Block I: myocardial/pericardial disease

Question 1

most cases of myocarditis are []

Answer 1

infectious
-viral bacterial, rickettsial, spirochetal, fungal, parasitic
-

Question 2

[] is the most common cause myocarditis

Answer 2

viral, exp. coxackie

Question 3

how might myocarditis patients present?

Answer 3

with heart failure without any preceding symptom

pleural or pericardial chest pain, often sharp in nature

Question 4

heart failure without preceding symptoms may indicate

Answer 4

myocarditis

Question 5

when might myocarditis occur in patients?

Answer 5

several days to a few weeks after the onset of an acute febrile illness or respiratory tract infection (although can be longer)

Question 6

PE exam reveals

1. tachycardia
2. gallop rhythm
3. heart failure
4. conduction defect

what do you suspect?

Answer 6

myocarditis

Question 7

what might be revels on PE in a myocarditis pt.

Answer 7

1. tachycardia
2. gallop rhythm
3. heart failure
4. conduction defect

Question 8

EKG in a myocarditis patient may reveal []

Answer 8

NOS ST-T changes and conduction disturbance

Question 9

what may appear on a CXR of a myocarditis patient?

Answer 9

cardiomegaly, nos but likely present

Question 10

[] provides the most convenient way of evaluating cardiac function

Answer 10

echo

-can be used to exclude other processes and view any dilation of ventricles

Question 11

how are you treating a myocarditis patient?

Answer 11

1. specific ABX when infecting agent ID

2. until agent det. treatment directed toward symptoms caused by heart failure and dysrhythmias

Question 12

what is the prognosis of myocarditis

Answer 12

1. most resolve spontaneously

2. others cardiac function deterioates progressively and may lead to dilated cardiomyopathy

Question 13

dilated cardiomyopathy may represnt []

Answer 13

end stage viral myocarditis

Question 14

why is rapid fluid expansion of 30 mL more detrimental than a slow fluid expansion of 1L (in terms if pericardial fluid)

Answer 14

pericardium cannot stretch rapidly, if fluid accumulates more quickly than it will affect hearts ability to pump

pericardium can stretch slowly over a period of time to acomodate slow increase in fluid

Question 15

what is a major complication of rapid effusion of pericardium

Answer 15

tamponade

Question 16

how much fluid is normally in the pericardium?

Answer 16

20-50mL

Question 17

how much pericardial fluid can cause significant disturbances?

Answer 17

60 mL

(20-50mL) normally

Question 18

[] results from inflammation of pericardium with subsequent accumulation of pericardial fluid (effusion)

Answer 18

acute pericarditis

Question 19

what causes pericarditis?

Answer 19

1. infectious

2. non- infectious (Ct disease, drug related, malignancy)

Question 20

the cardinal symptom of pericarditis is []

Answer 20

chest pain

Question 21

chest pain described as retrosternal, sharp, pleuritic pain is usually []

Answer 21

pericarditis

Question 22

pain that frequently radiates to the left trapezius ridge, and is aggravated by swallowing, coughing, and lying flat is usually

Answer 22

pericarditis

Question 23

pericardial pain may be alleviated by []

Answer 23

sitting upright and taking shallow breath

make sure its alleviated and not achieved

Question 24

what is the most common cause pericarditis

Answer 24

viral

males under age 50 most commonly affected

Question 25

pericardial involvement typically follows []

Answer 25

URI

Question 26

how will you treat a pericarditis pt?

Answer 26

1. sympotmatic - ASA - ibuprofen - indomethiacin - corticosteroids may be benificial in patients who do not respond to anti-inflammatory medication

Question 27

[] anticoagulant is considered safe for pts. who need anticoagulation that may also need surgeyr

Answer 27

heparin

Question 28

what patients should never be taken off of anticoagulants? even if surgery is sure?

Answer 28

patients with artificial valves

Question 29

what is a major early complication of pericarditis

Answer 29

tamponade ( < 5%)

Question 30

pericardial resection if indicated in []

Answer 30

constrictive pericarditis

Question 31

once purulent pericarditis is dx, what is the next step?

Answer 31

1. timely drainage of pericardial fluid & culture | 2. Vanc + ceftriaxone or cefepime until culture comes back

Question 32

pericarditis may occur 2-5 days after [] and is due to []

Answer 32

MI, transmural myocardial necrosis

Question 33

[] may be heard in a post MI pericarditis pt.

Answer 33

rub

Question 34

[] change on EKG of post MI pericarditis pt

Answer 34

replarization changes, may be confused with ischemia

Question 35

what can provide symptom releif to post MI pericarditis pt?

