Pericarditis Flashcards
layers of the pericardium
________ pericardium:
- visceral layer/epicardium (inner layer)
- parietal layer (outer layer)
- the space in between these two is the _________
_______ pericardium:
the outside covering of the heart (what you would see when looking at the heart)
serous pericardium:
- visceral layer/epicardium (inner layer)
- parietal layer (outer layer)
- the space in between these two is the pericardial space
fibrous pericardium:
the outside covering of the heart (what you would see when looking at the heart)
pericarditis
inflammation of the pericardium
causes of pericarditis (3)
- idiopathic
- post MI
- acutes exacerbations of systemic connective tissue diseases such as RA & SLE
clinical manifestations of pericarditis
- location of pain = __________ that radiates to ______ side of neck, shoulder, and/or back
- quality = _______ and ________ (hard to catch breath)
- aggravated by ________ (__________ usually), coughing, & swallowing
- exacerbated when ______ position and relieved when __________ or _________ position
- substernal or left precordial pain that radiates to left side of neck, shoulder, and/or back
- grating & oppressive (hard to catch breath)
- aggravated by breathing (inspiration usually), coughing, & swallowing
- exacerbated when supine, relieved by sitting up/leaning over
hallmark finding of pericarditis
pericardial friction rub
T/F
Nitroglycerin decreases pain associated with pericarditis.
False.
No effect because there is no vessel involvement with pericarditis.
Where is a pericardial friction rub best heard when listening with a stethoscope?
lower left sternal border
have patient hold their breath (eliminates breath sounds that could interfere, especially when trying to distinguish between pericardial or pleural friction rub)
patient should lean forward (brings heart closer to chest wall)
complications of pericarditis (2)
pericardial effusion
tamponade
clinical manifestations of a pericardial effusion (4)
cough
tachypnea
dyspnea
distant/muffled heart sounds
clinical manifestations of cardiac tamponade (9)
think:
breathing
pain
2 unique
sounds
dyspnea
chest pain
restless
anxious
↓ CO
marked JVD
muffled heart sounds
narrowed pulse pressure
pulsus paradoxus
___________ - build up of fluid in pericardium
______ - build up of fluid in pleural space
_________ - pericardial effusion increases in volume
pericardial effusion - build up of fluid in pericardium
pleural effusion - build up of fluid in pleural space
cardiac tamponade - pericardial effusion increases in volume
pulse pressure = ____ - ______
SBP - DBP
pulsus paradoxus is when
SBP 10 mm Hg or more higher on __________ than __________
OR
SBP 10 mm Hg or more lower on _______ than __________
SBP 10 mm Hg or more higher on expiration than inspiration
OR
SBP 10 mm Hg or more lower on inspiration than expiration
how to perform pulsus paradoxus (seasoned clinician)
- inflate cuff beyond ______ blood pressure
- deflate cuff gradually & note when sounds are first audible on ________ only
- id when sounds audible on ________ AND________
- > ____ mm Hg, indication of pulsus paradoxus
- inflate cuff beyond palpable blood pressure
- deflate cuff gradually & note when sounds are first audible on expiration only
- id when sounds audible on inspiration AND expiration
- > 10 mm Hg, indication of pulsus paradoxus
diagnostic tests of pericarditis (2)
and
(3) labs:
____ WBC, ____ ESR, ____ CRP
EKG changes (90% of time) - diffuse widespread ST elevation (not just in "2 contiguous leads" - but in many leads)
Echocardiogram
- determine if complications of either pericardial effusion or cardiac tamponade have occurred
Labs
- ↑ WBC, ↑ ESR, ↑ CRP
