Wk3 Terry Reynolds *Pericardial Disease Flashcards
- A common two-dimensional echocardiographic finding in patients with chronic renal failure is:
A. Pericardial effusion
B. Pulmonary hypertension
C. Valvular regurgitation
D. Valvular stenosis
A
- A possible etiology for pericardial effusion is:
A. Acute MI
B. Chronic AI
C. Chronic MR
D. Mitral valve stenosis
A
The most common location for a pericardial cyst is the:
A.Hilium
B.Left costophrenic angle
C. Right costophrenic angle
D. Superior mediastinum
C. Right costophrenic angle
The best guideline for differentiating pericardial effusion from pleural effusion by two-dimensional echocardiography is:
A. Pericardial effusion is located anterior to the descending aorta; pleural effusion is present posterior to the descending aorta.
B. Pericardial effusion is present posterior to the descending aorta; pleural effusion is located anterior to the descending aorta.
C. Pericardial effusion is usually seen as an anterior clear space; pleural effusion is usually seen as a posterior clear space.
D. Pericardial effusion is usually seen as a posterior clear space; pleural effusion is usually seen as an anterior clear space.
A. Pericardial effusion is located anterior to the descending aorta; pleural effusion is present posterior to the descending aorta.
Air in the pericardial sac is known as:
A. Cardiac tamponade
B. Effusive-constrictive pericardium
C. Hemopericardium
D. Pneumopericardium
D. Pneumopericardium
A posterior echo-free space is detected during the systolic phase only by M- mode/two-dimensional echocardiography. This is considered a:
A. Normal finding
B. Small pericardial effusion
C. Moderate pericardial effusion
D. Large pericardial effusion
A. Normal finding
A large pericardial effusion precludes the diagnosis of all the following EXCEPT:
A. Flail mitral valve
B. Mitral valve prolapse
C. Pulmonic valve prolapsed
D. Systolic anterior motion (SAM) of the mitral valve
A. Flail mitral valve
patients with pericardial effusion, an echo-free space will be seen between the epicardium and the:
A. Endocardium
B. Fibrous pericardium
C. Myocardium
D. Parietal Serous Pericardium
D. Parietal Serous Pericardium
*Note: The pericardial space lies between the parietal and
visceral pericardium
patients with pericardial effusion, an echo-free space will be seen between the epicardium and the:
A. Endocardium
B. Fibrous pericardium
C. Myocardium
D. Parietal Serous Pericardium
D. Parietal Serous Pericardium
*Note: The pericardial space lies between the parietal and
visceral pericardium
Fibrin within a pericardial effusion most likely indicates:
A. Cardiac tamponade
B. Constrictive pericarditis
C. Infective endocarditis
D. Long-standing pericardial effusion
D. Long-standing pericardial effusion
Doppler evidence of cardiac tamponade from diastolic hepatic vein flow is:
A. Expiratory decrease
B. Expiratory increase
C. Inspiratory increase
D. Inspiratory reversal
A. Expiratory decrease
The most effective treatment for cardiac tamponade is:
A. Aspirin
B. Bed rest
C. Pericadiectomy
D. Pericardiocentesis
D. Pericardiocentesis
Diastolic collapse of the right ventricle in cardiac tamponade occurs during:
A. Early diastole
B. Mid-diastole
C. Late diastole
D. Atrial systole
A. Early diastole
The swinging heart syndrome is associated with:
A. Cardiac trauma
B. Constrictive pericarditis
C. Mitral valve prolapsed
D. Pericardial effusion
D. Pericardial effusion
- Common echocardiographic/Doppler findings in systemic lupus erythematosus include:
A. Aortic dissection
B. Granular appearance of the myocardium
C. Pericarditis
D. Valvular aortic stenosis
C. Pericarditis
*Lupus increases your risk for heart disease, including coronary artery disease(CAD) such as: endocarditis, myocarditis, and pericarditis
What is Beck’s triad?
Beck’s triad is a collection of three classic clinical signs associated with cardiac tamponade.
- muffled heart sound
- hypotension/weak pulses
- elevated venous pressure i.e distension of the jugular veins
what is pulsus paradoxus?
Pulsus paradoxus refers to an exaggerated fall in a patient’s systolic blood pressure during inspiration by greater than 10 mm Hg
regional tamponade affects selected chambers, typically the right heart due to loculated effusion or blood clot post cardiac surgery.
T or F ?
F
*regional tamponade typically affect left heart
low pressure tamponade is possible, and is caused by hypovolemia or over-diuresis
T or F
T
additional treatment option for tamponade include pericardial window or pericardiectomy
T or F ?
T
A pericardiectomy is a procedure done on the sac around the heart. A surgeon cuts away this sac or a large part of this sac. This allows the heart to move freely. A fibrous sac called the pericardium surrounds the heart
A pericardial window is a procedure done on the sac around the heart. Surgically removing a small part of the sac lets doctors drain excess fluid from the sac
ventricular respiratory variation is detected when the LV diastolic dimension _____ with inspiration and the RV diastolic dimension _____ with inspiration.
