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Clinical Medicine - Cardiology > Pericarditis > Flashcards

Pericarditis Flashcards

1
Q

What is the pericardium?

A

Fibroelastic sac

Visceral and parietal layers with pericardial cavity between them

15-50 mL of plasma ultrafiltrate

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2
Q

Definition of acute pericarditis

A

Rapidly developing inflammation of the pericardium

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3
Q

What is the most common cause of pericarditis?

A

idiopathic!

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4
Q

What are some causes of pericarditis?

A 
Radiation
Neoplasm
Trauma
Autoimmune
Metabolic
   ---Hypothyroidism
   ---Uremia
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5
Q

Cardiac causes of pericarditis

A

Early infarction pericarditis
Last post cardiac injury (Dresslers)
Myocarditis
Dissecting aortic aneurysm

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6
Q

What drugs can cause pericarditis? How?

A

Via drug induced lupus

Procainamide
Isoniazid
Hydralazine

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7
Q

Acute pericarditis - important viral, bacterial, and fungal causes

A

Viral
-coxsackie, echovirus, adenovirus, influenze, HIV

TB/histoplasmosis

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8
Q

Acute pericarditis pathologic anatomy

A

Usually fluid accumulation - most commonly serous

Bacteria or tumor cells

Sometimes bacterial infection causes a purulent pericarditis

Fluid may resolve or form adhesions

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9
Q

What sort of change is there is the surface of the heart with pericarditis?

A

It becomes roughened

–sometimes described as bread and butter pattern

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10
Q

Clinical features of pericarditis

A

Chest pain
Pericardial friction rub
ECG changes
Pericardial effusion

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11
Q

Acute pericarditis Presentation - chief complaints

A

Chest pain unrelated to exertion
Fatigue, dyspnea, malaise
Fever

(so basically flu like symptoms other than chest pain)

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12
Q

Type of chest pain seen with acute pericarditis

A

Sudden onset of pleuritic chest pain

  • -sharp, stabbing
  • -worse on deep inspiration and laying flat, better leaning forward
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13
Q

Pericardial friction rub is due to ..

What does it sound like?

A

friction between the two inflammated layers of pericardium

Scratchy, leathery sound - higher pitch than diastolic filling sounds

  • —best heart with the diaphragm
  • —heard over left sternal border
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14
Q

ECG findings with acute pericarditis

These changes signify …

A

Sinus tachycardia

ST elevation and PR depression

  • –aVR opposite
  • –ST changes are diffuse and not well correlated to acute ischemia or a single vessel

Changes signify inflammation of the epicardium, since the parietal pericardium itself is electrically inert

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15
Q

Acute pericarditis complications

A

Pericardial effusion & tamponade
Constrictive pericarditis (late)
Relapse

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16
Q

How do we treat idiopathic and viral causes of pericarditis?

A

Combination of NSAIDs (2 weeks) and colchicine (3 months)

17
Q

How do we treat pericardicitis post MI?

A

Aspirin and colchicine

Avoid NSAIDs since they may interfere with healing and scar formation

18
Q

When would glucocorticoids by used in pericarditis?

A

In patients with symptoms refractory to standard therapy

Acute pericarditis due to CT disease

Uremic pericarditis

(use these rarely and cautiously b/c of concern of recurrence of pericarditis)

19
Q

What is a pericardial effusion?

How does this relate to tamponade?

A

Accumulation of fluid in pericardial space

Pericardial fluid pushing on the heart creates tamponade

20
Q

What ECG changes are seen with pericardial effusion (and pericardial tamponade)?

A
  1. sinus tach
  2. low voltages (of all QRS)
  3. electrical alternans
21
Q

What is the presentation of pericardial tamponade like?

A
  • Depends on chronicity of the process
  • ‘CHF’ symptoms with clear lungs
  • Unexplained signs of R heart failure (edema, increased JVP)
  • New ‘cardiomegaly’ on CXR
  • ECG changes
22
Q

Pericardial tamponade - pathophysiology

A

Pericardial fluid increases intrapericardial pressure which impedes diastolic filing of LV and RV

RV and LV diastolic pressure rises
SV and CO decrease
Systemic BPdrops
Pulse pressure narrows
HR increases
23
Q

Pulsus paradoxus

  • definition
  • what is this seen with?
  • what is the mechanism behind this?
A

Fall of systolic blood pressure > 10 mmHg with inspiration

Seen with tamponade

With compressive fluid, the increase in venous return causes septal shift impinging on LV volume

24
Q

How do we check for pulsus paradoxus?

A

Can check by measuring the difference in systolic pressure
BUT, shouldn’t do this, instead
listen for the difference in when you start hearing rare korotkof sounds to when you start hearing all of them regularly

25
Q

Physical findings of pericardial tamponade

A 
Sinus tach
Tachypnea
Hypotension (late) with narrow pulse pressure
Elevated JVP with loss of Y descent
Edema
Pulsus paradoxus
26
Q

Treatment of pericardial tamponade

A 
Medical emergency!
IVF (temporizing)
Vasopressors as needed
Prompt pericardiocentesis
Pericardial windown

AVOID diuretics, vasodilators, etc.

27
Q

What labs should be done on someone with pericarditis?

A 
Cardiac enzymes
Inflamation markers (CRP, ESR, WBCs)
Thyroid fxn studies
Renal fxn studies
Body fluid cultures
TB skin test
28
Q

What is constrictive pericarditis?

A

Chronic thickening/scarring of pericardium leading to encasement of the heart and impaired diastolic filling of LV and RV

29
Q

Pathophysiology of constrictive pericarditis

A

Early diastolic filling unimpaired

Chambers expand and collide with unyielding pericardium which halts further diastolic filling

“dip and plateau” or “square root” sign seen on pressure tracing

30
Q

Constrictive pericarditis clinical presentation

A

Slow, indolent process

Unexplained right heart failure

  • -systemic congestion (edema, ascites, hepatomegaly)
  • -fatigue
  • -dyspnea

Often misdiagnosed as cirrhosis

31
Q

Physical findings with constrictive pericarditis

A

Elevated JVP with prominent X and Y descents
—(notice this is different than with tamponade)

Kussmaul’s sign
Pericardial knock
Systemic congestion
—hepatometgaly, ascites, edema

32
Q

What is Kussmaul’s sign?

A

Lack of an inspiratory decline in JVP

33
Q

What are the differences in patterns in jugular venous pressures in tamponade and constriction?

A

tamponade - loss of y descent

constriction - prominent x and y descents

34
Q

When is the pericardial knock heart?

A

After S2

During diastole

35
Q

What do we seen on a pressure tracing of all chambers when someone has constrictive pericarditis?

A

Equalization of diastolic pressures

36
Q

Chronic pericarditis can lead to what CXR findings?

A

calcification

37
Q

Constrictive pericarditis therapy

A

Diuretics

Pericardial stripping

Clinical Medicine - Cardiology (11 decks)

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