Answer 35

aspirin or NSAID

Question 36

[] occurs 1-12 weeks post MI or open heart surgery and is believed to be an autoimmune d/o that presents with pain, fever, malaise, leukocytosis

Answer 36

dressler's syndrome

Question 37

rapid collection of [] mL in pericardial fluid can cause severe hemodynamic compromise

Answer 37

100-200

Question 38

enlarged cardiac silhouette with globular configuration may suggest

Answer 38

effusion

Question 39

[] are beat to beat changes in one or more portions of electrocardiogram and is pathognomonic in pericardial effusion

Answer 39

electrical alternans

Question 40

[] is the primary method for demonstrating pericardial effusion

Answer 40

echocardiogram

Question 41

[] discriminates effusion from heart failure

Answer 41

echocardiogram

Question 42

[] is a possible precursor to tamponade

Answer 42

cardiac effusion

Question 43

[] can lead to thickened, fibrotic, adherent pericardium that restricts diastolic filling and produced chronically elevates venous pressure

Answer 43

constrictive pericarditis

Question 44

constrictive pericarditis most commonly occurs after []

Answer 44

1. radiation 2. cardiac surgery 3. viral pericarditis * histoplasmosis uncomoon

Question 45

[] is a paradoxical increase in JVD and pressure during inspiration

Answer 45

Kussmaul's sign

Question 46

describe Kussmaul's sign, when does this occur?

Answer 46

1. paradoxical increase in JVD and pressure during inspiration 2. occurs in constrictive pericarditis and restrictive cardiomyopathy

Question 47

an echocardiogram demonstrating thick pericardium and small chamber indicates

Answer 47

constrictive pericarditis

Question 48

how to treat constrictive pericarditis?

Answer 48

gentle diuresis and surgical removal of pericardium in symptomatic patients

Question 49

what d/o req. gentle diuresis?

Answer 49

constrictive pericarditis

Question 50

what is a rare but life threatening complication of pericardial effusion?

Answer 50

tamponade

Question 51

elevates intrapericardilal pressure of > 15mmHG that restricts venous reurn and ventricular filling is []

Answer 51

tamponade

Question 52

what is the characteristic of tamponde

Answer 52

elevated intrapericardial pressure of > 15 mmHG that restricts venous return and ventricular filling

Question 53

stroke volume and pulse pressure [] in tamponade

Answer 53

fall

Question 54

heart rate and venous pressure [] in tamponade

Answer 54

rise

Question 55

why might venous pressure rise in tamponade?

Answer 55

heart gets backs up in providing systemic circulatoin, veins cant deliver to backed up uheart

Question 56

1. tachycardia 2. tachypnea 3. narrow pulse pressure 4. preseved systolic P characteristics of []

Answer 56

tamponade

Question 57

what is beck's triad?

Answer 57

1. distended jugular veins 2. muffled heart tones 3. hypotension with narrowing pulse pressure *indicative of tamponade

Question 58

what is pulse pressure?

Answer 58

Systolic P - diastolic P =pulse pressure small diff of the two may indicate tamponade

Question 59

what is > 10 mmHG decline in systolic P during inspiration as compared to expiration

Answer 59

pulses paradoxicus

Question 60

what is pulsis paradoxicus and what might it reveal

Answer 60

> 10 mmHG decline in systolic pressure during inspiration as compared to expiration result of further impairment of ventricular fluid may lead to tamponade dx,

Question 61

puslses paradoxicus is a classic finding in []

Answer 61

tamponade

Question 62

hemodynamic deterioation during tamponade requires emergent []

Answer 62

drainage of pericardial fluid (pericardiocentesis) or throracic surgery (pericardial window)

Question 63

temporizing measures can be used to treat tamponade by []

Answer 63

increased pre-load, i.e. amount of blood pouring into ventricle

Question 64

what are some temporizing agents that can be used in tamponade?

Answer 64

inotropic agents dopamine, NE, Epi to expand volume

Question 65

what is a scratchy, triphasic, best heard along left sternal border during expiration when pt leands forward

Answer 65

rub

Question 66

when is a rub best heard?

Answer 66

1. when patient leads forward and holds expiration best heard over L sternal border

Question 67

what is a fundamental sign of pericarditis

Answer 67

pericardial friction rub

Question 68

distant/mufled heart sounds suggest []

Answer 68

pericardial effusion

Question 69

a chest x ray is usually [] in acute pericarditis

Answer 69

normal

Question 70

water bottle shaped heart on xray indicates []

Answer 70

chronic pericarditis, effusion of > 200 mL

Question 71

what are EKG changes assoc. with acute pericarditis

Answer 71

1. diffuse ST segment elevation with 2. upward concavity 3. absence of recpircoal ST seg depression in ALL LEADS

Question 72

pericarditis may have depression [] in EKG

Answer 72

PR interval

Question 73

low voltage QRS or electrical alternans may occur in []

Answer 73

effusion

Question 74

pericarditis may show ST elevation in [] leads

Answer 74

all

Question 75

MI may show elevation in [] leads

Answer 75

two