Pericarditis, Valve Prostheses, Cardiomegaly Flashcards
What are the subtypes of pericardial diseases?
Acute pericarditis
Effusion
Cardiac tamponade
Constrictive pericarditis
What is pericarditis?
inflammation of visceral or parietal pericardium
What is the most common etiologic agent of acute pericarditis as a sole pathology?
Virus (Coxsackie)
32 year old patient presents with sudden, severe, substernal chest pain that refers to the back and shoulder. Enzyme levels are normal. The patients only recent medical history is a bout with flu-like symptoms two weeks prior to his visit today. Auscultation reveals a friction rub. What is the likely diagnosis?
Acute pericarditis
What is pericardial effusion?
accumulations of excess fluid within the pericardial cavity, as either a transudate or an exudate
What is a serous pericardial effusion?
Inflammatory exudate in the pericardial sac of the heart with few cells and a pale, straw-, amber-coloured fluid
What is a common cause of a serous pericardial effusion?
Heart failure
What is a chylous pericardial effusion?
lymphatic fluid accumulation in the pericardium due to lymphatic obstruction (eg. tumor)
What is a seroanguinous pericardial effusion?
Inflammatory exudate in the pericardial sac of the heart with few cells and a red tinge
(serous + blood)
What is a fibrinous pericardial effusion?
Inflammatory exudate in the pericardial sac that presents with clotting factors (fibrin) and a shaggy mayonnaise or buttery appearance
(eg. pericardial friction rub)
What is hemopericardium?
Frank blood filling the pericardial sac around the heart
What can cause a hemopericardium (cardiac tamponade)?
Tearing of the heart wall or aneurysm of a coronary artery or other blood vessel
When is a cardiac tamponade most common?
One week post-MI
Patient presents with acute substernal chest pain. He suffered an acute MI 8 days prior to this visit today. Needle aspiration of the pericardial sac reveals 350 ml of frank blood. Radiograph reveals a heart that resembles a wine flask or water bottle. What is the likely diagnosis?
Cardiac tamponade
What radiographic feature is indicative of a cardiac tamponade?
Water bottle heart
What is constrictive pericarditis?
Chronic fibrosing disease of the pericardium that compresses the heart and restricts inflow
What is the etiology of constrictive pericarditis?
Prior radiotherapy to the mediastinum or Hx of cardiac surgery
Describe the pathogenesis of constrictive pericarditis
- acute pericardial injury
- pericardial space becomes obliterated, and visceral & parietal layers become fused in a dense, rigid mass of fibrous tissue
- scarred pericardium thickens so that orifices of venae cavae are narrowed
A patient presents with bilateral pitting edema of the lower limbs, ascites, and neck vein distension. What pathology do you suspect?
RSHF
A patient with a history of cardiac surgery presents with a flushed face, and neck vein distension. What pathology do you suspect?
Constrictive pericarditis (SVC syndrome)
What is a xenograft valve prosthesis?
A biological porcine (pig) or bovine (cow) aortic valve grafted onto a mechanical frame
How long does a xenograft valve last?
5-10 years (NOT durable)
A xenograft valve has good hemodynamic characteristics (TRUE/FALSE)?
TRUE
What are contraindications to a mechanical valve prosthesis?
- Pregnant or young females anticipating pregnancy
- Patients with coagulation disorders
A mechanical valve functions much longer than a xenograft valve (TRUE/FALSE)?
TRUE (excellent durability)
A patient with a ____ valve is put on immunosuppressant medication for life (TRUE/FALSE)?
Xenograft
A patient with a ____ valve is put on anticoagulant therapy for life
Mechanical (creates physical damage)
An 85 year old patient would most likely receive with type of valve prosthesis?
Mechanical
A 32 year old aspiring mother would most likely receive what type of valve prosthesis?
Xenovalve
How is cardiomegaly assessed?
Cardiothoracic ratio = width of the thorax divided by width of heart shadow
The heart should occupy less than 50% of the thorax (cardiothoracic ratio < 0.5)
What are some causes of cardiomegaly?
- hypertension (anything that can cause HTN)
- valvular disease
- hypertrophic cardiomyopathy (or dilative)
- acromegaly (due to GH secreting tumor)
- anemia (not enough O2 to body, heart works harder)
