Diseases of the Pericardium

Question 1

This is the layer of the pericardium that adheres to the outer wall of the heart

Answer 1

visceral pericardium

Question 2

This is the outer layer of the pericardium that is very tough.

Answer 2

Parietal pericardium

Question 3

This is the term that refers to the fact that the 2 ventricles share a fixed space limited by the rigid pericardium, so change in volume/pressure in 1 will result in a reciprocal change in the other.

Answer 3

Ventricular interdependence.

Question 4

This is an exaggeration of the normal decline in systolic BP that occurs with insipration.

Answer 4

Pulsus paradoxus

Question 5

How much must the decline in systolic BP be to be termed pulsus paradoxus?

Answer 5

> 10 mmHg

Question 6

During inspiration, how does the negative pressure in the chest cause pulsus paradoxus?

Answer 6

increase in RV volume –> ventricular septum shift to L –> smaller LV filling –> small SV –> ↓ BP

Question 7

Will BP increase or decrease in pericardial tamponade?

Answer 7

drop real big.

Question 8

True or False: in constrictive pericarditis, there is the pulsus paradoxus effect as in tamponade because of the inability of the heart to expand and fill.

Answer 8

FALSE. in constrictive pericarditis, the negative intrathoracic pressure created during inspiuration is not easily transmitted through the rigid pericardial shell.

Question 9

This is a signal of constrictive pericarditis because of increased blood in the thoracic and jugular veins from the inability of the RV to expand during breathing, thus, the jugulars distend during inspiration.

Answer 9

Kussmal sign

Question 10

What are the 2 viruses to cause viral pericarditis?

Answer 10

echovirus and coxsackievirus group B

Question 11

What is the bug to cause pericarditis in immunosuppressed patients?

Answer 11

TB

Question 12

What are teh 2 bugs to cause non-TB bacterial pericarditis in immunocompromised pts, especially with severe burns and malignancies?

Answer 12

S. pneumo and Staph

Question 13

Pericarditis can form a few days after what type of injury to the heart?

Answer 13

MI

Question 14

What is the name of the syndrome where pericarditis forms 2 weeks to several months after an MI, and due to an autoimmune origin?

Answer 14

Dressler syndrome

Question 15

Uremic pericarditis can from in pts with what type of problem?

Answer 15

Renal failure

Question 16

What forms in the pericardium in neoplastic pericarditis?

Answer 16

Tumors

Question 17

What are teh 3 things that can cause pericarditis assocaited with connective tissue diseases?

Answer 17

SLE, rheumatoid arthritis (RA) and progressive systemic sclerosis (PSS)

Question 18

What are the 2 drugs to cause drug-induced pericarditis?

Answer 18

procainamide and hydralazine

Question 19

This is the stage of pericarditis where there is local vasodilation with transduction of fluid into the pericardial space, increased vascular permeability, and leukocyte exudation.

Answer 19

Acute pericarditis

Question 20

What is the type of pain felt by a pericarditis pt?

Answer 20

Sharp, pleuritic chest pain, that’s aggrivated by inspiration and coughing and is positional.

Question 21

True or false: there is a fever in acute pericarditis.

Answer 21

True

Question 22

Why is there a friction rub in pericarditis?

Answer 22

pericardial layers move against 1 another

Question 23

What shows up on EKG in pericarditis?

Answer 23

ST ↑ with PR ↓

Question 24

What are the 3 complications to pericarditis?

Answer 24

pericardial effusion, tamponade, constricitve pericarditis

Question 25

Case: pt presents with muffled heart sounds, Ewart sign (dullness to percussion of the L lung), enlarged cardial silhouette, and electrical alternans. Dx?

Answer 25

Pericardial effusion

Question 26

Case: pt presents with JVP, systemic hypotension, small & quiet heart, pulsus paradoxus, and sinus tachycardia. Dx?

Answer 26

Pericardial tamponade

Question 27

Case: pt presents with reduced CO, elevated systemic venous pressures, and Kussmaul sign. Dx?

Answer 27

Constrictive pericarditis

Question 28

What is the Tx of acute pericarditis?

Answer 28

Rest, NSAIDs, Colchicine, treat cause

Question 29

What is the Tx of pericardial effusion?

Answer 29

pericardiocentesis

Question 30

What is the Tx of pericardial tamponade?

Answer 30

pericardiocentesis

Question 31

What is the Tx of constrictive pericarditis?

Answer 31

cut it out. ha. hahaha. hahahhahhsahahahahahahahahhahah

Question 32

This is the form of pericarditis where noninfectious inflammatory diseases cause irritation of the parietal pericardium and serous effusion.

Answer 32

Serous pericarditis

Question 33

These are the 2 most frequent types of pericarditis, caused by acute MI, Dressler syndrome, and others.

Answer 33

Fibrinous and Serofibrinous pericarditis

Question 34

What is the morphology of the pericardium in fibrinous pericarditis?

Answer 34

dry, granular

Question 35

What is the morphology of the pericardium in serofibrinous pericarditis?

Answer 35

yellow-to-brown turbid fluid from WBC's and RBC's and fibrin

Question 36

What are the Sx to fibrinous and serofibrinous pericarditis?

Answer 36

friction rub and pain

Question 37

This type of pericarditis is caused by invasion of the pericardial space by microbes, leading to the formation of pus within the pericardial sac.

Answer 37

Purulent or Suppurative pericarditis

Question 38

What are the 2 manifestations of purulent pericarditis?

Answer 38

1. spread to surrounding structures, leading to mediastinopericarditis 2. scarring

Question 39

This is the form of pericarditis where a malignant neoplasm causes exudate with blood and fibrinous or suppurative effusion.

Answer 39

Hemorrhagic pericarditis

Question 40

This is the form of pericarditis where TB causes disabling, fibrocalcific, chronic constrictive pericarditis.

Answer 40

Caseous pericarditis

Question 41

This is a manifestation of pericarditis where the pericardial sac adheres to surrounding structures, leading to cardiac hypertrophy.

Answer 41

Adhesive mediastinopericarditis

Question 42

This is a manifestation of pericarditis where the heart is encased in a dense, fibrous or fibrocalcific scar that limits diastolic expansion and CO.

Answer 42

Constrictive pericarditis

Question 43

Which bone disorder can cause fibrinous pericarditis in 20-40% of the pts?

Answer 43

Rheumatoid arthritis