Pericardial Diseases (complete) Flashcards Preview

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Flashcards in Pericardial Diseases (complete) Deck (23)
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1
Q

What are the layers of the pericardium?

A

Outside to inside:

  • Fibrous layer
  • Parietal pericardium
  • Pericardial cavity
  • Visceral pericardium
2
Q

What are the common causes of acute pericarditis?

A
  • Viral illness
  • CT or autoimmune diseases
  • Uremia
  • Metastatic tumors
3
Q

What are the common presentations of acute pericarditis?

A
  • Sudden onset chest pain (SEVERE) => sharp
  • Chest varies w/ position and breathing => this is NOT the case w/ MI

MI pain is also pressurized than sharp

4
Q

How do you diagnose acute pericarditis?

A
  • Chest pain varies w/ position, breathing
  • Pericardial rub on cardiac exam (comes and goes)
  • EKG => diffuse ST elevation
  • ECHO => pericardial fluid

There is a response to anti-inflammatory agents (NSAIDs are preferred, also aspirin and colchicine)

5
Q

Where do you see diffuse ST elevation on an EKG?

A

It’s everywhere! at every lead!

  • NOT an MI => you’d be dead by now
  • think pericarditis
6
Q

What are the common causes of pericardial effusion?

A
  • Viral/acute idiopathic pericarditis
  • Metastatic malignancy
  • Uremia
  • Autoimmune disease
  • Hypothyroidism

Now there’s fluid accumulation

7
Q

How is pericardial effusion best diagnosed?

A

ECHO

8
Q

Describe small pericardial effusions

A
  • W/o high intrapericardial pressure may be asymptomatic

- happens w/ acute trauma (gun shots, stabs)

9
Q

Describe large pericardial effusions

A
  • Has high intrapericardial pressures

- Causes cardiac tamponade

10
Q

What is cardiac tamponade?

A
  • Heart is unable to fill appropriately
  • Myocardial compression impairs diastolic filling
  • Causes by rapidly accumulates moderate sized or large effusions
11
Q

Describe the clinical presentation of pericardial effusion with tamponade

A
  • Decreased RV diastolic filling during inspiration
  • Distended neck veins
  • Inspiratory decrease in arterial pressure (15-20 mm drop in systolic pressure) => paradoxical pulse
12
Q

Why does the BP drop with pericardial tamponade?

A
  • Free wall of RV is unable to expand with each inspiration (b/c of effusion)
  • In order to accomodate for increase in blood flow => it pushes septum => LV has a decreased SV
13
Q

What medication do you not want to give to patients with pericardial tamponade?

A

Diuretics!

  • In fact you may want to give them fluid
  • A stab wound will already decrease the BP b/c of fluid loss => not enough blood being pumped
  • You want to increase BP to ^ blood to the rest of the body
  • Diuretics would cause the pt to go into shock
14
Q

What findings do you expect to see and not see in a chest Xray?

A
  • Enlarged heart

- Non-congested lungs (you would see this only in MI w/ lungs vessels accommodating the heart)

15
Q

Describe the findings in an ECHO of a pt w/ pericardial tamponade

A
  • Collapse of RA and RV at end-diastole

- Dilation of IVC (does not collapse during inspiration)

16
Q

What do you expect to see on an EKG of a pt/ with pericardial tamponade?

A
  • Low QRS voltage
  • Also sinus tachycardia
  • Electrical alternans w/ sinus tachy (every other beat the QRS voltage decreases)
17
Q

Describe constrictive pericarditis

A
  • Scarring or loss of elasticity of pericardium

- Impaired diastolic filling w/ NORMAL systolic function

18
Q

What are the causes of constructive pericarditis?

A
  • Idiopathic
  • After cardiac surgery
  • Radiation
  • Infectious (TB is common)
19
Q

Describe the clinical presentation of a pt w/ constructive pericarditis

A
  • Elevated JV pressure
  • Tachy (very little filling of heart chambers => decreased SV => ^ HR to maintain CO)
  • Often w/ hepatomegaly, edema, ascites

Looks like they have chronic liver disease

20
Q

How do you diagnose constrictive pericarditis?

A
  • Transthoracic echo may see pericardial thickening (maybe calcified)
  • MRI or CT can see pericardial thickening
  • Cardiac cath shows an early dip and plateau pattern (square root sign) during diastole
  • Cardiac cath shows equalization of diastolic pressures in RV and LV
21
Q

Describe the “clinical points” of constrictive pericarditis

A
  • Chronic disease => takes lots of time to develop
  • Cardiac silhouette normal sized but encased by thickened pericardium
  • Lungs not congested
  • Mistaken for liver disease b/c of prolonged high venous pressure => hepatic enlargement and ascites
22
Q

What is the treatment of constrictive pericarditis?

A

Surgical stripping of pericardium

23
Q

What is Kussmaul’s sign?

A

rise in JVP on inspiration