Pericardial Disease

Question 1

Name the layers of the heart from outer to inner

Answer 1

Fibrous pericardium, serous (parietal then visceral) pericardium, myocardium, endocardium

Question 2

What is a normal amount of serous fluid?

Answer 2

20-50mL

Question 3

Name 2 functions of the pericardium

Answer 3

Limits over distension, helps distribute diastolic pressure, reduces friction, infection barrier

Question 4

Increased amount of fluid within pericardial space

Answer 4

Pericardial effusion

Question 5

Fast increase in fluid accumulation

Answer 5

Tamponade

Question 6

Inflammation of the pericardial surfaces

Answer 6

Pericarditis

Question 7

What are the main signs of pericardial effusion?

Answer 7

Friction rub and muffled heart sounds

Question 8

ECG findings in pericardial effusion

Answer 8

• Low voltage ECG

- electrical alternans

Question 9

Higher intrapericardial pressures than diastolic intracardiac causes what?

Answer 9

Diastolic collapse of RT heart

Question 10

Fluid seen posterior to the descending AO

Answer 10

Pleural effusion

Question 11

When should the effusion be measured?

Answer 11

End diastole at pap level

Question 12

Tamponade impairs the cardiac chamber filling, what does this affect?

Answer 12

SV and CO

Question 13

Beck’s Triad

Answer 13

1. Low arterial BP
2. Distended neck veins (increased JVP)
3. Distant, muffled heart sounds

Question 14

Tamponade ECG findings

Answer 14

• tachycardia

- electrical alternans

Question 15

How does tamponade change the RT heart?

Answer 15

RV diastolic collapse, RA systolic and diastolic collapse, septal shifting, SVC/IVC become dilated

Question 16

RV volume on inspiration (tamponade)

Answer 16

Increased

Question 17

LV volume on inspiration (tamponade)

Answer 17

Decreased

Question 18

RV volume on expiration (tamponade)

Answer 18

Decreased

Question 19

How does inspiration affect septal shifting?

Answer 19

Inspiration: RT to LT
Expiration: normalization

Question 20

How does breathing affect MV (>25%) and TV (>50%) E velocities?

Answer 20

MV: insp: decreased, exp: increased
TV: insp: increased, exp: decreased

Question 21

Pericardium is not compliant, reducing diastolic function (grade 3, restricted)

Answer 21

Constrictive pericarditis

Question 22

Post MI pericarditis

Answer 22

Dressler’s syndrome

Question 23

Signs/symptoms of pericarditis

Answer 23

Pericardial friction rub murmur, chest pain, Kussmaul’s sign (JVP increase on inspiration)

Question 24

ECG presentation with pericarditis

Answer 24

Diffuse ST segment elevation

Question 25

Thickened, echogenic pericardium

Answer 25

Constrictive pericarditis

Question 26

Constrictive pericarditis m-mode finding

Answer 26

Railroad track appearance

Question 27

Similarities between RCM and CP (3)

Answer 27

Increased MV E/A ratio, decreased MV accel time, normal LV size and function

Question 28

Differentiate RCM and CP

Answer 28

RCM: decreased TDI overall CP: velocities change with breathing, dilated atria, increased medial e’ while lateral e’ is decreased

Question 29

Why is only the lateral e’ TDI decreased with CP?

Answer 29

Because the pericardium is stiff and constrictive from outside the heart, thus only affecting the lateral side

Question 30

Differentiate E/A waveforms with tamponade and CP

Answer 30

Tamponade: E/A is quite similar CP: E wave is significantly higher than A

Question 31

What happens during inspiration with CP?

Answer 31

Decreased LV filling, increased RV filling, IVS shifts left

Question 32

What happens during expiration with CP?

Answer 32

Increased LV filling, decreased RV filling, IVS shifts right