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CMT > Pericardial Disease > Flashcards

Pericardial Disease Flashcards

1
Q

function of the pericardium

A
  1. stabilize heart within thoracic cavity
  2. protect from trauma and infection
  3. decrease friction
  4. prevent excessive dilation
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2
Q

Pericarditis

what is it

A

acute inflammation of the pericardium

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3
Q

Pericarditis

can be due to?

4

A
  1. idiopathic/viral
  2. bacterial
  3. inflammatory
  4. trauma
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4
Q

Pericarditis

EKG findings

A
  • diffuse ST elevation that rarely exceeds 5 mm
  • no reciprocal ST segment lead changes
  • PR depression common
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5
Q

Pericarditis

CXR findings

A

usually normal, may have effusion

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6
Q

Pericarditis

why should you get an echo?

A

to rule out effusion

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7
Q

Pericarditis

lab work p

4 required, 4 supplemental

A

Absolutely Order
1. CBC
2. ESR
3. CRP
4. Troponin

Consider Ordering
1. blood cultures
2. ANA
3. TB test
4. Lyme test

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8
Q

Pericarditis

tx w/ dosing

A
  1. ASA 750-1000mg or Ibuprofen 600mg Q8 hrs, 1-2 wks
  2. above with Cochicine 0.5mg PO BID, 3 mo
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9
Q

Pericarditis

follow up

A
  • close monitoring of sx
  • ECG
  • repeat CRP
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10
Q

Pericarditis

what to do with:
* non-competitive athletes
* competitive athletes
* myopericarditis in athletes

A
  1. restrict until resolution of sx and ECG/biomarkers WNL
  2. clear an evaluation and be out at least 3 mo
  3. if myo, sit out 6 mo
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11
Q

Pericarditis

which viral causes are most common?

2

A
  1. echovirus
  2. coxsackie
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12
Q

Pericarditis

who may be eligible for inpatient tx?

|6

A
  1. tamponade
  2. mod to large pericardial effusion
  3. immunosuppressed
  4. anti-coagulated
  5. acute trauma
  6. failure to respond to tx
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13
Q

Constrictive Pericarditis

occurs how?

A

thickened, fibrotic, adherent pericardium reduces elastic properties of myocardium and/or intracellular matrix

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14
Q

Constrictive Pericarditis

from what?

4

A
  • TB
  • radiation
  • viruses, histoplasmosis
  • surgery
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15
Q

Constrictive Pericarditis

effects

A
  1. restricts diastolic filling
  2. produces elevated venous pressures
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16
Q

Constrictive Pericarditis

signs/sx

A
  1. progressive dyspnea, fatigue, weakness
  2. chronic edema, hepatic congestion, ascites
  3. may have afib
  4. elevated JVP, kussmaul’s sign
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17
Q

Constrictive Pericarditis

what is kussmaul’s sign?

A

paradoxical rise in right atrial pressure during inspiration

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18
Q

Constrictive Pericarditis

dx

4 imaging

A
  1. EKG
  2. Echo
  3. Cardiac CT/MRI
  4. Cath
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19
Q

Constrictive Pericarditis

EKG findings

A

no changes

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20
Q

Constrictive Pericarditis

echo findings

A
  • thickened pericardium
  • septal bounce
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21
Q

Constrictive Pericarditis

cardiac ct/mri findings

A
  • thickened pericardium
  • may have pericardial effusion
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22
Q

Constrictive Pericarditis

tx

A
  1. aggressive diuretics
  2. anti-inflammatories
  3. may require pericardiectomy
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23
Q

Restrictive Pericarditis

typically due to?

A

infiltrative (amyloidosis)

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24
Q

Restrictive Pericarditis

tx

A
  • treat underlying condition
  • transplant
25
Q

Pericardial Effusion

what is it?

A

extra fluid in pericardial space which creates pressure on the heart chambers when they beat

26
Q

Pericardial Effusion

causes

10

A
  1. inflammation
  2. autoimmune
  3. metastatic
  4. cancer
  5. radiation/chemo
  6. uremia
  7. hypothyroid
  8. trauma
  9. infection
  10. meds
27
Q

Pericardial Effusion

presentation

A
  1. can be asx
  2. constant dull ache, tachycardiac, hypotension, JVD, pulsus paradoxus, dysphagia, dyspnea, hoarseness, hiccups
  3. diminished heart sounds (muffled)
  4. Ewart’s sign
28
Q

Pericardial Effusion

what is ewart’s sign

A

dullness to percussion over L lung over angle of scapula

29
Q

Pericardial Effusion

what must you rule out?

