Lec 8 Disease of Pericardium

Question 1

What is normal morphology/function of pericardium?

Answer 1

• 1 to 2 mm thick
• inner serous visceral + parietal; outer fibrous
• no vital function
• anchors, lubricates, protects

Question 2

What are possible etiologies of acute pericarditis?

Answer 2

• viral: coxsackie, echovirus
• bacterial
• TB
• post MI
• hypothyroidism
• SLE

Question 3

What is post MI acute pericarditis?

Answer 3

• related to infarct size

early: inflammatory etiology
late: immune mediated wks to mos later = known as post cardiac injury syndrome or dressler’s syndrome

Question 4

What are manifestations of acute pericarditis?

Answer 4

• sharp chest pain, retrosternal, made worse by inspiration [pleuritic], relieved by sitting up/leaning forward [postural]
• pericardial friction rub best heard in expiration = highly specific

Question 5

What happens to EKG in acute pericarditis?

Answer 5

• ST segment elevation and/or PR depression

Question 6

What is treatment for acute pericarditis?

Answer 6

• bed rest
• NSAIDS = aspirin
• colchicine = treat or prevent recurrent pericarditis
• steroids if recurrent/relapsing

Question 7

What are potential complications of acute pericarditis?

Answer 7

• constriction: scarring –> lost elasticity of pericardial sac
• tamponade: accumulation pericardial fluid
• recurrent pericarditis: seen with idiopathic pericarditis

Question 8

What causes fibrinous acute pericarditis? major finding?

Answer 8

• Dressler syndrome [post MI]
• uremia
• radiation

finding: loud friction rub

Question 9

What causes serious acute pericarditis?

Answer 9

• viral pericarditis; non-infectious inflammatory disease [rheumatoid arthritis, SLE]

Question 10

What causes suppurative/purulent acte pericarditis?

Answer 10

usually bacterial infection [pneumococcus, strep]

Question 11

What causes pericardial effusion?

Answer 11

• acute pericarditis
• hypothyroidism [capillary permeability]
• CHF
• cirrhosis/nephrotic syndrome

Question 12

What are some etiologies of pericardial effusion?

Answer 12

• viral/bacterial/TB

- malignancy, uremia, radiation, trauam, dissecting aneuryism, HIV

Question 13

What are signs/symptoms of pericardial effusion?

Answer 13

• can have no symptoms
• dsypnea, cough, dysphagia, hoarsness, ab fullness
• muffled heart sounds
• decreased intensity of heart sounds
• Ewart’s sign = dullness to percussion of the left lung over the angle of the scapula

Question 14

What is cardiac tamponade?

Answer 14

compression of heart by fluid causing hypotension, tachycardia, decrease CO, limited filling of heart

occurs when intrapericardial pressure exceeds intracardiac pressure

diastolic pressure within each chamber is elevated and equal to the intrapericardial pressure

Question 15

What are most common causes of cardiac tamponade?

Answer 15

neoplasm
postviral
uremic pericarditis

Question 16

When is relationship cardiac tamponade and how fast effusion develops?

Answer 16

slowly developing effusion = pericardium stretches, tamponade occurs with larger volume

rapid developing = pericardium has no time to stretch, tamponade with smaller volume

Question 17

What are findings of cardiac tamponade?

Answer 17

beck triad = hypotension, distended neck veins [high JVP], distant heart sounds

• dyspnea, orthopnea, fatigue
• tachycardia
• low voltage QRS and eletrical alternans = swinging movement of heart
• signs of right heart failure

Question 18

What should you think: pt with pericarditis develops systemic vascular congestion and decrease CO?

Answer 18

think cardiac tamponade!

Question 19

What is beck’s triad for cardiac tamponade?

Answer 19

• decrease arterial pressure [hypotension]
• increase venous pressure [distended neck veins]
• distant heart sounds

Question 20

What is pulsus paradoxus? What does it indicated?

Answer 20

decrease amplitude of sytolic blood pressure by ? 10 mmHg during inspiration

seen in: cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup

Question 21

What is treatment of cardiac tamponade?

Answer 21

pericardiocentesis

Question 22

What major causes constrictive pericarditis?

Answer 22

used to be TB, now idiopathic

Question 23

What happens in constrictive pericarditis?

Answer 23

rigid scarred pericardium around heart
inhibits normal filling of cardiac chambers

stops mid-filling b/c can’t fill anymore –> get high systemic venous pressure and signs of right sided heart failure –> low SV/CO –> lower BP

Question 24

What are signs of constrictive pericarditis on histology?

Answer 24

chronic = fibrotic
subacute = inflammatory

Question 25

What are symptoms of constrictive pericarditis?

Answer 25

extertional dyspnea, R> L CHF
peripheral edema
weight gain
tachycardia, hypotension, high JVP, kussmauls sign

Question 26

What are causes of constrictive pericarditis?

Answer 26

heart surgery, radiation, idiopathic, connective tissue disease, infection, malignancy

Question 27

What is kussmaul sign?

Answer 27

inspiration causes increased venous return –> accumulates in intrathoracic system veins –> jugular veins more distended during inspiration

normal: inspiration causes decrease in jugular venous pressure

Question 28

What does kussmaul sign signify?

Answer 28

constricitve paricarditis

Question 29

What do you see on EKG with constrictive pericarditis?

Answer 29

atrial fibrillation in chronic cases

Question 30

What do you see on chest xray with constrictive pericarditis?

Answer 30

pericardial calcification

Question 31

What do you see on echo with constrictive pericarditis?

Answer 31

may show thickened pericardium

Question 32

What is treatment for constrictive pericarditis?

Answer 32

pericardiectomy