Pericardial Disease

Question 1

How much serous fluid is usually between the heart and the pericardium

Answer 1

15-50 ml

Question 2

How much fluid can the pericardium take on without creating too much of a change in the pericardial pressure?

Answer 2

200 ml

Question 3

Common causes of pericardial effusion

Answer 3

viral myopericarditis, metastatic malignancy, autoimmune disease and renal failure

Question 4

Symptoms of pericardial effusion

Answer 4

dull constant left chest ache, dyspnea, potential hiccups associated with phrenic nerve irritation, dysphagia (esophageal compression)

Question 5

Whats wrong with a chest x-ray when diagnosing pericardial effusion

Answer 5

You can’t tell the effusion from cardiomegally. Better to get an echo

Question 6

What might an electrocardiogram show with pericardial effusion?

Answer 6

decreased voltage of the QRS (a pattern of alternating large and small QRS complexes (electrical alternans)

Question 7

Hemopericardium

Answer 7

can be caused by cardiac rupture after transmural myocardial infarction (typically around day 5). Frequently happens fast, thats why its fatal

Question 8

Cardiac Tamponade

Answer 8

a condition of pericardial effusion or blood compressing the heart enough to impair filling and function

Question 9

Sudden cardiac tamponade leads to

Answer 9

pts having altered mental status, dyspnea, potentially cv collapse and cardiac arrest

Question 10

Slow Cardiac tamponade signs and symptoms

Answer 10

fatigue, leg edema, dyspnea on exertion

Question 11

What are the three signs of cardiac tamponade (Beck’s Triad)

Answer 11

JVD, Muffled Heart SOunds, Hypotension

Question 12

What will echo show

Answer 12

Diastolic collapse of right atrium and right ventricle

Question 13

Pathologic pericarditis types

Answer 13

Serous, fibrinous, purulent, hemorrhagic, constrictive

Question 14

Serous pericarditis

Answer 14

pericardium has a smooth surface and scant neutrophils, lymphocytes, and macrophages

Question 15

Finbrinous pericarditis

Answer 15

Surface is dry, roughened, and shaggy, with more neutrophils, lymphocytes, and macrophages

Question 16

Purulent Pericarditis

Answer 16

Red granular surface coated with pus, lots of subsurface neutrophils

Question 17

Hemorrhagic pericarditis is just….

Answer 17

serous, fibrinous, or purulent pericarditis plus hemorrhage

Question 18

Acute pericarditis

Answer 18

Most common disease of the pericardium…presumed to be viral but rarely proven to be viral, so purists call it idiopathic

Question 19

Most common viruses associated pericarditis

Answer 19

Coxsackie and echovirus

Question 20

Most common symptoms of pericarditis?

Answer 20

Sharp, pleuritic chest pain, improved by sitting up and leaning forward

Question 21

Signs of pericarditis

Answer 21

Pericardial friction rub. ST segment Elevation

Question 22

Primary pericarditis common or uncommon>

Answer 22

uncommon (usually due to a viral infection if it does occur). Usually it is secondary to MI.

Question 23

acute viral pericarditis exudate is usually fibrinous imparting an irregular , shaggy, appearance to teh pericardial surface.

Answer 23

truth

Question 24

Bacterial pericarditis usually has what appearance

Answer 24

pus filled

Question 25

Autoimmune pericarditis occurs in 30% of pts with lupus and is generally what types

Answer 25

serous or fibrinous

Question 26

Uremia causes pericarditis why>

Answer 26

Because some substance that is normally excreted by the kidneys is irritating to the pericardium

Question 27

Hemorrhagic pericarditis is generally assoicated with what?

Answer 27

metastatic carcinoma, leukemia, , tuberculosis,

Question 28

Constrictive pericarditis

Answer 28

entrapment of the heart is a dense fiber/ scar which prevents cardiac hypertrophy or dilation

Question 29

Myopericarditis

Answer 29

simultaneous inflammation of myocardium and pericardium, commonly attributed to viral infection

Question 30

pulsus paradoxus generally associated with what?

Answer 30

cardiac tamponade or asthma