Pericarditis CIS

Question 1

most commonly, pericarditis is

Answer 1

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

Question 2

normal pericardial rub

Answer 2

usually produced in the left ventricle

Every time the L Ventricle moves, there’s a rub, so 3 x

Question 3

pulseless electrical activity

Answer 3

beautiful EKG with no mechanical activity

Can be caused by cardiac tamponade, which needs to be drained

Question 4

what is baseline on the EKG?

Answer 4

the TP segment

Question 5

pericardial pain is

Answer 5

worse supine, relieved by sitting

usually viral

Question 6

Dressler’s

Answer 6

after MI, surgery or trauma, developing pericarditis

Question 7

Many cases of pericarditis include myocardial involvement (myocarditis) as well as pericardial and thus will be characterized by

Answer 7

troponin elevations, heart block, wall motion abnormalities, and CHF.

Question 8

Early disseminated Lyme disease

Answer 8

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

Question 9

Late Lyme disease

Answer 9

Oligoarthritis

Question 10

Treatment for Pericarditis

Answer 10

NSAIDs
Colchicine
Azathioprine
IVIGs
IL-1 antagonists (anakinra)

Question 11

Beck’s triad

Answer 11

neck vein distention, muffled heart sounds and low BP.

can be related in this case to a uremic pericardial tamponade .

Question 12

Pulsus Paradoxus

Answer 12

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%.

Question 13

what causes a change in the y descent during pericardial tamponade?

Answer 13

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.

Question 14

Cardiac ECHO in Cardiac Tamponade

Answer 14

Cardiac ECHO in pericardial tamponade may reveal that during diastole the thinner walled RV collapses.

Question 15

Please, Dr Beck, you PAY for the CT

Answer 15

Beck’s triad
Pulsus paradoxus
electrical Alterans
slowed Y descent
Cardiac Tamponade

Question 16

Kussmaul Sign

Answer 16

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).

Question 17

Constrictive pericarditis

Answer 17

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)

Question 18

Causes of constrictive pericarditis

Answer 18

TB
Post radiation
Cardiac surgery
Viruses
trauma

Question 19

How does one differentiate CP

from restrictive heart disease?

Answer 19

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.

Question 20

Treatment for Constrictive Pericarditis

Answer 20

Torsemide (bowel edema), thiazides, aldosterone antagonist (ascites).

pericardiectomy

Question 21

Summary of Cardiac Tamponade

Answer 21

= pulsus paradoxus, electrical alterans, and slow y descent = Dr Beck, “You PAY for the CT”!

Question 22

Summary of Constrictive Pericarditis

Answer 22

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