Pericarditis

Question 1

This form of pericardial disease is characterized by the combination of a tense effusion in the pericardial space and constriction of the heart by thickened pericardium.

Answer 1

Subacute Effusive-Constrictive Pericarditis

Question 2

Becks triad

Answer 2

1. Hypotension
2. Soft or absent heart sounds
3. Jugular venous distension with prominent X descent but absent y descent

Question 3

Greater than normal (10mmhg) inspiratory DECLINE in systemic arterial pressure

Answer 3

PULSUS PARADOXUS

Question 4

PULSUS PARADOXUS is seen at

Answer 4

Cardiac tamponade
1/3 of constrictive pericarditis
Subacute Effusive constrictive pericarditis

Question 5

2d echo confirms diagnosis and shows that tricuspid and pulmonic valve flow velocities INCREASED markedly during inspiration.

there Is late diastolic inward motion (collapse) of the right ventricular freewall and the right atrium

Answer 5

Cardiac tamponade

Question 6

With simultaneous fever and precordial pain 10 to 12 days after a presumed viral illness with audible pericardial friction rub. With Increasd CRP and WBC. ECG showing ST segment Alterations and abnormal T waves that persist for years. What is the diagnosis?

Answer 6

Viral or idiopathic form of acute pericarditis

Question 7

With myocardial injury with blood in the pericardium after cardiac operation. Px with fever, pleuritis and pneumonitis. Findings shows fibrinous pericarditis and pericardial effusion. What is the diagnosis and treatment?

Answer 7

Post cardiac injury syndrome
Tx: ASPIRIN AND ANALGESICS

IF with disabling recurrences: another NSAID, Colchicine or glucocorticoid

Question 8

Pericarditis sec collagen vascular diseases such as

Answer 8

SLE, RA, SCLERODERMA, PAN

Question 9

Generally with fever, chills, Septicemia, and evidence of infection elsewhere. Poor prognosis. Requires drainage and antibiotic treatment.

Answer 9

PYOGENIC PERICARDITIS

Question 10

Pericarditis without pain

Answer 10

Uremic pericarditis
Pericarditis sec to neoplasticism diseases
Tb pericarditis

Question 11

Px on chronic HD with normal BUN and CREA.

Answer 11

Dialysis associated pericarditis

Question 12

Treatment of PERSISTENT uremic pericarditis

Answer 12

PERICARDIECTOMY

Question 13

Most common primary ca that causes pericarditis due to neoplasticism diseases

Answer 13

LUNG
BReast
Malignant melanoma
Lymphoma
Leukemia

Question 14

May cause acute pericarditis and or chronic constrictive pericarditis, no pain

Answer 14

Mediqstinal irradiation For neoplasm
or
post irradiation or neoplasm

Question 15

Drug induced lupus

Answer 15

Procainamide

Hydralazine

Question 16

This disorder results when the healing of an acute fibrinous or serofibrinous pericarditis or the resorption of a chronic pericardial effusion isfollowed by obliteration of the pericardial cavity with the formation of granulation tissue.

Answer 16

Chronic constrictive pericarditis

Question 17

In developing countries, most common cause of Chronic constrictive pericarditis is

Answer 17

TB

Question 18

pulses paradoxus is seen in

Answer 18

Pericardial tamponade
Massive pulmonary embolism
Severe obstructive lung disease
Tension pneumothorax

Question 19

May be palpable at the brachial artery or femoral artery when the pressure difference exceeds >15mmhg

Answer 19

Pulsus paradoxus

Question 20

True or false

Pulsus paradoxus can be difficult to measure in tachycardic and tachypneic patients

Answer 20

True

Question 21

Murmurs that diminishes in length and intensity with valsalva maneuver

Answer 21

Austin murmur
Graham steell murmur
Murmur of PDA

Question 22

Prominent x and y descent

Answer 22

Chronic constrictive pericarditis

Question 23

Physical signs in Chronic constrictive pericarditis

Answer 23

1. Broadbents sign (decrease apical pulse)
2. Kussmauls sign ( venous pressure do not fall during inspiration)
3. Pericardial knock -early S3
4. Pulsus paradoxus in 1/3 of patients

Question 24

ECG findings in Chronic constrictive pericarditis

Answer 24

Low voltage QRS complexes
Diffuse flattening or inversion of Twaves
P mitral din px w sinus rhythm
AF in 1/3 of patients

Question 25

2d echo findings of Chronic constrictive pericarditis

Answer 25

Pericardial thickening
Atrial enlargement
Dilated inferior vena cava and hepatic veins

Question 26

Only definitive treatment for Chronic constrictive pericarditis

Answer 26

Pericardial resection

Question 27

Pre-operative management for px >50 years old to exclude CAD

Answer 27

Coronary angiography

Question 28

Tense pericardial effusion + constrictive pericarditis

Answer 28

Subacute effusive constrictive pericarditis

Question 29

This chronic infection is a common cause of chronic pericardial effusion, especially in the developing world where active tuberculosis and HIV are endemic.

Answer 29

Tuberculous pericarditis