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Nayla Foundations > Pericarditis > Flashcards

Pericarditis Flashcards

1
Q

What can chronic pericardial inflammation lead to

A

rigid, thickened, calcified pericardium

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2
Q

What are the causes of pericardial disease

A 
Viral 
Bacterial
Fungal
Parasitic
Systemic inflammatory dz (SLE)
Malignancy
Uremia
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3
Q

Why is the epidemiology of pericarditis

A

in 0.1-0.2% of hospitalized patients

up to 5% of ED patients with non-ischemic CP

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4
Q

What is the most common cause of acute pericarditis

A

Idiopathic

most are undiagnosed VIRAL infections; coxsackie B, Influenza

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5
Q

What is the most common presenting symptom in acute pericarditis

A

CHEST PAIN; sharp and pleuritic, improves by leaning forward, exacerbated by cough

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6
Q

Describe pericardial CP vs ischemic CP

A

Pericardial: sudden one, anterior chest, sharp, pleuritic, improves leaning forward, worse with cough inspiration or lying flat
Ischemic: radiates, relieved with nitro

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7
Q

What is common to see on pericarditis PE

A

Pericardial friction rub; squeaky, scratchy over LSB

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8
Q

What are characteristic ECG findings for pericarditis

A

Diffuse ST elevation (concave upward) and PR segment depression
Stage 1: diffuse ST elevation and PR depression
Stage 2: normal
Stage 3: diffuse deep T wave inversion
Step 4: normal

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9
Q

What other diagnostic tests should you get

A

CT (shows thick pericardium)
Cardiac MRI
Echo (normal unless effusion present)

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10
Q

Are pericardiocentesis and pericardial biopsy used in acute pericarditis

A

Rarely, they are low yield
but can be therapeutic and diagnostic
Pericardiocentesis if refractory to med therapy or in hemodynamic compromise
Biopsy if illness >3 weeks, or recurrent

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11
Q

What lab tests would be elevated in acute pericarditis

A

Troponin
High CRP, ESR, and WBC can help support the diagnosis
(if patient is febrile check blood cultures)

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12
Q

What further work up should you consider if patient isn’t improving

A

ANA, rheumatoid factor
TB testing
HIV serology
Malignancy work up

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13
Q

What is the diagnostic criteria for acute pericarditis

A

Need TWO of the following:

  1. Typical CP
  2. Pericardial friction rub
  3. Characteristic ECG changes
  4. Pericardial effusion
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14
Q

What is pericarditis admittance criteria

A 
Fever
immunocompromised
subacute onset
Hemodynamic compromise 
Oral anticoagulants (hemorrhagic effusion)
trauma
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15
Q

How do you medically manage acute pericarditis

A

NSAIDs +/- Colchicine (reduce sx and decrease rate of recurrence) 2 weeks or less
-If pt can’t take NSAIDs, give glucocorticosteroids

-Activity restriction until Sx resolved and biomarkers normalize

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16
Q

How long until a patient shows improvement with medical management of pericarditis

A

within one week

if Sx persist, may need more workup

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17
Q

What is a pericardial effusion

A

amount of fluid in pericardium more than normal (15-50 ml) secondary to injury to pericardium
acute, subacute, or chronic

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18
Q

What kind of effusion progression is better

A

Slower development; the pericardium has more time to stretch and adapt

19
Q

How does a pericardial effusion usually present

A

Asymptomatic!
May have CP/pressure/discomfort relieved by sitting up or leaning forward
Syncope, light headed, palpitations, Resp. Sx

20
Q

What can you find on pericardial effusion PE

A

Usually none unless hemodynamically significant

**Pulsus Paradoxus (SBD decrease >10 with inspiration) = falling CO during inspiration

21
Q

How do you measure Pulsus Paradoxus

A

When taking BP, listen for first korotkoff sound only on expiration, deflate cuff until you hear during inspiration and expiration
If difference >10, positive test

