Pericarditis, pleural effusion, tamponade Flashcards
Acute pericarditis is associated with _ and _ on ECG
Acute pericarditis is associated with diffuse ST elevation and PR-interval depression on ECG
Viral infection is a common cause of pericarditis; _ is a classic example
Viral infection is a common cause of pericarditis; Coxsackie B virus is a classic example
Upon cardiac auscultation, patients with acute pericarditis will commonly have a _ described as a _
Upon cardiac auscultation, patients with acute pericarditis will commonly have a pericardial friction rub described as a high-pitched scratchy sound
The pericardial fluid is located between _ and _ layer of the heart
The pericardial fluid is located between parietal layer of the serous pericardium and visceral layer of the serous pericardium
The layers of the pericardium include _ and _
The layers of the pericardium include visceral pericardium and parietal pericardium
* The visceral layer is attached to the heart surface and may include adipose tissue
* The parietal layer is the outer layer
Between the parietal and visceral pericardium is the _
Between the parietal and visceral pericardium is the pericardial cavity/space
* Normally we find 15-50 mL of serous fluid inside
The pericardial fluid gets produced by _
The pericardial fluid gets produced by lining epithelial cells
Name some causes of acute pericarditis
Acute pericarditis may be caused by
* Infections
* Toxin/ metabolites (uremia in kidney disease)
* Systemic disease (RA, sarcoidosis, SLE, etc)
* Postinjury (MI, radiation)
* Tumor, aortic dissection, etc
Clinical manifestations of acute pericarditis include _
Clinical manifestations of acute pericarditis include..
* Fever, malaise, myalgia
* Chest pain- pleuritic (worse with inspiration/cough)
* Chest pain that is worse in supine position, better sitting up and forward
* Non-productive cough
* Dyspnea
The ECG marker for acute pericarditis is _
The ECG marker for acute pericarditis is diffuse ST elevation with PR depression
* The diffuse ST elevation represents inflammation of the myocardium
* The PR depression is abnormal atrial repolarization from the inflammation
Acute pericarditis sounds like _
Acute pericarditis sounds like friction rub best heard over the LSB
* It is highly specific
* Sounds like rubbing a balloon
Patients with pericardial effusion may have pulsus paradoxus which is _
Patients with pericardial effusion may have pulsus paradoxus which is a fall of systolic BP > 10 during inspriation
* Normally we get increased venous return and preload during inspiration that should increase SV and BP
* But when the pericardium is full of fluid, the increase in RV volume compresses the LV such that SV is reduced and BP dips
The difference between pericadial effusion and cardiac tamponade is that _
The difference between pericadial effusion and cardiac tamponade is that the pericadial constraint is present throughout the cardiac cycle with cardiac tamponade
Cardiac tampanode is _
Cardiac tampanode is an accumulation of pericardial fluid under pressure
* Compresses all chambers
* Greatly enhances ventricular interdependence
* Diastolic pressure in each chamber increases and equalizes
Becks triad of cardiac tamponade
Beck’s triad:
1. Elevated JVP
2. Muffled heart sounds
3. Hypotension
Explain what the atrial waveform would look like in cardiac tamponade
Impaired RV filling –> blunted y-descent
Increased right sided venous return –> impaired RV filling due to high pericardial pressure –> septum bulges into LV cavity –> impaired LV filling –> impaired cardiac output (shock)
Describe what the jugular vein waveform would look like in constrictive pericarditis
Early diastolic filling is characteristic of constrictive pericarditis; therefore the y descent will have a dramatic descent (atria emptying into ventricles)
A jugular venous waveform that shows a shallow y descent is likely (tamponade/ constrictive pericarditis)
A jugular venous waveform that shows a shallow y descent is likely tamponade (because the atria can’t really relax)
