Sketchy Path: Pericarditis Constrictive & Pericarditis

Question 1

One of the most common causes of pericarditis that was not mentioned in the myocarditis Sketch is __________.

Answer 1

lupus (like the wolf behind the guitar player with the open, red guitar case next to him)

Question 2

Myocardial infarction is associated with two types of pericarditis: _____________________.

Answer 2

• Fibrinous pericarditis around 3 days after the MI that is localized to the area of necrosis
• Dressler syndrome 2-4 weeks later that affects the entire heart

(Think of the guitar’s broken string to remember MI as a cause of pericarditis.)

Question 3

What renal pathology can cause pericarditis?

Answer 3

Uremia (like the girl hopping up and down with the BUN burger)

Question 4

What disease is represented by the guitar picks?

Answer 4

Malignant pericarditis (the picks have crabs on them)

Question 5

All that causes ___________ can also cause pericarditis.

Answer 5

myocarditis (which is why the myocarditis Sketch is in the background)

Question 6

List the symptoms of pericarditis.

Answer 6

• Fever (flame bandana on soloist)
• Tachycardia (manager raising clock to signal that the band has to stop playing)
• Pleuritic chest pain that’s worse when swallowing but improves with leaning forward (guitar player leaning forward with sharp shark tooth necklace)
• Friction rub (like the girl rubbing the stage as she’s being pulled away by security)
• Diffuse ST elevation (like the collection of STreet signs hanging above the stage)

Question 7

How can you differentiate pleural rub from pericardial rub?

Answer 7

Pleural rubs will stop when you stop breathing.

Question 8

How are the ST elevations caused by pericarditis different from those caused by MIs?

Answer 8

• Pericarditis presents with diffuse ST elevation, as opposed to the two or three that usually arise in MI.
• The ST elevations are more sloped in pericarditis, whereas they are broadly rising –like a tombstone –in an MI.

Question 9

There are two different kinds of pericardial effusion that can arise from pericarditis: ________________.

Answer 9

• Transudative (like the clear fluid in the guitar case on stage)
• Hemorrhagic (like the ketchup packets spilled into the puddle by the BUN girl)

Question 10

Hemorrhagic pericardial effusion is more common in _______________.

Answer 10

uremic pericarditis and malignant pericarditis (like the BUN girl trying to catch the crab guitar picks)

Question 11

What determines the severity of pericardial effusion?

Answer 11

The rate of fluid entry

Fast entry causes tamponade, while slow entry can accumulate to quite a large volume.

(Think of the “speed kills” sticker on the stiff guitar case with fluid in it.)

Question 12

What is Beck’s triad?

Answer 12

The trio of symptoms that suggest pericarditis:

• Hypotension (guy fainting on stage)
• JVD (jug spilling into stiff guitar case)
• Muffled heart sounds (drummer with ear muffs)

Question 13

Why does pulsus paradoxus occur?

Answer 13

Normally, the right ventricle can expand outward during inspiration to accommodate the influx of venous blood. In pericarditis, it can’t. Instead, it bulges the interventricular septum and decreases left EDV.

(Think of the crowd surfer equally pressing on all of the people holding him as he drops his sphygmomanometer.)

Question 14

The only treatment for pericardial effusion is ______________.

Answer 14

rapidly draining the fluid (like the guy drinking from the stiff guitar case)

Question 15

Pericarditis can lead to what long-term complication?

Answer 15

Constrictive pericarditis (like the girl lassoing the waiter’s heart)

Question 16

Constrictive pericarditis presents nearly identically to _______________.

Answer 16

restrictive cardiomyopathy: JVD, Kussmaul sign, rapid Y descent

(Think of the waiter’s jug, the falling martini glass, and the other waiter’s cookies.)

Question 17

Constrictive pericarditis presents with what sound?

Answer 17

The constrictive knock (like the cowgirl knocking on the table)

Question 18

What CT sign can be evident with constrictive pericarditis?

Answer 18

White rim around the heart (like the white brim on the cowgirl’s hat)

Question 19

_____________ classically causes constrictive pericarditis in immigrants.

Answer 19

TB (like the cactus on the cowgirl’s table)

Question 20

Constrictive pericarditis can also result from ______________.

Answer 20

surgery (like the scalpel in the steak) or radiation (beam of light on cowgirl)