Pericarditis and Cardiomyopathy Flashcards
Class 1 recommendations for pericardial disease echo
pts with suspected pericardial disease including effusion, constriction
pations with suspected bleeding in pericardium
follow up for recurrence
pericardial friction rub in MI with symptoms like pain nausea and hypotension
Thickened pericardium measurement
greater than 4mm
Pericardial anatomy
normally contains 5-30mL serous fluid
reflections create oblique and transverse sinus
fused with diaphragm
congenital absence of pericardium
mulibrey nanism
leads to CHF, constrictive pericarditis
normal spontaneous respirophasic variation
transtricuspid inflow increase by 20% on inspiration and decrease by 20% on expiration
transmitral inflow increase by 10% on expiration and decrease by 10% on inspiration
intrathoracic pressure from -3 to -6 with normal respirations
gradient for filling RV is RAP - negative intrathoracic pressure. Increased RV filling, decreased LV filling during inspiration
increased LV filling , decreased RV filling during expiration
Septum shifts to left
negative pressure inspiration
less rv afterlaod
increased rv filling
decreased lv filling
increased lv afterload
negative pressure expiration
decreased systemic venous return
decreased rv filling
increased rv afterload
increased LV filling
decreased LV afterload
CP and tamponade with spontaneous variation
changes of inspiration and expiration exaggerated in both with spontaneous ventilation
Tamponade changes with ppv
decrease in variation. So much that you can end up causing arrest
Constrictive pericarditis
increased resp variation with both spont and ppv
elevated and equalized CVP , Pulm vein and LVEDP
prominent early filling (exagerrated Y descent)
pulus paradoxus uncommon but kussmauls sign common
tamponade
increased resp variation with spontaneous
decreased resp variation with ppv
elevated and equalized cvp, pulm vein and LVEDP pressures
prominent systolic filling (loss of y descent)
pulsus paradoxus common
kussmauls sign uncommon
congenital pericardial problems
rare
partial or total absence
mulibery nanism (muscle liver brain eye nanism) = chf and CP
pericarditis
inflammation of pericardium
Triad : chest pain, ekg changes (diffuse st elevation) , friction rub at left sternal border with pt leaning forward. Pain better leaning forward
Chronic can lead to constrictive
Often idiopathic / viral
infection
neoplastic
autoimmune
post surgical
post radiation
drugs/ trauma/ uremia
thickness usually greater than 4mm but not always. Use MRI>CT=TEE>TTE
CP vs RICM
peak velocity pulm vein D wave variation > 18%
peak velocity TM E wave variation >10% in CP
color m mode Vp >100cm/sec in CP
Tissue doppler e’<8 cm/sec in RICM
Tissue doppler septal velocity > lateral velocity in CP
pericardial knock in cp, s3 in RICM
BNP <100 pg/ml in CP but elevated in RICM
thickness >4mm favors CP
tissue doppler cp vs ricm
e’<8cm/sec in ricm
e’>10 cm/sec in cp
annulus reversus lat e’<sep e’ in CP
annulus paradoxus E/e’ <15 in CP
hepatic venous reversal spontaneous
cp- reversal during expiration
ricm- reversal during inspiration
pulm venous resp variation spontaneous
peak velocity d wave variation >18% in cp
MRI comparison of cp vs ricm
late gad enhancement of pericardium and thick - cp
lge of sub endocardium - ricm
LA : RA volume CP»RICM
Max septal excurtion b/w in and ex cp>RICM
speckle tracking differences
cp- ratio of LV free wall strain to septal wall strain and RV were less in CP than RICM
Vp
<50 cm/sec = ricm
>100 cm/sec=cp
cardiac cath cp vs ricm
elevation and equalization of diastolic pressures in cp
lvedp>rvedp in ricm