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Cardio > Pericarditis > Flashcards

Pericarditis Flashcards

1
Q

Layers of the normal pericardium

A

Outer fibrous layer – no vital function

Inner serous layer – lubricates, anchors the heart. Has two layers – visceral and parietal.

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2
Q

Cause of acute pericarditis

A

Viral: Coxsackie, Echovirus
TB
Bacterial

Non infectious: Post MI
Severe hypothyroidism
Cardiac surgery
Trauma
Mediastinal radiation
Drugs and Toxins
SLE, RA
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3
Q

If pericarditis is caused by an MI, how big is the lesion?

A

It’s related to infarct size.

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4
Q

Early post-MI pericarditis vs late post-MI pericarditis

A

Inflammatory, but weeks to months later mostly immune mediated process.

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5
Q

Post cardiac injury syndrome

A

Months to weeks after MI, immune mediated pericarditis

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6
Q

Symptoms of acute pericarditis

A

Retrosternal chest pain due to friction. Related to position.

Rare fever, dyspnea

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7
Q

Signs of pericarditis on exam?

A

Peristernal friction rub – highly specific. Best heard when patient is sitting and expiring.

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8
Q

EKG findings of acute pericarditis?

A

Don’t worry about it now. But know that there’s universal ST elevation.

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9
Q

How to treat acute pericarditis

A

Aspirin
Colchicine
Steroids if recurrent

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10
Q

Complications of acute pericarditis

A

Constriction from scarring and loss of elasticity.

Cardiac tamponade, accumulation of pericardial fluid under pressure.

Recurrent pericarditis

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11
Q

Etiology of pericardial effusion

A

Viral, bacterial, tb

Malignancy, uremia, radiation, trauma, dissecting aneurysm

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12
Q

Symptoms of pericardial effusion

A

Sometimes asymptomatic

Dyspnea, cough, hoarseness, abdominal fullness

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13
Q

Signs of pericardial effusion on exam

A

Muffled heart sounds, Ewart’s sign.

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14
Q

Ewart’s Sign

A

Dullness to percussion of subscapular area. Sign of pericardial effusion

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15
Q

How does pericardial effusion appear on x-ray?

A

Flask like appearance of heart – water bottle.

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16
Q

How to treat effusions?

A

Drain them with a needle, unless it’s an aortic dissection

17
Q

Cardiac tamponade

A

Hypotension, tachycardia

Occurs when intrapericardial pressure exceeds intracardiac pressure. Ventricles cannot contract and low SV.

18
Q

What is development of tamponade based upon?

A

Time of development, not amount of fluid.

19
Q

Effect of breathing on heart in tamponade

A

During inspiration, large volume of blood floods right side. Because heart can’t expand out, the septum will push and expand to the left side of the heart, which diminishes filling. Decreased SV.

During expiration, the septum will push on the right side of the heart.

20
Q

Pathophysiology of cardiac tamponade and constrictive pericarditis

A

Impaired diastolic filling of ventricles leads to elevated venous pressures (causing pulmonary congestion and systemic congestion), and impaired stroke volume– decreases CO.

21
Q

Symptoms of cardiac tamponade

A

Dyspnea, orthopnea, fatigue

22
Q

Beck’s Triad

A

Decreased arterial pressure, increased venous pressure, distant heart sounds

23
Q

Other signs of cardiac tamponade that aren’t decreased arterial pressure, increased venous pressure and decreased heart sounds.

A 
Tachycardia
Pulsus paradoxus 
Increased JVP
Decreased systolic blood pressure with narrow pulse pressure
Muffled heart sounds
Ewart's Sign
24
Q

Pressure tracing of RA or JVP with tamponade or constriction

A

Tamponade: Very shallow Y descent because right ventricle is compressed.

Constriction: Deep Y descent because higher atrial pressures without ventricles being too constricted.

25
Q

Pulsus paradoxus

A

Exaggerated drop in systemic blood pressure with inspiration because RV expands into LV and impairs filling so SV decreases.

Septum must be intact to occur

26
Q

How to treat tamponade

A

Pericardiocentesis along with IV fluids and pressor agents

27
Q

Constrictive pericarditis effect on heart

A

Impedes diastolic filling of the heart. No effect on systolic function.

28
Q

What happens in constrictive pericarditis

A

Diastolic heart failure – exertional dyspnea, R>L CHF, peripheral edema

29
Q

Causes of constrictive pericarditis

A

Heart surgery, radiation, connective tissue diseases (RA, SLE), infection, malignancy

30
Q

Kussmaul’s sign

A

Distention in jugular veins with inspiration. This is paradoxical. Seen when ventricles resist filling. Seen in tamponade more than constriction because of the lack of a y descent.

31
Q

How to treat constrictive pericarditis?

A

Remove it

32
Q

Pericardial Knock

A

When ventricle fills during diastole (S3). Increase.

Cardio (23 decks)

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