Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Foundations of Clinical Practice II > Pericardium 1.29.18 > Flashcards

Pericardium 1.29.18 Flashcards

1
Q

Pericarditis differential diagnosis

A
  • STEMI, NSTEMI
  • pulmonary embolism
  • heart failure
  • pericardial effusion
  • cardiac tamponade
  • aortic dissection
  • pneumothorax
  • GERD
  • Musculoskeletal pain/costochondritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name the layers of pericardium superficial to deep

A
  1. Fibrous pericardium
  2. serous layer
    a. Parietal pericardium
    ~~~~pericardial fluid ~~~
    b. Visceral pericardium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pericardial cavity usually contains how much plasma ultrafiltrate?

A

15-50mL (about a shot glass worth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dressler’s syndrome

A

Post-cardiac injury immune response targeting the pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common disorder of the pericardium?

A

Acute pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is the peak time you might see acute pericarditis?

A

spring and fall (coincides with viral illnesses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute pericarditis is often either idiopathic or viral infection. Which are two of the most likely viral offenders?

A
  1. Coxsackie virus B

2. Influenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the main presenting symptoms in more than 95% of patients with acute pericarditis?

A
  • Chest pain, improves with leaning forward
  • radiation to the trapezius ridge is specific

worse with coughing, inspiration, lying flat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a highly specific physical exam finding for Acute pericarditis?

A

pericardial friction rub (scratchy, squeaky quality)

-Loudest at left sternal border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most important ECG change in acute pericarditis?

A

Diffuse ST elevation!

-PR depression is highly specific but often overlooked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What will ECG acute pericarditis in stage 1 look like?

A

diffuse ST elevation and PR depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What will ECG of acute pericarditis in stage 2 look like?

A

normalization of ST and PR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What will ECG of acute pericarditis in stage 3 look like?

A

diffuse, deep T wave inversions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What will ECG of acute pericarditis in stage 4 look like?

A

normalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 3 differences between acute pericarditis and STEMI ECG

A
  1. ST elevation is diffuse
  2. ST is concave up
  3. No reciprocal changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Using echocardiography what might you find if effusion present?

A

“swinging heart”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When should pericardiocentesis be peformed

A

if patient is not responding to medical therapy or if hemodynamic compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When should a biopsy be considered in pericarditis?

A
  • illness lasting more than 3 weeks

- recurrent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What may labs look like in acute pericarditis?

A
  • Elevated troponin
  • CRP
  • ESR
  • WBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If needing further workup and patient is not improving, what labs would you get (pericarditis)

A
  • ANA
  • Rheumatoid factor
  • TB test
  • HIV
  • malignancy workup
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the (4) diagnostic criteria of pericarditis? How many of these are needed to diagnose?

A
  1. Typical chest pain (sharp, pleuritic, improved with sitting up and leaning forward)
  2. Pericardial frictino rub
  3. Characteristic ECG changes (diffuse ST elevation)
  4. New/worsening pericardial effusion

NEED 2 OF THESE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

High risk patients need to be admitted for pericarditis. Name some risk factors

A

*anticoagulants (may develop hemorrhagic effusion!)

  • Trauma
  • Fever
  • Immunocompromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name 3 overal treatment goals for pericarditis

A
  1. Pain relief
  2. Resolve inflammation
  3. Prevent recurrence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What medication(s) is/are used to managed pericarditis?

A

NSAIDS +/- colchicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When do you use glucocorticoids for pericarditis and why isn’t it first line treatment?

A
  • used if NSAIDS are contraindicated

- glucocorticoids associated with higher recurrence rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How long do you typically treat someone for pericarditis?

A

2 weeks or less

27
Q

Pericardial effusion: clinical presentation

A
  • chest pain/pressure/discomfort
  • syncope
  • palpitations
  • respiratory symptoms: cough, dyspnea, hoarseness

*often discovered incidentally

28
Q

How is the pain from pericardial effusion relieved?

A

sitting up and leading forward

29
Q

How is the pain from pericardial effusion made worse?

A

lying flat

30
Q

Pericardial effusion: physical exam findings?

A
  • Pericardial friction rub
  • elevated JVP
  • tachycardia
  • tachypnea
  • decreased lung sounds at the bases (if concurrent with pleural effusion)
  • hepatosplenomegaly
  • weakened peripheral pulses
  • edema
  • cyanosis
31
Q

What is the name for decrease in systolic blood pressure of more than 10mmHg with inspiration?

A

Pulsus paradoxus

-signals falling CO during inspiration

32
Q

“water bottle” or “boot shaped” heart refer to what?

