Pericarditis Flashcards
Define cardiac tamponade
XS pericardial fluid compresses heart
Decr CO
Define constrictive pericarditis
chronic process when pericardium thickens and compresses heart
decr CO
Common causes of acute pericarditis
1) viral illness
2) Connective tissue/autoimmune diseases
3) uremia
4) metastatic tumor
most common presentation of acute pericarditis
1) sudden onset severe chest pain
2) varies with position and breathing
diagnosis of acute pericarditis
1) chest pain vary with position and breathing
2) pericardial rub on exam
ekg of acute pericarditis
diffuse ST elevation
echo of acute pericarditis
pericardial fluid
treatment of acute pericarditis
NSAIDS
ibuprofen 300-800 mg PO Q6-8 hr
or
Aspirin 325-650 mg
or
Colchicine
common causes of pericardial effusion
1) viral or acute idiotpathic pericardiitis
2) metastatic malignancy
3) uremia
4) autoimmune disease
5) hypothyroidism
6) Trauma
how to dx pericardial effusion
xray or echo
small effusions WITHOUT INTRAPERICARDIAL PRESSURE may be
asymptomatic
with LARGE EFFUSIONS + HIGH INTRAPERICARDIAL PRESSURE, what happens?
cardiac tamponade + myocardial compression
–> IMPAIR DIASTOLIC FILLING
KEY OF PERICARDIAL TAMPONADE
1) HIGH INTRAPERICARDIAL PRESSURE
2) IMPAIRS FILLING OF RIGHT HEART
3) DECR RV OUTPUT
4) LUNGS NOT CONGESTED = clear unlike HF
COMPARE PERICARDIAL TAMPONADE with dilated cardiomyopathy
in dilated cardiomyopathy there is pulmonary venous congestion in lungs
define paradoxical pulse in pericardial tamponade
–> inspiration increases filling of RV causing septum to impinge on LV lowering stroke volume (usually have enough space for RV expansion)
> 10 mmHg fall in systolic Pressure during inspiration
electrical alternans on ECG means
movement of heart back and forth in fluid (QRS amplitude alternates in height)
–> pericardial tamponade
cause of constrictive pericarditis
scarring + loss of elasticity of pericardium
common causes of constrictive pericarditis
1) idiopathic
2) after cardiac surgery
3) radiation
4) infectious (TB)
pathophys of constrictive pericarditis
impaired diastolic filling with normal systolic function
presentation of constrictive pericarditis
1) elev JVP (disappear into jaw)
2) hepatomegaly
3) edema
4) ascites
5) tachycardia
how to diagnose constrictive pericarditis
echo and xray
what does constrictive pericarditis look like on xray
thickened or calcified pericardium
clinical signs of constrictive pericarditis!!
1) takes long time to develop
2) cardiac silhouette normal but covered by thick pericardium
3) lung NOT CONGESTED because constriction impairs filling of LV
4) mistaken for liver disease due to high venous pressure
treatment of constrictive pericarditis
surgical stripping of pericardium
catheterization in constrictive pericarditis
1) rapid filling in early diastole but no further filling of diastole
2) diastolic filling pressures equalized btwn LV and RV (normally RV < LV)
how to separate pericardial pain from other causes
1) PLEURITIC - activ by deep breathing + positional change
pain from acute PE can be pleuritic but lacks ECG change of pericarditis
pneumonia may have pleuritic but rales in lung + sputum
separate tamponade from CHF
major impairment
tamponade = problem with right heart filling during diastole
CHF = no impaired right heart filling, decr myocardial fxn –> pulm + systemic congestion
separate tamponade from CHF
common features
1) distended neck vein
2) tachy
3) hypotension
4) decr RV disatolic fillingw with inspiration ara
4) large heart on CXR
separate tamponade from CHF
physical exam + xray
tamonade = lung clear on exam + xray
CHF = lung congested with rales on exam and redistrib blood flow to upper lobes
separate tamponade from CHF
pulsus paradoxicus
mostly in tamponade
separate tamponade from CHF
heart sounds
tamponade = distant sounds, apex may not be palpable
CHF = normal heart sounds + S3 + lifts
separate tamponade from CHF
ECG
tamponade = large pericardial effusion, RA collapse, lack of decr in IVC diameter
CHF = poor contractile + dilation of ventricles
separate tamponade from constrictive pericarditis
common
1) decr diastolic function
2) good systolic fxn
3) JVD
4) tachy + hypotension
separate tamponade from constrictive pericarditis
CXR
tamponade = large cardiac silhouette
constrictive = normal silhouette + pericardial calcif
separate tamponade from constrictive pericarditis
pulsus paradoxicus
tamponade = present
constriction = uncommon
separate tamponade from constrictive pericarditis
progression
tamponade = quick onset
constrictive = slow + hepatic congestion, ascites, pedal edema
separate tamponade from constrictive pericarditis
echo
tamponade = pericardial fluid + RA collapse with inspiration
constriction = none of those
fluid btwn which 2 layers
visceral pericardium and parietal pericardium
ecg in cardiac tamponade
1) low voltage with sinus tachy –> fluid around heart so not conduct
2) electrical alternans
kussmaul sign
1) inspiration, decr intrathoracic pressure
2) incr in blood to right side but blood can’t get into RA –> bulge in venous pressure