decrease, increase
Pulsed-wave Doppler evidence of cardiac tamponade includes:
A. Systolic flow reversal in the pulmonary veins
B. Systolic flow reversal in the hepatic veins
C. Insipiratory increase in peak velocity across the mitral valve with an inspiratory decrease in peak velocity across the tricuspid valve
D. Inspiratory decrease in velocity across the mitral valve with an inspiratory increase in velocity across the tricuspid valve
D. Inspiratory decrease in velocity across the mitral valve with an inspiratory increase in velocity across the tricuspid valve
The single most reliable echocardiographic predictor of cardiac tamponade that can be identified by M-mode or two-dimensional imaging is diastolic collapse of the:
A. Left atrium
B. Left ventricle
C. Right atrium
D. Right ventricle
D. Right ventricle
The pulse associated with cardiac tamponade is:
A. Pulsus alternans
B. Pulsus bisferiens
C. Pulsus paradoxus
D. Pulsus parvus
C. Pulsus paradoxus
A possible auscultatory finding in a patient with pericarditis is:
A. Fixed splitting of S2
B. Mid-systolic click
C. Friction rub
D. Pericardial knock
C. Friction rub: The sounds heard are typically described as scratchy, and occur due to the inflamed pericardium rubbing against the heart
In acute pericarditis, a possible electrocardiographic finding in most if not all leads is:
A. Depressed ST segments
B. Elevated ST segments
C. Increased QRS voltage
D. Pathologic Q waves
B. Elevated ST segments
*Note:
Pericarditis vs STEMI
Classic teaching of generalised concave up ST elevation and PR elevation in aVR is not reliable for distinguishing pericarditis from ST elevation myocardial infarction (STEMI).
- Pericarditis can cause localised ST elevation but there should be no reciprocal ST depression (except in AVR and V1).
- STEMI, like pericarditis, can also cause concave up ST elevation.
- Only STEMI causes convex up or horizontal ST elevation.
- ST elevation greater in III than II strongly suggests a STEMI.
Low voltage of the QRS complex throughout the electrocardiogram is often found in:
A. Constrictive pericarditis
B. Mitral stenosis
C. Pericardial effusion
D. Pleural effusion
C. Pericardial effusion
*Note: What causes low voltage QRS complexes?
There are three general processes that contribute to low QRS voltage:
Damping of the electrical signal due to
- excess air (emphysema, COPD)
- fluid (pericardial effusion, pericardial constriction, pleural effusion)
- edema (anasarca)
- fat (obesity), or amyloid cardiomyopathy.
A possible M-mode finding for constrictive pericarditis is premature opening of the:
A. Aortic valve
B. Mitral valve
C. Pulmonic valve
D. Tricuspid valve
C. Pulmonic valve
It affects the right heart due to its lower pressure
*Note:
Constrictive pericarditis is a condition where the pericardium becomes stiffer and thicker than normal (prevents heart from expanding). That interferes with your heart’s pumping ability and can lead to severe problems like heart failure
An M-mode echocardiographic sign for constrictive pericarditis is:
A. B notch
B. Chaotic notch
C. Fibrillatory notch
D. Spanish notch
D. Spanish notch
An M-mode echocardiographic sign of constrictive pericarditis is
A. B notch sign
B. Mid-late systolic dip sign
C. Smoke-signal sign
D. Square root sign
D. Square root sign
Doppler evidence of constrictive pericarditis includes:
A. Increased peak velocity across the mitral valve with inspiration
B. Increased peak velocity across the aortic valve with inspiration
C. Increased peak velocity across the mitral valve with expiration
D. Increased peak velocity across the tricuspid valve with expiration
C. Increased peak velocity across the mitral valve with expiration
*Note: TV & MV are opposite
Normally blood flow increase during inspiration and decrease during expiration.
right heart is more affected/compressed due to its low pressure
Echocardiographic signs associated with constrictive pericarditis include all the following EXCEPT:
A. B notch
B. Inferior vena cava plethora
C. Railroad track sign
D. Septal bounce
A. B notch
*Note: The B bump on mitral valve M-mode echogram is predictive of significant elevation of left ventricular end-diastolic pressure (LVEDP)
The square root is commonly found in:
A. Aortic valve stenosis
B. Constrictive pericarditis
C. Pericardial effusion
D. Pulmonary hypertension
B. Constrictive pericarditis
*Note:
Dip & plateau pattern’ or ‘square root sign’: Early diastolic filling of the ventricles is unimpeded and abnormally rapid, but late diastolic filling is abbreviated and halts abruptly when total cardiac volume expands to the volume limit set by the stiff pericardium
Cardiac catheterization findings in constrictive pericarditis include:
A. Absent “a” wave
B. Dip-and-plateau waveform
C. Increased “v” wave
D. Increased peak-to-peak pressure gradient
B. Dip-and-plateau waveform
The most common etiology of constrictive pericarditis is:
A. Cardiac surgery
B. Idiopathic
C. Rheumatic fever
D. Tuberculosis
B. Idiopathic
Possible complications of aortic dissection include all the following EXCEPT:
A. Aortic insufficiency
B. Left ventricular inflow tract obstruction
C. Pericardial effusion/tamponade
D. Progressive enlargement
B. Left ventricular inflow tract obstruction
Likely complications of cardiac metastatic tumors include all the following EXCEPT:
A. Congestive heart failure due to myocardial infiltration.
B. Embolization of parts or pieces of the tumor.
C. Pericardial effusion/tamponade.
D. Valvular fenestration.
D. Valvular fenestration.
patients with pericardial effusion, an echo-free space will be seen between the epicardium and the:
A. Endocardium
B. Fibrous pericardium
C. Myocardium
D. Parietal Serous Pericardium
D. Parietal Serous Pericardium
A large pericardial effusion precludes the diagnosis of all the following EXCEPT:
A. Flail mitral valve
B. Mitral valve prolapse
C. Pulmonic valve prolapsed
D. Systolic anterior motion (SAM) of the mitral valve
A. Flail mitral valve
A posterior echo-free space is detected during the systolic phase only by M- mode/two-dimensional echocardiography. This is considered a:
A. Normal finding
B. Small pericardial effusion
C. Moderate pericardial effusion
D. Large pericardial effusio
A. Normal finding
