02.14a Surgical Diseases of the Pericardium Flashcards Preview

Cardiology > 02.14a Surgical Diseases of the Pericardium > Flashcards

Flashcards in 02.14a Surgical Diseases of the Pericardium Deck (33):
1

Normal pericardial fluid

< 15 mL

2

Acute inflammation of the parietal and visceral pericardium
Mostly idiopathic

Acute pericarditis

3

Most common bacterial cause of pericarditis in the Philippines

TB

4

Most common cause of idiopathic pericarditis

Viral infection

5

Pericardial effusion two weeks after surgery

Postpericardiotomy syndrome

6

Substernal chest pain during inspiration, worsened by supine position and relieved by leaning forward
Orthopnea, dyspnea
Pericardial friction rub
Beck's triad (hypotension, distended neck veins, muffled heart sounds)
Four stages of ECG

Acute pericarditis

7

ST segment elevation with concave upward ST segments
Noted in all leads except aVR
With reciprocal depressions in a aVR and sometimes in V1

First stage

8

ST segments return to baseline with T-wave flattening

Second stage

9

T-wave inversion without Q wave formation

Third stage

10

Characterized by ECG normalization

Fourth stage

11

Imaging to detect effusion

CXR

12

Imaging to detect and determine the degree of effusion, thickness of pericardium

2D echo

13

What do we look for on imaging?

Right ventricular collapse
Left ventricular collapse
Dilated inferior vena cava

14

Work up to establish the etiology of pericarditis

Fluid examination
Pericardial biopsy

15

Treatment for bacterial or purulent pericarditis

Antibiotics

16

Treatment for postpericadiotomy syndrome, viral, post-MI, idiopathic pericarditis

Short course NSAIDS (5-7 days)

17

Indication of surgery in patients with acute pericarditis

Tamponade (emergency), suppurative pericarditis
Need to perform biopsy
Not responding to treatment

18

Two methods to drain

Pericardiocentesis
Tube pericardiostomy

19

Smaller bore tube is preferred instead of a needle
Local anesthesia is given
Percutaneous insertion
Permits repeated drainage
Cannot obtain pericardium for biopsy
Prone to myocardial injury

Pericardiocentesis

20

Bigger bore tube, less prone to clog
Subxiphoid incision down to pericadium
Less prone to myocardial injury
More painful

Tube pericardiostomy

21

Sequelae of untreated acute pericarditis or TB pericarditis
Thickened fibrotic pericardium impedes normal diastolic filling
Male>female

Constrictive pericarditis

22

Most common cause(s) of constrictive pericarditis

Idiopathic
Post-cardiothoracic surgery

23

Constriction prevents dilatation, hence there will be a decrease in strove volume and consequent decrease in CO
The clinical manifestation is easy fatigability

Chronic constrictive pericarditis

24

Most common presenting symptoms and occurs in virtually all patients

Dyspnea

25

Elevated JVP
Sinus tachycardia
Normal or low BP
Apical impulse often impalpable
Distant or muffled heart sounds
Pericardial knock

Constrictive pericarditis

26

Sudden cessation of ventricular filling early in diastole

Pericardial knock

27

Work up for constrictive pericarditis

Blood test
Brain natriuretic peptide
CXR
EC(not reliable)
MRI
ECG (not reliable)
Cardiac catheterization

28

Imaging of choice for pericardium

High resolution CT scan
Fast MRI

29

Pathognomonic for constrictive pericarditis in cardiac catheterization

Square root sign

30

Treatment of constrictive pericarditis

Pericardiectomy

31

Preferred approach of pericardiectomy

Median sternotomy

32

Priority in pericardiectomy

To free the ventricles

33

Treatment with TB pericarditis

Prophylactic pericardiectomy