Lec 8 Disease of Pericardium Flashcards Preview

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Flashcards in Lec 8 Disease of Pericardium Deck (32):
1

What is normal morphology/function of pericardium?

- 1 to 2 mm thick
- inner serous visceral + parietal; outer fibrous
- no vital function
- anchors, lubricates, protects

2

What are possible etiologies of acute pericarditis?

- viral: coxsackie, echovirus
- bacterial
- TB
- post MI
- hypothyroidism
- SLE

3

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

4

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

5

What happens to EKG in acute pericarditis?

- ST segment elevation and/or PR depression

6

What is treatment for acute pericarditis?

- bed rest
- NSAIDS = aspirin
- colchicine = treat or prevent recurrent pericarditis
- steroids if recurrent/relapsing

7

What are potential complications of acute pericarditis?

- constriction: scarring --> lost elasticity of pericardial sac

- tamponade: accumulation pericardial fluid

- recurrent pericarditis: seen with idiopathic pericarditis

8

What causes fibrinous acute pericarditis? major finding?

- Dressler syndrome [post MI]
- uremia
- radiation

finding: loud friction rub

9

What causes serious acute pericarditis?

- viral pericarditis; non-infectious inflammatory disease [rheumatoid arthritis, SLE]

10

What causes suppurative/purulent acte pericarditis?

usually bacterial infection [pneumococcus, strep]

11

What causes pericardial effusion?

- acute pericarditis
- hypothyroidism [capillary permeability]
- CHF
- cirrhosis/nephrotic syndrome

12

What are some etiologies of pericardial effusion?

- viral/bacterial/TB
- malignancy, uremia, radiation, trauam, dissecting aneuryism, HIV

13

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

14

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

15

What are most common causes of cardiac tamponade?

neoplasm
postviral
uremic pericarditis

16

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

17

What are findings of cardiac tamponade?

beck triad = hypotension, distended neck veins [high JVP], distant heart sounds
- dyspnea, orthopnea, fatigue
- tachycardia
- low voltage QRS and eletrical alternans = swinging movement of heart
- signs of right heart failure

18

What should you think: pt with pericarditis develops systemic vascular congestion and decrease CO?

think cardiac tamponade!

19

What is beck's triad for cardiac tamponade?

- decrease arterial pressure [hypotension]
- increase venous pressure [distended neck veins]
- distant heart sounds

20

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

21

What is treatment of cardiac tamponade?

pericardiocentesis

22

What major causes constrictive pericarditis?

used to be TB, now idiopathic

23

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

24

What are signs of constrictive pericarditis on histology?

chronic = fibrotic
subacute = inflammatory

25

What are symptoms of constrictive pericarditis?

extertional dyspnea, R> L CHF
peripheral edema
weight gain
tachycardia, hypotension, high JVP, kussmauls sign

26

What are causes of constrictive pericarditis?

heart surgery, radiation, idiopathic, connective tissue disease, infection, malignancy

27

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

28

What does kussmaul sign signify?

constricitve paricarditis

29

What do you see on EKG with constrictive pericarditis?

atrial fibrillation in chronic cases

30

What do you see on chest xray with constrictive pericarditis?

pericardial calcification

31

What do you see on echo with constrictive pericarditis?

may show thickened pericardium

32

What is treatment for constrictive pericarditis?

pericardiectomy