Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen Med Unit 7: Cardio > Pericarditis/Cardiac Tmaponade > Flashcards

Pericarditis/Cardiac Tmaponade Flashcards

1
Q

define acute pericarditis

A

Inflammation of pericardium

Often asst with pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What demographic group is commonly affected by acute pericarditis?

A

Males < 50 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common cause of acute pericarditis?

A
  1. Viral
    A. May be preceded by flu-like resp. or GI sx’s
  2. Idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are other causes of acute pericarditis?

A
  1. Autoimmune Dz
  2. Radiation
  3. Neoplasm
  4. Post cardiac surgery or post-MI
    A. Dressler syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define Dressler syndrome

A

Pericarditis may occur 2-5 days after MI due to an inflammatory reaction to transmural myocardial necrosis; can also occur after cardiac surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the layers of the heart?

A
  1. Visceral – attached to myocardium
  2. Parietal – surrounds the visceral layer
  3. Pericardial space - potential space between 2 layers
    A. Normally contains small amount of fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the pathophys of acute pericarditis?

A 
1. Damaged pericardial tissue releases chemical mediators of inflammation into surrounding tissue:
A. Prostaglandins
B. Histamine
C. Bradykinins
D. Serotonin
2. Initiate inflammatory response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does inflammation of the pericardium cause?

A
  1. Friction occurs as inflammed pericardial layers rub against each other
  2. Inflammatory mediators → vasodilation and ↑ capillary permeability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a complication of pericarditis?

A

pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the classic sxs of acute pericarditis?

A 
1. Substernal chest pain
A.  Acute, Sharp & Pleuritic 
OR
B. Dull w/ radiation to trap areas 
C. Postural: Relieved by sitting up or leaning forward
2. Dyspnea
3. Fever
4. Pericardial friction rub
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is acute pericarditis diagnosed?

A

Diagnosis is usually clinical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What labs are indicated in acute pericarditis?

A
  1. CBC-Leukocytosis
  2. ↑ CRP
  3. ESR
  4. Normal troponin
  5. Blood Cx if fever > 38° C
  6. CXR
  7. Normal ECHO with trivial amount of fluid
  8. EKG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What may be the EKG findings for an acute pericarditis?

A
  1. May have non specific ST-T wave changes & low QRS voltage
  2. Diffuse ST elevation –> over time, returns to baseline followed by T wave inversion
  3. Asst PR segment depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What CXR results may be seen with acute pericarditis?

A

New cardiomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is acute pericarditis treated?

A
  1. NSAIDs: 1-2 wks or
  2. ASA: 1-2 wks or
  3. Prednisone: 1-2 wks
  4. Colchicine (Always)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What NSAIDs are indicated in acute pericarditis?

A
  1. Indomethacin (Indocin) 50 mg po bid

2. Ibuprofen (Motrin) 600-800 mg po tid

17
Q

What is the dosing and indications for asa use in acute pericarditis?

A

650-1000 mg po tid
Drug of choice in Dressler Syndrome post MI
Fever, pleuritic pain, effusion or friction rub

18
Q

When is prednisone used in acute pericarditis?

A
  1. refractory cases or autoimmune

2. 0.25-0.5 mg/kg/d

19
Q

When is colchicine used in acute preicarditis?

A

Always used!

0.5-0.6 mg po bid x 3 mo

20
Q

What lifestyle modifications are needed after acute pericarditis?

A

Limit strenuous activity x 3 mo

21
Q

What are treatments are indicated in acute pericarditis?

A 
Taper meds as CRP returns to baseline/sx’s improve
Cont. Colchicine x 3 mo (no taper)
GI protection w/PPI
Interventional effusion drainage prn
Manage underlying Dz if indicated
22
Q

What serious complications can occur form acute pericarditis? How is it managed?

A

Cardiac tamponade
A. Early complication that occurs in <5% of pts
B. Can be asst with uremic pericarditis, neoplastic pericarditis or radiation pericarditis
C. Partial pericardiectomy or “pericardial window” often necessary

23
Q

What determines the physiologic importance of a pericardial effusion and tamponade?

A

Speed of accumulation of pericardial fluid determines physiologic importance

24
Q

How is pericardial tamponade characterized?

A

Tamponade is characterized by elevated intrapericardial pressure (>15 mm Hg) which restricts venous return and ventricular filling leads to shock & death

25
Q

When may cardiac tamponade be asymptomatic?

A

Because pericardium stretches, large effusions (> 1000ml) that develop slowly may produce no hemodynamic effects

26
Q

WHat are the characteristics of small pericardial effusions?

A

Smaller effusions that appear rapidly can cause tamponade due to volume and pressure

27
Q

What are the sxs of pericardial effusion?

A 
1. Pain
A. If asst with inflammatory process
2. Painless
A. Neoplastic or uremic effusions
3. Dyspnea
4. Cough
5. Pericardial friction rub
28
Q

What are the sxs of cardiac tamponade?

A
  1. Tachycardia
  2. Tachypnea
  3. Muffled heart sounds
  4. Hypotension
  5. Narrow pulse pressure
  6. Pulsus paradoxus
  7. Central venous pressure is elevated
29
Q

Define pulsus paradoxus

A

> 10 mm Hg decline in SBP during inspiration due to impairment LV filling
Classic finding

30
Q

What are the dx studies for cardiac tamponade/pericardial effusion?

A 
1. CXR
A. Enlarged cardiac silhouette with globular configuration
2. EKG
A. Nonspecific T wave changes
B. May have low QRS voltage
3. ECHO
31
Q

What is the study of choice for pericardial effusion & tamponade

A

ECHO

32
Q

How is cardiac tamponade treated?

A
  1. IV hydration to increase preload, improve filling
  2. Vasopressors prn for hypotension
  3. Pericardiocentesis
  4. Treat underlying condition that leads to tamponade
33
Q

What are the Signs of hemodynamic instability that warrant pericardiocentesis?

A
  1. Falling SBP or SBP 10ml/Hg
  2. Large effusion >20mm on echo
  3. RV collapse on echo
34
Q

How are pericardial effusions treated?

A

Small effusions can be followed clinically
Careful observation JVP
Serial ECHO’s

35
Q

If a pericardial effusion and a cardiac tamponade are present, how is this treated?

A
  1. Urgent pericardiocentesis
    A. Removal of small amt of fluid decreases pressure significantly
    B. However, complete drainage with catheter is preferred
    -Pericardial window

Gen Med Unit 7: Cardio (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions