Pericarditis

Question 1

Define cardiac tamponade

Answer 1

XS pericardial fluid compresses heart

Decr CO

Question 2

Define constrictive pericarditis

Answer 2

chronic process when pericardium thickens and compresses heart

decr CO

Question 3

Common causes of acute pericarditis

Answer 3

1) viral illness
2) Connective tissue/autoimmune diseases
3) uremia
4) metastatic tumor

Question 4

most common presentation of acute pericarditis

Answer 4

1) sudden onset severe chest pain

2) varies with position and breathing

Question 5

diagnosis of acute pericarditis

Answer 5

1) chest pain vary with position and breathing

2) pericardial rub on exam

Question 6

ekg of acute pericarditis

Answer 6

diffuse ST elevation

Question 7

echo of acute pericarditis

Answer 7

pericardial fluid

Question 8

treatment of acute pericarditis

Answer 8

NSAIDS
ibuprofen 300-800 mg PO Q6-8 hr

or
Aspirin 325-650 mg

or
Colchicine

Question 9

common causes of pericardial effusion

Answer 9

1) viral or acute idiotpathic pericardiitis
2) metastatic malignancy
3) uremia
4) autoimmune disease
5) hypothyroidism
6) Trauma

Question 10

how to dx pericardial effusion

Answer 10

xray or echo

Question 11

small effusions WITHOUT INTRAPERICARDIAL PRESSURE may be

Answer 11

asymptomatic

Question 12

with LARGE EFFUSIONS + HIGH INTRAPERICARDIAL PRESSURE, what happens?

Answer 12

cardiac tamponade + myocardial compression

–> IMPAIR DIASTOLIC FILLING

Question 13

KEY OF PERICARDIAL TAMPONADE

Answer 13

1) HIGH INTRAPERICARDIAL PRESSURE
2) IMPAIRS FILLING OF RIGHT HEART
3) DECR RV OUTPUT
4) LUNGS NOT CONGESTED = clear unlike HF

Question 14

COMPARE PERICARDIAL TAMPONADE with dilated cardiomyopathy

Answer 14

in dilated cardiomyopathy there is pulmonary venous congestion in lungs

Question 15

define paradoxical pulse in pericardial tamponade

Answer 15

–> inspiration increases filling of RV causing septum to impinge on LV lowering stroke volume (usually have enough space for RV expansion)

> 10 mmHg fall in systolic Pressure during inspiration

Question 16

electrical alternans on ECG means

Answer 16

movement of heart back and forth in fluid (QRS amplitude alternates in height)

–> pericardial tamponade

Question 17

cause of constrictive pericarditis

Answer 17

scarring + loss of elasticity of pericardium

Question 18

common causes of constrictive pericarditis

Answer 18

1) idiopathic
2) after cardiac surgery
3) radiation
4) infectious (TB)

Question 19

pathophys of constrictive pericarditis

Answer 19

impaired diastolic filling with normal systolic function

Question 20

presentation of constrictive pericarditis

Answer 20

1) elev JVP (disappear into jaw)
2) hepatomegaly
3) edema
4) ascites
5) tachycardia

Question 21

how to diagnose constrictive pericarditis

Answer 21

echo and xray

Question 22

what does constrictive pericarditis look like on xray

Answer 22

thickened or calcified pericardium

Question 23

clinical signs of constrictive pericarditis!!

Answer 23

1) takes long time to develop
2) cardiac silhouette normal but covered by thick pericardium
3) lung NOT CONGESTED because constriction impairs filling of LV
4) mistaken for liver disease due to high venous pressure

Question 24

treatment of constrictive pericarditis

Answer 24

surgical stripping of pericardium

Question 25

catheterization in constrictive pericarditis

Answer 25

1) rapid filling in early diastole but no further filling of diastole
2) diastolic filling pressures equalized btwn LV and RV (normally RV < LV)

Question 26

how to separate pericardial pain from other causes

Answer 26

1) PLEURITIC - activ by deep breathing + positional change

pain from acute PE can be pleuritic but lacks ECG change of pericarditis

pneumonia may have pleuritic but rales in lung + sputum

Question 27

separate tamponade from CHF

major impairment

Answer 27

tamponade = problem with right heart filling during diastole

CHF = no impaired right heart filling, decr myocardial fxn –> pulm + systemic congestion

Question 28

separate tamponade from CHF

common features

Answer 28

1) distended neck vein
2) tachy
3) hypotension
4) decr RV disatolic fillingw with inspiration ara
4) large heart on CXR

Question 29

separate tamponade from CHF

physical exam + xray

Answer 29

tamonade = lung clear on exam + xray

CHF = lung congested with rales on exam and redistrib blood flow to upper lobes

Question 30

separate tamponade from CHF

pulsus paradoxicus

Answer 30

mostly in tamponade

Question 31

separate tamponade from CHF

heart sounds

Answer 31

tamponade = distant sounds, apex may not be palpable

CHF = normal heart sounds + S3 + lifts

Question 32

separate tamponade from CHF

ECG

Answer 32

tamponade = large pericardial effusion, RA collapse, lack of decr in IVC diameter

CHF = poor contractile + dilation of ventricles

Question 33

separate tamponade from constrictive pericarditis

common

Answer 33

1) decr diastolic function
2) good systolic fxn
3) JVD
4) tachy + hypotension

Question 34

separate tamponade from constrictive pericarditis

CXR

Answer 34

tamponade = large cardiac silhouette

constrictive = normal silhouette + pericardial calcif

Question 35

separate tamponade from constrictive pericarditis

pulsus paradoxicus

Answer 35

tamponade = present

constriction = uncommon

Question 36

separate tamponade from constrictive pericarditis

progression

Answer 36

tamponade = quick onset

constrictive = slow + hepatic congestion, ascites, pedal edema

Question 37

separate tamponade from constrictive pericarditis

echo

Answer 37

tamponade = pericardial fluid + RA collapse with inspiration

constriction = none of those

Question 38

fluid btwn which 2 layers

Answer 38

visceral pericardium and parietal pericardium

Question 39

ecg in cardiac tamponade

Answer 39

1) low voltage with sinus tachy –> fluid around heart so not conduct
2) electrical alternans

Question 40

kussmaul sign

Answer 40

1) inspiration, decr intrathoracic pressure

2) incr in blood to right side but blood can’t get into RA –> bulge in venous pressure