Pericarditis & Cardiac Tamponade

Question 1

Pericarditis definition

Answer 1

Inflammation of pericardium

Question 2

Causes of pericarditis

Answer 2

Idiopathic
Viral
Bacterial
fungal
Parasitic
Post MI -> Dressler’s syndrome
Post cardiac surgery -> Dressler’s syndrome
Trauma
Connective tissue - SLE , RA
Rheumatic fever
Uremia
Neoplasia
Myxoedema
Amyloid disease

Question 3

Important sequalae of pericarditis

Answer 3

Cardiac tamponade
Constrictive pericarditis

Question 4

Treatment of pericarditis

Answer 4

NSAIDs - aspiring if MI also, ibuprofen

Colchicine

Glucocorticoids like Prednisolone

Question 5

Type of fluids possible in inflammation in acute pericarditis

Answer 5

Serous
Purulent
Hemorrhagic

Question 6

Acute causes of cardiac tamponade

Answer 6

Hemopericardium in blunt injuries, cardiac rupture from MI, rupture of type A aortic dissection into pericardium

Question 7

Chronic causes of cardiac tamponnade

Answer 7

Bacteria
TB
Uremia
Malignany

Question 8

Factors affecting Hemodynamic effect from cardiac tamponade

Answer 8

Volume of fluid
Rate of accumulation
Distensibility of pericardium

Question 9

Pathophysiology of cardiac tamponade

Answer 9

Normal pericardial pressure lower than diastolic pressure
When large volume of fluid in pericardium -> increase in intrapericardial pressure
Pressure for Ventricular filling is cancelled out
Diastolic collapse of RA, LA, RV
Restricted venous return , diastolic filling of ventricles
Reduced SV -> reduced CO
Peripheral vasoconstriction to non essential organs

Question 10

Main symptom in acute cardiac tamponade

Answer 10

Shortness of breath

Question 11

Symptoms in chronic cardiac tamponade

Answer 11

Weakness
Weight loss
Sweating

Question 12

Examination findings in cardiac tamponade

Answer 12

Ill looking patient
Distended neck veins
Tachycardia
Low BP
Pulse pressure narrow
Rapid and shallow respiration
Cold and clammy extremities
Urine output reduced
Pericardial friction rub (50%)
Pulsus paradoxus
Kussmauls sign
Faint heart sound

Question 13

Findings of cardiac tamponade on chest xray

Answer 13

Water bottle sign - globular increase in size of cardiac silhouette

Question 14

Cardiac tamponade findings on ECG

Answer 14

Tachycardia
Low voltages
T wave inversion in précordial leads

Question 15

Role of echocardiograph

Answer 15

Fluid detection
Fluid quantification and nature
Fibrin strand detection
Treatment and intervention evaluation
Reduction in size of LV cavity

Question 16

Is acute cardiac tamponade an emergency

Answer 16

Yes

Question 17

Equipment used in acute management of cardiac tamponade

Answer 17

Pericardiocentesis
Echocardiographic guidance
ECG if echocardio not available

Question 18

Angle of pericardiocentesis

Answer 18

45 degrees

Question 19

For chronic large effusion how long should you leave catheter

Answer 19

Few days

Question 20

What can be injected into catheter during chronic drainage

Answer 20

Chemotherapeutic
Cytotoxic agents
Sclerosing agents
Air for xray

Question 21

What is chronic pericardial effusion

Answer 21

Slow accumulation of fluid allowing pericardium to expand without rise in intrapericardial pressure

Question 22

Findings on ECG for chronic pericardial effusion

Answer 22

Low voltages
ST segment elevation
Electrical alternan of QRS complex

Question 23

Chest x ray finding on chronic pericardial effusion

Answer 23

Marked enlargement of cardiac silhouette
Smooth outline without indentation

Lungs fields clear

Question 24

Goal of echocardiography in chronic pericardial effusion

Answer 24

Confirm diagnosis

Question 25

Management of pericardial effusion

Answer 25

Pericardiocentesis (relief) Pericardiostomy Pericardiectomy

Question 26

Definition constrictive pericarditis

Answer 26

Parietal and visceral pericardium form rigid envelope of fibrous or calcified tissue Fibrous tissue adheres to myocardium which can sometime infiltrates the myocardium

Question 27

Effects of constrictive pericarditis

Answer 27

compression of heart Restricted diastolic filling Can lead to chronic constrictive pericarditis if not treated well

Question 28

Main causes of constrictive pericarditis

Answer 28

Viral Tb Inadequately treated purulent pericarditis Hemopericardium

Question 29

Early symptoms of constrictive pericarditis

Answer 29

Unspecified Loss of previous stamina Fatigue Exertional dyspnoea

Question 30

Symptoms in Severe cases of constrictive pericarditis

Answer 30

Abdominal swelling due to ascites Pedal edema possible Cough Orthopnea PND rare

Question 31

Findings in Examination of patients with chronic pericarditis

Answer 31

ill looking Muscles atrophy Distended neck veins due to venous pressure Low bp Narrow pulse pressure Pulsus paradoxus 50% .Abdominal distension in ascite and hepatomegaly

Question 32

ECG findings in constrictive pericarditis

Answer 32

◦ Low voltages ◦ Flat t waves ◦ Inverted t waves ◦ Atrial fibrillation

Question 33

Chest x ray findings in constrictive pericarditis

Answer 33

Normal sized heart shadow With possible dystrophic calcification

Question 34

Echocardiograph findings in constrictive pericarditis

Answer 34

◦ Pericardial thickening ◦ Small and active LV ◦ Normal or reduced wall thickness ◦ Abnormal and septal wall motion

Question 35

Which one is superior in visualization of thickening of pericardium in constrictive pericarditis , echocardiography or ct scan

Answer 35

Ct scan

Question 36

When is cardiac catheterization useful in constrictive pericarditis

Answer 36

When trying to differentiate from restrictive cardiomyopathy

Question 37

Management of constrictive pericarditis

Answer 37

Only pericardiectomy useful to peel off calcified pericardium