Module 17 : Pericardial Disease Flashcards
(69 cards)
1
Q
what are the anatomical layers of the pericardium from inner to outer
A
- visceral layer (epicardium)
- fluid
- partial layer
- fibrous layer
2
Q
where does the pericardium insert posteriorly
A
- IVC and superiors to the pulmonary veins
3
Q
where does the pericardium insert superiorly
A
- great vessels
4
Q
where is the normal amount of serous fluid
A
20-50 ml
5
Q
what are 4 functions of the pericardium
A
- limits over distension of the heart
- helps distribute diastolic pressure
- reduces friction
- infection barrier
6
Q
what is the epicardial fat
A
- layer of fat anterior to the heart
- usually along the AV groove & inter ventricular & coronary after tracts
7
Q
what is the purpose of the epicardial fat
A
- protects from blunt force trauma
8
Q
what is/causes a pericardial effusion
A
- increased amount of fluid within pericardial space
- irritation/injury to pericardium
9
Q
what is pericardial tamponade
A
- marked or fast increase in intrapericardial pressure above intracardiac pressures
- compresses the heart and impairs its ability to fill
10
Q
what is pericarditis and what does it do
A
- inflammation of the pericardial surfaces
- restricts diastolic function
11
Q
what two things cause pericardial effusion
A
- injury to/inflammation of pericardium
- when irritated visceral pericardium secretes fluid
12
Q
what is a consequence of pericardial effusion and what are the consequences dependant on
A
- large effusions that accumulate fast reduces SV by restricted filling
- effects depend on the amount of fluid and rate of accumulation
13
Q
what are the 3 descriptors of pericardial effusion
A
- location
- amount
- hemodynamic comprise
14
Q
what is common about most locations of pericardial effusions
A
- tends to be dependant (posterior at first)
- will then extend anterior to aorta
15
Q
what are the 3 different ways to describe amount of pericardial
A
- small
- moderate
- large
16
Q
what are 2 different ways to describe locations pericardial effusions
A
- circumferential
- loculated
17
Q
what are 6 different aetiologies of pericardial effusions
A
- infectious
- inflammation
- anasarca
- malignant
- trauma
- iatrogenic
18
Q
what are the signs and symptoms
A
- chest pain
- SOB
- increased JVP
- pericardial rub
- quiet heart sounds
- sand paper
19
Q
what will the ECG look like with pericardial effusions
A
- low voltage ECG
- electrical alterans
20
Q
what are the intrapericardial and intracardial pressures in normal heart
A
- low intrapericardial
- high intracardiac
21
Q
what are the intrapericardial and intracardial pressure in effusion and what does it cause
A
- high intrapericardial
- high intracardiac
- diastolic collapse of right heart
22
Q
what happens with PP > RAP
A
- MAP and CO fall
23
Q
what happens with PP > RVP
A
- MAP and CO fall even more
24
Q
what is the 2D role of echo with effusions
A
- location
- potential collapse of chambers
- differentiation of pleural effusion
- size
- clear space or echoes within
- pericardial thickness
25
what are the doppler roles of echo with pericardial effusions
- diastolic function assessment
| - changes in LV and RV filling with respiration
26
what is the characteristics of physiological pericardial effusion
- 2-5mm space in systole
| - 20-50 ml of fluid
27
what is the characteristics of mild pericardial effusion
- < 0.5-1 cm space in systole and diastole
| - 50-100 ml
28
what is the characteristics of moderate pericardial effusion
- 1-2 cm (posterior space in systole and diastole)
| - 100-500 ml fluid
29
what is the characteristics of large pericardial effusion
- >2cm and and posterior space in systole and diastole
| - >500ml
30
when is pericardial effusion measured
- end diastole in PSAX or LAX at pap muscle level
31
what is pericardial effusion always anterior to
anterior to descending AO
32
what is pleural effusions always posterior to
heart
33
when is the pericardial effusion measured in M mode
- anechoic space between epicardium and pericardium to be measured in diastole
34
when does the posterior wall lift off the pericardial border in M mode
systole
35
which way does the septum shift with inspiration and expiration
- left = inspiration
| - right = expiration
36
what are the 2D imaging considerations with PE
- gain too high fills in space
- image depth too shallow miss
- anterior pericardial fat
- dilated coronary sinus
- pseudo aneurysms
- large pleural effusion
37
what are the M mode considerations with PE
- parasternal beam transects DAO misten for PE
38