A

cardiomegaly

33
Q

What are 2 more extreme ways to deal with recurrent cases of pericardial effusion?

A
  1. Repeat pericardiocentesis

2. Pericardiectomy

34
Q

How long is a chronic pericardial effusion present?

A

3 months or more

35
Q

Hemorrhagic pericardial effusion is most often caused by?

A
  1. Malignancy
  2. Iatrogenic (we caused it)
  3. MI complication
36
Q

Cardiac Tamponade

A

compression of all 4 cardiac chambers due to increased pericardial pressure

37
Q

Systemic venous return to the right side of the heart _____ with inspiration

A

increases

38
Q

Pulmonary venous return to the left side of the heart_______ with inspiration

A

decreases

39
Q

What does acute cardiac tamponade result in if untreated?

A

cardiogenic shock

40
Q

Regional cardiac tamponade

A

localized hematoma compressing only selective chambers

41
Q

Cardiac tamponade: what patient symptom is specific to cardiac tamponade

A

dyspnea

Also:
Tachypnea, sinus tachycardia, syncope, peripheral edema, chest discomfort

42
Q

What are the three most imporant physical exam findings in a patient with cardiac tamponade?

A

Beck’s triad:

  1. Hypotension
  2. JVD
  3. Muffled heart sounds
43
Q

What is Beck’s Triad?

A

Beck’s triad cardiac tamponade PE signs:

  1. Hypotension
  2. JVD
  3. Muffled heart sounds
44
Q

When is Beck’s Triad usually observed?

A

acute cardiac tamponade

45
Q

What are some ECG findings of cardiac tamponade?

A
  • Electrical alternans (specific)

* Low voltage QRS (suggestion that this is only present with cardiac tamponade, not pericardial effusion)

46
Q

What are 2 findings you would expect to find doing echocardiogram of cardiac tamponade?

A
  1. Diastolic collapse of the RV

2. IVC plethora (reflects marked elevation in central venous pressure)

47
Q

What 2 factors affect hemodynamic effects of pericardial effusion?

A
  1. Size of effusion

2. Rate of fluid accumulation

48
Q

What are 3 treatments to consider for cardiac tamponade?

A
  1. cardiology consult, hospital admission **
  2. Echo-guided pericardiocentesis (if hemodynamic compromise)
  3. Surgical drainage (also allows for biopsy)
49
Q

What is typically the cause of pericarditis?

A

viral infection

50
Q

Diagnosis of pericarditis and cardiac tamponade are usually _____?

A

clinical

51
Q

What are pericarditis and pericardial effusion treated with?

A

NSAIDs + colchicine

52
Q

Constrictive pericarditis: definition

A

Scarring and loss of normal elasticity of the pericardial sac (thickened, rigid)

53
Q

What is a main distinguisher between tamponade and constrictive pericarditis?

A

tamponade has respiratory variation: systemic venous return can increase with inspiration

constrictive pericarditis: Systemic venous return can’t increase with inspiration

54
Q

Most common presentation of constrictive pericarditis

A

symptoms of heart failure (peripheral edema, anasarca)

other symptoms: dyspnea, chest pain

55
Q

Constrictive pericarditis: physical exam

A
  • Elevated JVP**
  • Pulsus paradoxus
  • Kussmaul’s Sign
56
Q

Kussmaul’s Sign

A

lack of inspiratory decline in JVP with inspiration

57
Q

Pericardial “knock”

A

abnormal heart sound heard slightly earlier than S3

58
Q

What is the difference between carotid pulse and internal jugular vein pulse?

A

Carotid pulse is ONE brisk upstroke

Internal Jugular Vein: “doube pulsation”

59
Q

What is a highly specific finding for constrictive pericarditis on CXR?

A

pericardial calcification

can also see this on CT

60
Q

How long is a trial of conservative treatment considered before pericardiectomy is recommended?

A

2-3 months (ex. diuretics)

(if constriction isn’t transient: pericardiectomy is the only definitive treatment

61
Q

Which has poorer prognosis:; radiation-induced constrictive pericarditis or idiopathic?

A

radiation-induced is associated with poort outcomes

62
Q

Which is more likely if a patient has amyloidosis:

Restrictive cardiomyopathy or constrictive pericarditis?

A

amyloidosis = restrictive cardiomyopathy more likely

63
Q

Is a pericardial knock more likely Restrictive CM or constrictive pericarditis?

A

constrictive pericarditis = pericardial knock

Foundations of Clinical Practice II (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions