Pericardial and Endocardial Disorders Flashcards Preview

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Flashcards in Pericardial and Endocardial Disorders Deck (34)
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1

Most common disorder of the pericardium

Acute Pericarditis

2

Pericarditis from cardiac surgery, post MI, or post trauma. Purely inflammatory.

Dressler's Syndrome

3

Most common population for acute pericarditis

Men <50 yrs

4

EKG changes most commonly associated with acute pericarditis

Diffuse ST-segment elevation, convex

"Smiling ST's"

5

Patients with significant CKD

Uremic Pericarditis (elevated BUN/Cr)

Needs dialysis

6

CXR in pericarditis

May show cardiac enlargement if effusion is present

Lesions/nodes if neoplastic in origin

7

Echo in pericarditis

Thickened pericardium and/or effusion

8

Labs in pericarditis

Elevated WBCs, ESR, Cardiac enzymes,

If uremic, elevate BUN/Cr

9

Treatment of acute idiopathic / viral / Dressler's pericarditis

NSAIDs or ASA (aspirin) **Aspirin preferred for older and Dressler's patients** for 5-7 days

Colchicine or Corticosteroids if not responding to aspirin or NSAIDs

Dialysis and Colchicine if uremic

Last resort: Partial Pericardiectomy

10

Pharm contraindication in acute pericarditis

Anticoagulation!

**can cause hemopericardium**

11

Important differential with acute pericarditis

MI !!

Similar presenting symptoms, similar patient population (males <50, cardiac risk factors)

12

Key symptoms in acute pericarditis

1. Sharp substernal pleuritic chest pain, worse lying down and relieved sitting up/leaning forward
2. Pain can radiate to left trapezius / arms
3. May have fever, dyspnea

13

Pathognomonic physical exam findings, acute pericarditis

Cardiac friction rub, LLS border **pathognomonic**

14

Often secondary to pericarditis, uremia, or cardiac trauma - Produces restrictive pressure on the heart

Pericardial Effusion

15

Clinical features of pericardial effusion

May be painful or painless

Often accompanied by cough and dyspnea

16

Diagnosis of Pericardial Effusion

CXR - **"Bottle-shaped heart**

** 2D Echocardiogram**

17

EKG changes associated with pericardial effusion

***Low QRS voltage***
***Electrical Alternans*** (consecutive, normally-conducted QRS complexes alternate in height.)

Tachycardia
Nonspecific T-wave changes

18

Treatment of pericardial effusion

Pericardiocentesis

19

3 most common causes of pericardial effusion

(Pericarditis)
1. Idiopathic
2. Neoplastic
3. Renal - uremic

20

Pulsus paradoxus

> 10mmHg drop in systolic BP upon inspiration

**indicative of pericardial effusion**

21

Pericardial effusion - effects on BP and JVP

Pulsus paradoxus, on inspiration

JVP elevates and BP gradually drops as increasing intracardial pressure impedes venous return and decreases ventricular filling

22

Beck's Triad

Pericardial Effusion

1. Elevated JVP
2. Muffled Heart Sounds
3. Low BP

23

Rapid accumulation of fluid, compromises cardiac filling and impairs cardiac output

Cardiac Tamponade

(an effusion gone horribly wrong)

An effusion turns into tamponade if fluid accumulates fast enough or in amounts high enough.

24

Usually culprits of native valve infective endocarditis

**Typically an underlying regurgitant cardiac defect present, providing a nidus for: **

Streptococcus viridians

Staphylococcus aureus (**IV drug users**)

Enterococci

25

Most common cause of endocarditis in IV drug users - and which valve involved

Staph aureus

Tricuspid Valve (shoot into veins > vena cava > R atrium > tricuspid valve)

26

Prosthetic valve endocarditis most often caused by

Staph aureus

Gram neg organisms

***fungi, if infection develops during first 2 months after implantation***

27

Medical procedures associated w risk of endocarditis

Dental
Upper Respiratory
Urologic
Lower GI

28

Classic features of endocarditis (which only occur in 25% of patients)

5 (PE findings)

Palatal, subungual, or conjunctival petechiae

Splinter hemorrhages (subungual)

Osler nodes (painful purple lesions on fingers/toes/feet)
Janeway lesions (painLESS red lesions, palms or soles)

Roth spots (exudative lesions in retina)

29

Other clinical features of endocarditis

1. Fever and nonspecific symptoms (flank/GI pain, arthralgias)

2. Stable murmur (may be absent in R side infections)

3. Pallor

4. Splenomegaly

30

Clinical Criteria for diagnosis of infective endocarditis
("Duke criteria")

Must have 2 major, or 1 major + 3 minor, or 5 minor

MAJOR
1. Two positive blood cultures of tip causative org
2. Echo w new valvular regurge

MINOR
1. Predisposing factor
2. Fever >100.4
3. Vascular (embolism, pulm infarction)
4. Immune (Osler nodes, Roth spots, nephritis)
5. Positive blood culture not meeting major criteria