Tamponade/Pericarditis/Endocarditis Flashcards
There are many many causes to pericaritis. Name some common ones.
infection (viral or bacterial); coxsackievirus, influenza virus, hepatis, measles, mumps autoimmune or connective tissue disorders neoplasms radiation therapy chemotherapy other drug toxicity cardiac surgery myxedema tuberculosis HIV!!!!!!
who is pericarditis more common in?
men and under the age of 50
what are the primary presenting symptoms of acute pericarditis?
review book: pleuritic substernal radiating chest pain relieved by sitting upright and leaning forward; a friction rub is characteristic
pays book: several days of fever, myalgias, and malaise followed by the sudden onset of severe chest pain that worsens with respiratory movements an with lying down. pain may radiate to the back, it is generally felt in the anterior chest pain
What are the physical/Laboratory findings of acute pericarditis:
phys: low grade fever, sinus tachycardia, pericardial friction rub (heard at the apex & LLSB)
pays: EKG: depression of PR segments, diffuse ST segment elevation, flattening and inversion of the T waves
RB - LABS: often show elevated erythrocyte sedimentation rate, c reactive protein, and white blood cell count
***elevated white blood cell count = infection, therefore you must do blood and pericardial fluid cultures
ECHO: may show pericardial effusion
treatment of acute pericarditis
NSAIDS = colchicine as an adjunct
steroids / glucocorticouids if former doesn’t work
**do not use NSAIDS following an MI
review book:
what is secondary to pericarditis, uremia, or cardiac trauma) produces restrictive pressure on the heart?
What occurs when fluid compromises cardiac filling and impairs cardiac output?
- pericardial effusion
2. cardiac tamponade
review book:
1. what are the clinical features of pericardial effusions?
What are the clinical features of cardiac tamponade?
- painful or painless, often accompanied by **cough or **dyspnea. (horsneness, dysphagia)
- tachycardia, tachypnea, narrow pulse pressure, and pulses paradoxus
review book: what are the laboratory findings of
- pericadial effusions?
- cardiac tamponade?
- chest radiography or echo is useful to determine the extent of cardiac effusions and calcification
- ECG chafes include nonspecific T-wave changes and low QRS voltage. ELECTRICAL ALTERANS is PATHOGNOMONIC OF EFFUSIONS
- Echo, Doppler Untrasonography, CT, and MRI are helpful for more accurate diagnosis or before invasive procedure.
REview bOok: What is the treatment of Pericardial disorders?
- In the presence of hemodynamic compromise, pericardiocentesis is necessary to relieve fluid accumulation.
- strictly inflammatory conditions may be treated with steroids or NSAIDs
- Infectious conditions require antibiotic infection is suspected
What are the 3 main causes of pericardial effusions:
- Hypothyriodism
- Chylopericardium = accumulation of chylous from an injured thoracic duct
- Hemopericardium = accumulation of blood in the pericardial space (often results from direct trauma, cardiac rupture after MI, and aortic dissection
phys book:
- transudate = serous effusion that develops with left heart failure, over hydration, or hypoporteinemia.
- exudate = pericardial inflammation that with acute pericarditis, heart surgery, some chemo agents, autoimmune disorders such as SYSTEMIC LUPUS ERYTHEMATOUS SLE*
- Serosanguineous = tuberculosis, neoplasma UREMAI, or RADIATIO, or coagulation defects.
- CHYLE LEAKS through the thoracic duct it may enter the pericardium and lead to cholesterol pericarditis
Physical Examination of Pericardial Effusion?
*if the effusion develops gradually, the pericardium can stretch to accommodate large quantities of fluid without compression the heart.
if effusion is large it may creat sufficient pressure to cause CARDIAC COMPRESSION aka CARDIAC TAMPONADE
-apical impulse may be difficult to palpate & heart sounds will be muffled
what is the danger of the pressure exerted by the pericardial fluid in relation to the right atrium and ventricle.
the pressure exerted may equal diastolic filling pressures within the heart chambers, thus PREVENTING CHAMBER FILLING during diastole.
right atrium nd ventricle rare first because their diastolic pressures are the lowest/
what does preventing filling in the right atrium cause?
- increased venous pressure
- systemic venous congestion
- sighns and symptoms of RIGHT HEART FAILURE (distention of JVP, edema, hepatomegally)
- decreaed atrial filling leads to decreased ventricular filling which decreases stroke volume, which reduces cardiac output HYPOTENSION!
What are the signs and symptoms of cardiac tamponade?
MEDICAL EMERGENCYYYY
HYPOTENSION
**DECREASED LV FILLING DURING INSPIRATION
dyspnea on exertion, JVD, cardiomegaly, and PULSUS PARADOXUS
muffled heart sounds, poorly palpable apical pulse, dull chest piano
—a chest roentgenogram may disclose a “water-bottle” configuration of the cardiac silhouette
–an echo can detect an effusion as small as 20 ml and is considered the MOST ACCURATE AND RELIABLE
–CT is commonly used
When do you drain the pericardial guild by percutaneous FNA
persisetnt (>2 weeks) pericardial effusion
analysis includes hematocrit and cell found determination - glucose proitn cholesterol and triglycerides
