Pericarditis CIS Flashcards
most commonly, pericarditis is
a benign, non-recurring disease not requiring hospitalization and rarely requiring pericardiocentesis or surgery
usually coxsackie virus, in young men
hallmark of the disease is a rub– no rub, no pericarditis.
inflammation causes the rubbing sound
Many causes of pericardial effusion do not cause pericarditis
normal pericardial rub
usually produced in the left ventricle
Every time the L Ventricle moves, there’s a rub, so 3 x
pulseless electrical activity
beautiful EKG with no mechanical activity
Can be caused by cardiac tamponade, which needs to be drained
what is baseline on the EKG?
the TP segment
pericardial pain is
worse supine, relieved by sitting
usually viral
Dressler’s
after MI, surgery or trauma, developing pericarditis
Many cases of pericarditis include myocardial involvement (myocarditis) as well as pericardial and thus will be characterized by
troponin elevations, heart block, wall motion abnormalities, and CHF.
Early disseminated Lyme disease
The classic triad of acute neurologic abnormalities is meningitis, cranial neuropathy*, and motor or sensory radiculoneuropathy, although each of these findings may occur alone.
Cardiac involvement with heart block and myopericarditis
Late Lyme disease
Oligoarthritis
Treatment for Pericarditis
NSAIDs Colchicine Azathioprine IVIGs IL-1 antagonists (anakinra)
Beck’s triad
neck vein distention, muffled heart sounds and low BP.
can be related in this case to a uremic pericardial tamponade .
Pulsus Paradoxus
inspiratory drop in BP
decreased LV ejection during inspiration due to the high CVP leading to increased RV filling with septal motion toward the LV, thus limiting LV filling and LVEF. At the same time, inflow across the mitral valve will decrease by 25%.
what causes a change in the y descent during pericardial tamponade?
Pericardial Tamponade is characterized by intrapericardial pressures
of > 15 mmHg which restricts venous return and ventricular filling.
acv waves showing lack of y descent can be seen in the LA via
measuring wedge pressures.
Cardiac ECHO in Cardiac Tamponade
Cardiac ECHO in pericardial tamponade may reveal that during diastole the thinner walled RV collapses.
Please, Dr Beck, you PAY for the CT
Beck’s triad Pulsus paradoxus electrical Alterans slowed Y descent Cardiac Tamponade
Kussmaul Sign
In constrictive pericarditis the jugular engorges with inspiration. This is referred to as the Kussmaul sign. (This sign can also be positive in severe COPD, pulmonary hypertension with RV failure, and more rarely in cardiac tamponade).
Constrictive pericarditis
M or W configuration related
to early and abrupt diastolic
filling with rapid (sharp) X and
Y descent.
diastolic pericardial knock (like an S3) and “septal bounce
“Square root” sign on heart cath (rapid ventricular filling followed by a plateau phase during diastole)
Causes of constrictive pericarditis
TB Post radiation Cardiac surgery Viruses trauma
How does one differentiate CP
from restrictive heart disease?
One must do cardiac catherization to differentiate constrictive pericarditis (CP) from restrictive cardiomyopathy (RC). The LV end diastolic pressure is unequal (5 mmHg or higher) to the RV diastolic pressure in restrictive cardiomyopathy, whereas they are equal in constrictive pericarditis (square root sign). Also, pulmonary pressure is high in restrictive cardiomyopathy and low in constrictive pericarditis.
BNP - elevated in RC, but normal in CP.
Treatment for Constrictive Pericarditis
Torsemide (bowel edema), thiazides, aldosterone antagonist (ascites).
pericardiectomy
Summary of Cardiac Tamponade
= pulsus paradoxus, electrical alterans, and slow y descent = Dr Beck, “You PAY for the CT”!
Summary of Constrictive Pericarditis
positive Kussmaul, ie. constrictive pericarditis associated with Kussmauls sign = ConstrictivePericarditisKussmaul. Now add the LV or RV tracing of quick plateau of diastolic ventricular pressure = √CPK
