Flashcards in Lec 8 Disease of Pericardium Deck (32):
What is normal morphology/function of pericardium?
- 1 to 2 mm thick
- inner serous visceral + parietal; outer fibrous
- no vital function
- anchors, lubricates, protects
What are possible etiologies of acute pericarditis?
- viral: coxsackie, echovirus
- post MI
What is post MI acute pericarditis?
- related to infarct size
early: inflammatory etiology
late: immune mediated wks to mos later = known as post cardiac injury syndrome or dressler's syndrome
What are manifestations of acute pericarditis?
- sharp chest pain, retrosternal, made worse by inspiration [pleuritic], relieved by sitting up/leaning forward [postural]
- pericardial friction rub best heard in expiration = highly specific
What happens to EKG in acute pericarditis?
- ST segment elevation and/or PR depression
What is treatment for acute pericarditis?
- bed rest
- NSAIDS = aspirin
- colchicine = treat or prevent recurrent pericarditis
- steroids if recurrent/relapsing
What are potential complications of acute pericarditis?
- constriction: scarring --> lost elasticity of pericardial sac
- tamponade: accumulation pericardial fluid
- recurrent pericarditis: seen with idiopathic pericarditis
What causes fibrinous acute pericarditis? major finding?
- Dressler syndrome [post MI]
finding: loud friction rub
What causes serious acute pericarditis?
- viral pericarditis; non-infectious inflammatory disease [rheumatoid arthritis, SLE]
What causes suppurative/purulent acte pericarditis?
usually bacterial infection [pneumococcus, strep]
What causes pericardial effusion?
- acute pericarditis
- hypothyroidism [capillary permeability]
- cirrhosis/nephrotic syndrome
What are some etiologies of pericardial effusion?
- malignancy, uremia, radiation, trauam, dissecting aneuryism, HIV
What are signs/symptoms of pericardial effusion?
- can have no symptoms
- dsypnea, cough, dysphagia, hoarsness, ab fullness
- muffled heart sounds
- decreased intensity of heart sounds
- Ewart's sign = dullness to percussion of the left lung over the angle of the scapula
What is cardiac tamponade?
compression of heart by fluid causing hypotension, tachycardia, decrease CO, limited filling of heart
occurs when intrapericardial pressure exceeds intracardiac pressure
diastolic pressure within each chamber is elevated and equal to the intrapericardial pressure
What are most common causes of cardiac tamponade?
When is relationship cardiac tamponade and how fast effusion develops?
slowly developing effusion = pericardium stretches, tamponade occurs with larger volume
rapid developing = pericardium has no time to stretch, tamponade with smaller volume
What are findings of cardiac tamponade?
beck triad = hypotension, distended neck veins [high JVP], distant heart sounds
- dyspnea, orthopnea, fatigue
- low voltage QRS and eletrical alternans = swinging movement of heart
- signs of right heart failure
What should you think: pt with pericarditis develops systemic vascular congestion and decrease CO?
think cardiac tamponade!
What is beck's triad for cardiac tamponade?
- decrease arterial pressure [hypotension]
- increase venous pressure [distended neck veins]
- distant heart sounds
What is pulsus paradoxus? What does it indicated?
decrease amplitude of sytolic blood pressure by ? 10 mmHg during inspiration
seen in: cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup
What is treatment of cardiac tamponade?
What major causes constrictive pericarditis?
used to be TB, now idiopathic
What happens in constrictive pericarditis?
rigid scarred pericardium around heart
inhibits normal filling of cardiac chambers
stops mid-filling b/c can't fill anymore --> get high systemic venous pressure and signs of right sided heart failure --> low SV/CO --> lower BP
What are signs of constrictive pericarditis on histology?
chronic = fibrotic
subacute = inflammatory
What are symptoms of constrictive pericarditis?
extertional dyspnea, R> L CHF
tachycardia, hypotension, high JVP, kussmauls sign
What are causes of constrictive pericarditis?
heart surgery, radiation, idiopathic, connective tissue disease, infection, malignancy
What is kussmaul sign?
inspiration causes increased venous return --> accumulates in intrathoracic system veins --> jugular veins more distended during inspiration
normal: inspiration causes decrease in jugular venous pressure
What does kussmaul sign signify?
What do you see on EKG with constrictive pericarditis?
atrial fibrillation in chronic cases
What do you see on chest xray with constrictive pericarditis?
What do you see on echo with constrictive pericarditis?
may show thickened pericardium