4.5: Pericardial disease Flashcards Preview

Clin-Med B2 > 4.5: Pericardial disease > Flashcards

Flashcards in 4.5: Pericardial disease Deck (16):
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Timeline

Acute 6 month

Especially for Constrictive pericarditis

1

Acute pericarditis- info

acute inflammation of pericardial cavity
Days to weeks
Virus- Cocksackie*, HIV, CMV, EBV, Flu
Bacteria- Pneumococcus, Staph,
TB
Fungus- Histoplasmosis, Blastomycosis
Non-infectious: Post-MI* (immediate or Dressler's), Malignancy (mesothelioma), Mets, Uremia*, Radiation, Trauma
Hypersensitivity: SLE, Sarcoidosis, Procainamide, Hydralazin, INH&

2

Acute pericarditis- sx

Chest pain- Sharp
Ask the pts to hold breath and pain remains-> Pericardial pain
""pain goes away-> Pluritic pain
Moderate raise in myocardial biomarker and ST elevation*
Pain: Lying down makes it worse, sitting up makes it better*
"" pain does not change: MI
Scratchy sound on auscultation: sound stays with holding of breath
"": sound goes away with Pluritic cause

3

EKG AP/MI

ST elevation
AP: concave on all the LEADs
MI: convex on specific LEADs

PR segment depression: AP only

4

Pericardial effusion- info

Excess fluid in pericardial cavity >200
Cause: Acute pericarditis
Amount and Rate is IMP
If its slow-> can accomodate up to 2L
If its fast-> even 200mL can cause it

5

Pericardial effusion- sx

Compression on local structure

6

Pericardial effusion- exam

Heart sound- quieter, muffled
Scratchy sound might go away
Ewart's sign: area of dullness lower medial side of left scapula

7

Pericardial effusion- dx

EKG (QRS complex: small. QRS alternants [big and small-> since the heart is floating in fluid and oscillates back and forth])
Ecocardiogram
Chest X-ray (enlarged heart shadow)*
Pericardial centesis: from xiphisternum up toward collar bone

8

Pericardial effusion- tx

symptomatic
Pericardial centesis
Recurrent: Pericardiotomy

9

Cardiac tamponade- info

Medical emergency
Outside pressure takes over inside pressure of heart due to too much blood or blood is filling up too fast in pericardial cavity.
The same pressure in all 4 chambers during diastole**
With Uremia, post-MI lateral free wall rupture, Malignancy

10

Pericardial tamponade- exam

Dyspnea, syncope
JVD: dilated
Pulsus paradoxis: drop in systolic BP during inspiration >10mmHg* (LV is compressed even more by external pressure)
Normal on inspiration- more blood in the right side of the heart, RV compress LV-> slight dip in systemic BP <10mmHg*

11

Cardiac tamponade- Atrial pressure

NO y wave (the filling of ventricle by pressure difference of A/V, since there is no pressure difference in all 4 chambers during diastole

12

Cardiac tamponade- tx

Immediate pericardial centesis

13

Constrictive pericarditis- info

Subacute or chronic
Concrete layer/ calcification around the heart

14

Constrictive pericarditis- sx

Back up of blood since heart cannot be filled-> distention
Kussumaul sign: on inspiration, JVD increases (normal: decrease)
Pericardial knock: when heart expands on diastole, makes a knocking sound
Fredrick's sign/ Square root sign: sudden drop of intracardial pressure during filling until the heart hits the wall

15

Constrictive pericarditis- tx

Pericardial stripping