21 - Pericardial Dz Flashcards
4 basic fns of pericardium
limit acute dilation during acute hypervolemic states
maintaine optimal PV relationships in cardiac chambers
favor ejection of similar stroke volumes for both ventricles
shield heart against infections from contiguous structures
cardiac tamponade
impairment of diastolic filling of heart caused by inc in intrapericardial pressure due to abrupt pericardial fluid accumulation
causes of cardiac tamponade
trauma rupture of heart or great vessels pericarditis malignancies anticoags
MCC pericardial dz
malignancies
3 signs of cardiac tamponade
equalized chamber pressures
steep x descent (rapid early atrial filling)
pulsus paradoxus (exaggerated inspiratory filling of RV)
pulsus paradoxus
exaggerated inspiratory drop in SBP >10 mmHg
(not paradoxical)
hallmark of cardiac tamponade
how can you detect pericardial effusion?
CXR, echo
clinical triad of cardiac tamponade
inc JVP
low BP
quiet heart
etiology of constrictive pericarditis
idiopathic (most common) infectious irradiation connective tissue dz (rheumatoid arthritis, SLE) post hemopericardium uremia neoplastic
PE findings in constrictive pericarditis
CHF signs - dependent edema, hepatomegaly, ascites, JVD JV pressure elevated w/ steep y descent small quiet heart and clear lungs Kussmaul sign pericardial knock extra sound
kussmaul’s sign
neck veins more prominent during inspiration - “stubborn” jugular vein
seen in constrictive pericarditis
pericardial knock
ealy diastolic extra sound
sounds like an S3 (but isnt one)
results from abrupt cessation or slowing of ventricular filling due to stiff pericardium
dip and plateau RV pressure assoc w/
constrictive pericarditis
clinical triad for constrictive pericarditis
CHF sx
prominent Y descent in neck veins
small quiet heart
tx of pericardial dz
tamponade - pericardiocentesis
constrictive - pericardiectomy