22
Q

What is characteristic of an ECG for pericardial effusion

A

Low voltage QRS

  • Sinus tachy
  • *Electrical alternans (normal then abn QRS)
    • **= highly specific for pericardial effusion
23
Q

What is a characteristic CXR finding for pericardial effusion

A

Enlarged cardiac silhouette

24
Q

What is your imaging modality of choice for pericardial effusion

A

ECHOCARDIOGRAM (large effusion= >20 mm)

25
Q

What diagnostic exam is low yield for pericardial effusion

A

Pericardiocentesis

Indicated if impending hemodynamic compromise, suspected infectious, or uncertain etiology

26
Q

How do you treat pericardial effusion

A

NSAID +/- Colchicine if with pericarditis
treat underlying cause
refractory cases need recurrent pericardiocentesis

27
Q

What is a chronic pericardial effusion

A

Present for >3 months, asymptomatic, hemodynamically tolerated
Pericardectomy needed if fluid reaccumulates despite repeat pericardiocentesis

28
Q

What is a hemorrhagic pericardial effusion

A

When blood fills the pericardial space, most likely due to malignancy (can also be Iatrogenic, MI complication like free wall rupture)

29
Q

What is cardiac tamponade

A

compression of heart chambers due to increased pericardial pressure (pericardium has reached max capacity)

30
Q

How does blood flow in the heart change with cardiac tamponade

A

Diastolic compliance reduced (less room)

RV bows into LV during inspiration and decreases filling more causing decrease in CO and BP

31
Q

What are the causes of cardiac tamponade

A

Acute within minutes, due to trauma , leads to cariogenic shock
Subacute occurs days-weeks, neoplastic
Regional occurs s/p MI or post-pericardectomy, and only select chambers are compressed

32
Q

What are symptoms of cardiac tamponade

A

DYSPNEA

fatigue, chest discomfort, peripheral edema

33
Q

What is Becks Triad (seen with cardiac tamponade)

A
  1. Hypotension
  2. JVD
  3. Muffled heart sounds
34
Q

How do you know if your patient is in cariogenic shock

A

On exam, cold clammy extremities with mottled skin

Indicate poor end organ perfusion due to cardiac dysfunction

35
Q

While diagnosis is CLINICAL, what can help you diagnose cardiac tamponade

A

ECG: Electrical alternates and Low voltage QRS
Echo: hemodynamic significance
Labs: + based on underlying cause (from fluid sample)

36
Q

How do you treat cardiac tamponade

A

CARDIO CONSULT
**Urgent Echo guided pericardiocentesis OR
Surgical drainage

37
Q

What is constrictive pericarditis

A

CHRONIC Scarring of normal elasticity of pericardial sac making it rigid and thick
Cause reduced CO and SV

38
Q

Why does systemic venous return increase on inspiration with cardiac tamponade but NOT with constrictive pericarditis

A

In tamponade, pericardial space is open (fluid filled) but in CP, it is all thick so filling won’t change with respiration

39
Q

What causes constrictive pericarditis

A

Any pericardial disease process
idiopathic or viral
S/p radiation or cardiac surgery or infection

40
Q

How does CP usually present

A

*Symptoms of RHF (peripheral edema, anasarca)

fatigue, dyspnea, DOE (reduced CO)

41
Q

What will you see on CP physical exam

A

Elevated JVP
Kussmaul’s sign
Pericardial Kock (before S3)

42
Q

What are charac. CP diagnostic exam findings (ECG, CXR, Echo, MRI)

A

ECG: non-specific ST/T wave changes
CXR: pericardial CALCIFICATION
Echo: abnormal passive filling
MRI: tells you effusion vs thickening

43
Q

What is the treatment for CP

A

Conservative treatment for 2-3 months
If persistent, pericardectomy**
(diuretics can temp reduce Na)

44
Q

How can you tell the difference between CP and RCM

A

Both have high filling pressure and normal systole, and Kussmaul’s sign
CP: pt has had prior pericarditis or systemic disease. Pericardial knock!
RCM: pt has amyloidosis

Nayla Foundations (18 decks)

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