

drainage of fluid if there is cardiac tamponade or symptomatic pericardial effusion

26
Q

complications of pericarditis

A
  1. pericardial effusions
  2. cardiac tamponade
  3. chronic constrictive pericarditi
27
Q

what are pericardial effusions

A

Accumulation of fluid in the pericardial sac

can also be caused by Hypothyroidism

28
Q

what is cardiac tamponade

A

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
Q

what is chronic constructuve pericarditis

A

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
Q

signs and symptoms of pericardial effusion and tamponade

A
  • Effusion obscures apex beat, and heart sounds are soft
  • Hypotension
  • Tachycardia
  • Elevated JVP – rises with inspiration (Kussmaul’s sign)
  • Pulsus paradoxus
31
Q

what is pulsus paradoxus

A

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
Q

investigations for pericardial effusion and tamponade

A

echocardiography
chest x ray
ecg

33
Q

what would echocardiography for periocardial effusion and tamponade show

A

diagnostic, shows echo-free space around heart

34
Q

what would chest x ray for periocardial effusion and tamponade show

A

globular heart

35
Q

what would ecg for periocardial effusion and tamponade show

A

shows low voltage complexes with sinus tachycardia

36
Q

how to diagnose pericardial effusion

A

CXR – large heart
ECG – low voltage QRS complexes and sinus tachycardia
Echocardiogram

37
Q

how to diagnose cardiac tamponade

A

CXR – large heart

Beck’s triad
- Falling BP
- Rising JVP
- Muffled heart sounds

ECG

Echocardiogram

38
Q

management of pericardial effusions and cardiac tamponade

A

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
Q

are most pericarditis cases idiopathic

A

yes or

or they result from intrapericardial haemorrhage during heart surgery

40
Q

signs and symptoms of constrictive pericarditis

A

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
Q

investigations for constructive pericarditis

A

CXR – shows normal heart and pericardial calcification

CT or MRI – diagnostic, shows pericardial thickening and calcification

Echocardiography

42
Q

treatment for constructive pericarditis

A

surgical excision of pericardium

43
Q
A

PHASE 2 cardio conditions (20 decks)

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