- Low arterial BP - JVD - distant muffled heart sounds

Pericarditis - Carnevale Flashcards by Jassie McGovern

Pericardial sac contains 30-50mL of …

thin, clear, straw-colored fluid

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Pericardial disease arise when there’s…

fluid accmulation, inflammation, fibrous constriction, or some combination of these processes

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Slow accumulating pericardial effusion can become large without interfering with ….

heart functions

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4 types of Pericardial diseases

1) serous fluid (pericardial effusion)
2) Fibrinous or serofibrinous pericarditis
3) Hemopericardium
4) Purulent pericarditis

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Pericardial disease associated with CHF

pericardial effusion

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Pericardial disease most frequent post acute MI

fibrinous or serofibrinous pericarditis

development of pericardial friction rub

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Causes of pericardial disease

1) all types of infectious agents (viral, bacterial, fungal, parasitic)
2) Immunologically mediated
3) Others include MI, uremia, neoplasia, trauma, radiation

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Presumably immunologically mediated cause of pericardial disease

Rheumatic fever
SLE (systemic lupus erythematous)
Scleroderma
CV surgery
Dressler syndrome
Drug hypersensitivity

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Protein-rich exudate, clear

serous pericarditis

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Fibrin-rich exudate

fibrinous pericarditis

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Tamponade can either be …

sudden acute or MI rupture

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MI rupture occurs ____ post MI

3-7 days

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Beck’s triad

Low arterial BP
JVD
distant muffled heart sounds

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Paradoxus pulse

drop of greater or equal than 10 mmHg in arterial BP on inspiration, standing

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Different types of acute pericarditis

serous pericarditis
fibrinous pericarditis
tamponade

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3 types of constrictive pericarditis

1) metastatic neoplasia
2) tuberculosis
3) organization of purulent pericarditis

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Characteristics of constrictive pericarditis

thickening and scarring of pericardium

loss of elasticity –> prevents stretching
proliferation of fibrous tissue with occasional small foci of calcification

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residual of foramen secudum

foramen ovale

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What fuses to form the atrial septum?

septum secundum

septum primum

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Foramen ovale closes soon after birth due to

increase in left atrium pressure

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Septum primum grows toward…

endocardial cushion

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What forms while foramen primum disappears?

foramen secundum

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Function of foramen secundum

shunts blood R –> L

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Septum secudum expands and covers most of ….

foramen secundum

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General term to describe abnormalities of the heart of great vessels that are present at birth

congenital heart disease

Most disorders of congenital heart disease arise from embryogenesis during weeks ....

3-8

Occurrence of congenital heart disease (name most prevalent to least prevalent affected structures)

VSD>ASD>Pulmonary stenosis>PDA

Most common genetic disease with congenital heart disease

Down Syndrome (Trisomy 21)

Abnormal communication or opening between cardiac chambers and/or blood vessels, direction of blood flow depends on pressure gradient

shunt

Abnormal narrowing, causes partial obstruction of blood flow

stenosis

Failure of an anatomical feature to form or develop

atresia

3 major categories of CHD

1) L-->R shunt 2) R-->L shunt 3) obstruction

Initially non-cyanotic but later becomes cyanotic

L--> R shunt

Causes of L-->R shunt

- ASD - VSD - PDA

Cyanotic congenital heart disease

R-->L shunt

Causes of R--> shunt

- tetralogy of fallot - transposition of great vessels - paradoxical embolism

Causes of obstruction congenital heart disease

coartation of aorta

This CHD raises both flow volumes and pressures in pulmonary circulation

L-->R shunt

Etiology of L-->R shunt

- RH is getting oxygenated blood from the LH, as well as its normal volume of unoxygenated blood - extra volume can cause RV hypertrophy and athersclerosis of pulmonary vasculature

L-->R shunt does what to blood flow, esp to pulmonary?

increases

Consequences of L-->R shunt

pulmonary vascular resistance approaches systemic levels - produces R-->L shunt - causes unoxygenated blood to get into systemic circulation - late cyanotic CHD or Eisenmenger

Most common defect

VSD

Consequences large VSD

can difficulties at birth

Consequences of small VSD

generally well-tolerated for years, may not be recognized until later in life - 50% close spontaneously - blood is shunted L-->R

Caused by fixed atrial septum opening

ASD (atrial septal defect)

90% of ASD involves what structure? what about others?

``` 90% - septum secundum (middle) septum primum (lower) sinus venosus (upper) ```

Etiology of ASD

L-->R shunt where blood is going from L atria to R atria | R-sided volume overload - pulmonary blood flow 2-4x normal

Consequences of ASD

generally well tolerated and usually asymptomatic before 30

Etiology of patent ductus arteriosus (PDA)

ductus arteriosus remains open (normally closes at birth) | - machinery-like murmur

This defect is most commonly found in Down Syndrome

Atrioventricular septal defect (AVSD)

Etiology of AVSD

failure of the endocardial cushions of the AV canal to fuse | - malformations of tricuspid and mitral valves

Partial AVSD

primum ASD and cleft anterior mitral leaflet --> mitral insufficiency

Complete AVSD

large combined AV septal defect and large common AV valve - hole in the center of heart - both tricuspid and mitral valves involved

Causes cyanosis

R-->L shunts

Tetralogy of Fallot

1) obstruction of RV outflow (subpulmonary stenosis) 2) RV hypertrophy 3) aorta that overrides VSD 4) large VSD

Resembles isolated VSD and shunt, may lead to L-->R shunt | NO cyanosis

Mild subpulmonary stenosis in TOF

Results in greater resistance to RV outflow, R--> L shunt and cyanosis

Classic TOF | Severe subpulmonary stenosis

Complications of TOF (5)

1) systemic cyanosis 2) polycythemia/ thromboses 3) bacterial endocarditis 4) paradoxic embolism 5) cerebral abscess

Etiology of transposition of great arteries

aorta arises from RV and lies anterior and to the R of pulmonary artery - defect in formation of truncal and aortopulmonary septa (membrane doesn't twist like it's supposed to)

Blood flow in transposition of great arteries

RV --> systemic circulation LV --> pulmonary **reverse of normal

Narrowing, constriction of the oarta

coartation of aorta

Two classic forms of coartation of aorta

1) proximal to PDA | 2) distal to closed ductus arteriosus and distal to arch vessels

Severity of C of A with PDA

severe - do not survive past neonatal period without surgical intervention - cyanosis in lower half of body

Severity of C of A without PDA

asymptomatic unless severe narrowing | - may have weak pulses and hypotension in lower extremities, claudication and coldness

Notched ribs

symptom of C of A | - circulation backed up into intercostals