A

tamponade

30
Q

Pericardial Effusion

work up components

A
  1. EKG
  2. CXR
  3. Echo
  4. CBC, CMP, TSH, ANA, pericardial fluid analysis, pericardial bx
31
Q

Pericardial Effusion

EKG findings

A
  1. low QRS voltage
  2. sinus tachy
  3. electrical alternans
32
Q

Pericardial Effusion

what are electrical alternans

A

changing amplitude of the QRS which is caused by the heart swinging in the pericardium

33
Q

Pericardial Effusion

CXR findings

A

enlarged cardiac silhouette with clear lungs

34
Q

Pericardial Effusion

echo findings

A

need to quantify effusion and assess hemodynamic impact

35
Q

Pericardial Effusion

tx

A
  • monitor for stability
  • NSAIDs, corticosteroids, colchicine
  • Pericardiocentesis if tamponade
  • pericardiectomy for recurrent
36
Q

Pericardial Effusion

what sx to watch for with colchicine

A

gi upset

37
Q

Pericardial Effusion

avoid which meds?

A

vasodilators and diuretics

38
Q

Cardiac Tamponade

this is a???

A

MEDICAL EMERGENCY

39
Q

Cardiac Tamponade

how does this occur?

A

impaired filling pressure impairs cardiac output

40
Q

Cardiac Tamponade

presentation

7

A
  1. tachycardia
  2. tachypnea
  3. HYPOTENSION
  4. narrow pulse pressure
  5. pulsus paradoxus
  6. ELEVATED JVP
  7. MUFFLED/DISTANT HEART SOUNDS
41
Q

Cardiac Tamponade

what is pulsus paradoxus?

A

decline of > 10 mmHg in systolic pressure during inspiration

42
Q

Cardiac Tamponade

dx

A
  1. EKG
  2. Echo
43
Q

Cardiac Tamponade

EKG findings

A

low voltage, sinus tachy

44
Q

Cardiac Tamponade

echo findings

A

RV collapse during diastole, dilated IVC

45
Q

Cardiac Tamponade

tx

A
  1. urgent pericardial window
  2. urgent pericardiocentesis
46
Q

Myocarditis

what is it

A
  • inflammation of myocardium
  • can be acute or chronic
  • inflammation can be focal or diffuse
47
Q

Myocarditis

presentation

5 components

A
  • variable, depends on stage
  • unexplained heart failure
  • decreased exercise tolerance
  • chest discomfort
  • arrhythmias
48
Q

Myocarditis

dx

A
  • suspect in pts +/- cardiac sx
  • rise in troponin
  • EKG changes consistent with ischemia
  • arrhythmia
  • unexplained changes to ventricular function
49
Q

Myocarditis

work up

A
  1. history/PE
  2. Labs: ESR, CRP, serial troponin, pro-BNP
  3. EKG, CXR, echo
50
Q

Myocarditis

what can you consider for dx?

A
  1. cath: r/o ischemia
  2. cardiac MRI: additional supportive evidence
  3. endomyocardial bx: if it will help guide tx
51
Q

Myocarditis

tx

A
  1. supportive care
  2. activity restriction
  3. ACE/ARB/ARNI/BB
  4. Cardiac rehab
52
Q

Myocarditis

what should you absolutely avoid?

A

NSAIDs

53
Q

Giant Cell Arteritis

AKA

A
  1. Temporal Arteritis
  2. Horton Disease
54
Q

Giant Cell Arteritis

what is it?

A

vasculitis of extracranial branches of carotid artery

55
Q

Giant Cell Arteritis

associated with?

A

polymyalgia rheumatica

56
Q

Giant Cell Arteritis

presentation

5

A
  1. headache
  2. jaw claudication
  3. visual changes
  4. acute vision loss
  5. fever/malaise/night sweats
57
Q

Giant Cell Arteritis

PE findings

3

A
  1. scalp tenderness
  2. thickened temporal artery
  3. tongue necrosis (blackened!)
58
Q

Giant Cell Arteritis

work up

A
  • clinical dx
  • increased ESR, CRP
  • temporal bx
  • temporal artery ultrasound
59
Q

Giant Cell Arteritis

treatment

A
  • high dose corticosteroid ASAP
  • ASA low dose
  • complication is blindness

CMT (72 decks)

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