Cardiac Pathologies: -itises - Lecture #2 Flashcards by Jawric Cuyzon

What are the presenting sx in the patient hx?

onset of progression, nature, any aggravating or alleviating sx
chest pain with SOB and heart palpatations
Overall fatigue
syncope and dizziness
hx of smoking, alcohol and drug use
risk factors for CVD

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What are we looking for in the chart review?

diagnostic tests, imaging, procedures
any lab values and ABGs (arterial blood gas)
PMH/PSH and hospital course
any medications and diet
social hx, any cognitive and language ability and learning ability

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What should we be checking for examinations?

General observation: patient posture, how they breath and are they able to cough
skin = blueish, are they pale, somewhat washed out and sweaty (within limits)
pulses = are they off and how do they feel
vitals
heart and lung sounds
Chest wall motion and palpation
How is the rhythm (EKG)
Checking circulation and lympathic system (which includes the peripheral vascular system)

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What is pericarditis?

Inflammation of the pericardium (usually serous pericardium) or the pericardial fluid

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What is the most common causes of pericarditis?

viral infection
- other infection: bacterial, uremia, acute MI and pericardiotomy (has to do with cardiac surgery, TB, malignancy, drug and toxin induced)

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What are the other causes of pericarditis?

Systemic disease:
- autoimmune disorders (CT diseases)
- other inflammatory disorders (eg. sarcoidosis, amyloidosis, inflammatory bowel disease)
- drug toxicity
- chest irradiation
- hypothyroidism

Trauma

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Can pericarditis have sx?

May not present with any signs or sx

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What are the sx of acute pericarditis?

retrosternal chest pain that is sharp, stabbing right behind the breastbone on the left side of the chest (or can be dull and achy)
that pain can go to the back and left middle trap area
dyspnea (with no exercise), cough and hoarseness
general fatigue and fever

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What makes acute pericarditis worse?

gets worse by coughing
deep breathing
supine

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What makes acute pericarditis better?

helps when they sit up or lean forward

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What is the EKG results of acute pericarditis?

abnormalities not common
- if there is = it will diffuse ST segment elevation

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What populations do we see acute pericarditis?

seen in young and healthy because of a viral and idiopathic causes
- COVID 19 vaccinations

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What do we hear when we’re auscultating?

Theres usually a friction rub because of the inflammed pericardial layers rubbing against one another

Usually best heard when the patient is leaning forward during an exhale

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What do the labs say for acute pericarditis?

The labs will show acute inflammation
- increased levels of WBCs
- erythricyte sedimentation rate (sed rate)
- C-reactive protein
- May have mild elevated troponins indicating that myocardium is inflammed (will not continue to increase so might be MI)

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how do we evaluate for acute pericardial effusion?

echocardiography

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What the usualy timeline for acute pericarditis?

A self-limited disease around 1-3 weeks

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How is acute pericarditis managed?

through rest, pain relief usually via anti-inflammatory drugs or sometimes steroids

Since it can be highly infectious or bacterial
- high dose of antibiotics through IV
- or pericardial drainage

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What is constrictive pericarditis?

its a form of chronic pericarditis or pericardial effusion which ends up with thickening and scarring of the pericardium

What are the sx of constrictive pericarditis?

dyspnea and fatigue because of decreased cardiac output
LE and abdominal swelling
Dizziness or syncope
Vague retrosternal chest pain
Jugular venous distention

How much fluid is in the pericardial effusion?

15-50 mL of fluid

What is the medical workup for constritive pericarditis?

chest x-ray
echo
CT
cardiac catherization

What is pericardial effusion?

accumulation of fluid within that pericardial space

What can lead to pericardial effusion?

pericarditis or other pathologies or even trauma

What is the mechanism of the pericardium which can be affected by effusion?

Since the pericardium is already stiff - it doesn’t tolerate well to large changes of fluid in a short time period

What are sx of pericardial effusion?

A very serious condition which can result in death - feeling of fullness in chest - has a cough - hoarseness - dysphagia (hard time swallowing) - but can be asymptomatic

What is the medical work up for pericardial effusion?

- muffled heart and lung sounds - dullness to percussion of the left lung at the angle of the scapula - chest radiograoh can show big cardiac silhouette - echo

What is the treatment for pericardial effusion?

Pericardiocentesis to drain the fluid

What is cardiac tamponade?

over accumulation of fluid in the pericardial space which increases the pressure on the heart - **a medical emergency ** - any pericarditis can progress

What is the most common progression towards cardiac tamponade?

- neoplastic - post viral - blunt or penetrating chest trauma - dissecting aortic aneurysm

What are the sx of cadiac tamponade?

Poor filiing of the heart = decreased BP Hypotension, shock and possibly death Decreased CO signs: dyspnea, fatigue, syncope or dizziness - theres also coughing, tachycardia and tachypnea Jugular vein distentionw/ pulsus paradoxus (abdnormal drop in systolic BP during inspiration) Decreased heart sounds (Beck's triad)

What is the medical work up and treatment?

- echo - when its an emergency, treated with pericardial (or cardiac) window = cutting a hole in the fibrous pericardium to let fluid drain or relieve pressure - pericardiocentesis = inserting a fluid to draw out the fluid

What is endocarditis?

infection of the endocardium from a bacteria or fungi

What is the cause of endocarditis?

Usually travels from one part of the body (usually from dental work or GI/urinary procedures) - caths, tattoos, IV drug use - Rheumatic fever

How is endocarditis treated?

With long term antibiotic since if left untreated can lead to destructive of valves and is often fatal cardiac supportive measures possible valve replacement

What are the sx of endocarditis?

Flu like sx pain with breathing SOB swelling fever - quick onset of flu sx - can possibly hear the mitral valve regurgitation on auscultation

How are at most at risk with endocarditis?

artificial heart valves reservoir for germs damaged valves or congenital heart defect

What are the complications of endocarditis?

bacterial vegetation can travel to other areas of the body - heart valve damage - abscesses - PE - kidney and spleen

What is the medical workup for endocarditis?

labs: - sed rate - C-reactive proteins - WBCs - blood cultures to isolate organism EKG Echo/TEE

What is the prevention of endocarditis?

- prophylactic antibiotic before dental work - Upper respiratory procedures that has to do with incisions or biopsies - GI/GU procedures if an effection is there

What is myocarditis?

Otherwise known as inflammatory cardiomyopathy It's an infection or inflammation of the heart wall/muscle Generally viral or bacterial infection; rare: drug induced - streptococcal which is the most common - rheymatic fever affects both pump and electrical conduction

What is the sx of myocarditis?

* diffuse chest pain * fatigue * SOB * edema * arrhythmias * fever * general weakness

What does myocarditis do for the pump?

Weakens pump action (diffusion chest pain, fatigue, SOB, edema) and arrhythmias =

What does a decreased pump action result in?

Heart failure because of damaged cardiac muscle

If left untreated, what can myocarditis lead to?

Heart failure MI or CVA because of the poor pump action which leads to pooling in the ventricles Arrythmias (sudden cardiac death) because of the decreased electrical effienciency