32_pericardial disease Flashcards
(24 cards)
Etiologies of Acute pericarditis include:
Idiopathic, Viral, fungal, uremic, tuberculosis, trauma, radiation, drug reaction
The 3 stages of Acute pericarditis are:
- Local vasodilation
- Increased vascular permeability
- Leukocyte followed by mononuclear infiltration
Scant infiltrate in acute pericarditis
Serous pericarditis
Bread and butter infiltrate
Serofibrinous pericarditis
Bloody effusion
Hemorrhage pericarditis
Intense exudate in acute pericarditis
Purulent (suppurative) pericarditis
Acute pericarditis is better with inhalation(T/F)
False
Acute pericarditis is relieved when standing and leaning forward (t/f)
True
Which has a sharp, stabbing angina? (MI or Pericarditis or both)
Pericarditis is associated with a sharp, stabbing chest pain while MI has more of heavy pressure-like squeezing
When do you see convex ST elevations on an ECG? (MI or Pericarditis or both)
Myocardial infarction usually has a localized convex ST elevation. Pericarditis has a wide concave ST elevation.
Therapy for acute pericarditis includes:
NSAIDS
Colchicine
Corticosteroids
Each etiology has some specific therapies i.e. uremic - dialysis, purulent - catheter drainage
When would outpatient treatment NOT be enough for acute pericarditis cases?
High fever Trauma Immunocompromised Tamponade Myocarditis
Characteristic etiology and pathophysiology of Pericardial Effusion
Any pericarditis
Non inflammatory serous effusion
Increased capillary permeability (hypothyroidism)
Increased capillary hydrostatic pressure (CHF)
Decreased plasma oncotic pressure (nephrotic syndrome)
Trauma
Pericardiocentesis is the indicated in any pericardial effusion case (t/f)
False. Pericardiocentesis is only used in hemodynamically significant cases
Characteristics of pericardial effusion on Diagnostic tests
ECG: Low voltage complexes, Electrical altercans (variation in QRS height)
CXR: if >200-250 cc = water bottle heart
Patients with pericardial effusion can have the following symptoms:
Asymptomatic
Dull heart sounds
Compression of surrounding structures (trachea, esophagus, recurrent laryngeal nerve-voice,lung)
Ewart sign - dull percussion of left scapula inferior angle
Friction rub
Cause of tamponade?
Any cause of effusion Acute hemorrhage (trauma, post MI wall rupture, cmplxn of aortic dissection)
What happens in tamponade?
Each chamber diastolic pressure increases and equals the pericardial pressure.
This leads to reduced venous return–> lower stroke volume and lower cardiac output. With failed compensatory mechanisms fail (tachycardia, systemic vasoconstriction, etc.) cardiogenic shock can develop.
Beck’s Triad (systemic hypotension, distension of JV, quiet heart)
Inspiratory fall in systolic blood pressure
Diagnosing tamponade?
Cardiac Cath is definitive hemodynamic marker of tamponade
Echo shows chamber collapse as well as inhalation variation in inflow
Is the “y descent” blunted or rapid in tamponade?
Y descent should be blunted because the increased diastolic pressure in the chambers reduces the decline in pressure of the atria
How do you distinguish restrictive cardiomyopathy from constricted pericarditis?
Biopsy- RCM will show abnormalities while constricted pericarditis will be normal
Does constricted pericarditis have blunted or rapid y descent?
Its y descent is rapid in early diastole because the ventricles are able to expand to a certain point before the scarred pericardium prevents further expansion.
What would the result of Kussmaul sign be if I have constricted pericarditis?
On inspiration, the jugular vein should be distended indicating dysfunction in the right heart. Normally inspiration decreases thoracic pressure , allowing more expansion during diastole, thus dropping JVP.
What is the only treatment for severe constricted pericarditis?
Pericardiectomy