pathophysiology of pericardial tamponade
- rapid accumulation of fluid
- heart swings in chest
- high pressure intrapericardial cavity
- impairs cardiac chamber filling due to a rise in intrapericardial pressure thus impatiens SV and CO
- life threatening
- intrapericardial pressure rises
39
what is the order of chambers that would collapse with pericardial tamponade
- RA
- RV
- LAP
- LV
40
what happens to the right heart with tamponade
```
- affected first
+ RA systolic collapse
+ RV diastolic collapse
+ reciprocal RV/LV respiratory changes (septal shifting)
+ reduced TD velocities
+ SVC nad IVC dilated
```
41
what happens to the left heart with tamponade
- LV diastolic filling imparied
- volume changed with respiration
- SV drops= BP drops
- tachycardia
42
what type of pericardial tamponade is most common
- subacute and chronic
43
what are the two types of causes of pericardial tamponade
- acute
| - subacute chronic
44
what are the causes of acute tamponade
- trauma
- AO dissection
- dressers
- MI
- iatrogenic
45
what are the causes of subacute chronic tamponade
- idiopathic
- viral pericaditis
- mets
- radiation
- fluid varys
- pericardium stretches
- fibrin strains seen
46
what will tamponade look like on ECG
- tachycardia
| - electrical alterans ( alternating amplitudes QRS changes)
47
what are the clinical signs of tamponade
- becks triad
| - pulses paradoxus
48
what is Becks triad
- low arterial BP
- distended neck veins
- muffled heart sounds
49
what is pulsus paradoxes
- abnormally large decrease in pulse amplitude during inspiration
50
what are complications to tamponade
- shock
- hypotension
- altered mental state
- death
51
what is ventricular interdependence
- any size, shape pressure or volume of one ventricle changes the size shape volume of other ventricle
- becomes prominent with pericardial effusion
52
how does inspiration and expiration change the echo findings in echo with tamponade
- insp = increased RV volume, decreased LV volume
| - exp = decreased RV volume
53
what are the doppler findings of tamponade
- >/= 25-30% change of MV E velocities
| - TV E velocities > 50-60% change with respiration
54
what are the 2 treatments of tamponade
- pericardiocentiusis = echo guided, low risk, needle aspirated, drain from catheter
- pericardial window = surgical, reserved for chronic effusions and chronic pericarditis
55
what is hemoperricardium
- collection of blood in pericardial sac
| - blood does not usually clot due to antithrombotic factors in pericardial effusion
56
what is the definition of pericarditis
- inflammation of pericardial sac
57
what is the result of pericarditis
- fibrosis
- thickenin g
- purulent ( stuck pericardium)
58
what is constrictive pericarditis
- parietal pericardium no compliant
| - RV and LV diastolic filling is reduced and restricted Grade 3 DD
59
what are the common aetiologies of pericarditis
- acute infection
- trauma
- post surgical
- post MI
- chronic pericardial effusion
60
what happens with constrictive pericarditis
- normally heart allowed to expand
- with fluid in pericardial sac >> decreased expansion
- with further restricted pericardium >> decreased expansion worse
61
what are the sounds heard with pericarditis
- friction rub
- heard with auscultation
- may be caused by crystals
62
what are the symptoms of pericarditis
- chest pain
| - JVP pressure increases with inspiration
63
what is the ECG look like with
- diffuse ST segment elevation
64
what are the 2D findings with pericarditis
- thickened echo genie pericardium
- fibrotic
- shadow
- pericardium may be stuck to myocardium
- pericardial fluid
- pleural effusion
- IVC dilated
65
what are the M mode features of constrictive pericarditis
- posteriori LV wall stuck to pericardium
- pericardial layers look bright and thickened
- RAIL ROAD TRACK appearance
66
what are the doppler findings of constrictive pericarditis
```
- restrictive physiology
+ increased MV E/A ratio
+ decreased MV DT
+ decreased IVRT
+ IVC plethora
- tissue doppler E prime increased (septal > lateral)
```
67
how is filling changed with inspiration with CP
- decreased LV filling
- increased RV filling
- IVS shift toward the left
- > 25 - 30% change in MV inflow velocity is abnormal
68
how is filling changed with expiration with CP
- increase LV filling
- decreased RV filling
- IVS shifts toward right
- > 25-30% change in MV inflow velocity is abnormal
69
characteristics of pericardial masses
- invasion of pericardium with mets
- hard to differentiations form clots of fibrin clusters
- lung breasts lymphatic
