Pericardial Disease Flashcards Preview

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Flashcards in Pericardial Disease Deck (18):
1

lab findings acute pericarditis

Mild elevation of WBC count

lymphocytosis

mild ESR elevation

1

mechanism cholchine

disrupt microtubules > mitotic spindle

significant anti-inflamm

3

role of pericardial prostaglandin secretion

modulation of coronary vascular tone

4

two layers of pericardium

visceral - mesothelial cells, adjacent to heart

 

parietal - collagen and elastic wavy+streight bundles

4

COPE study outcome

 

ICAP study outcome

open label randomized trial - addition of cholicincine to ASA, steroids halved the recurrance rate after intiial attack (level B)

 

reduced rate of incessant or reccurrent pericarditis (Level A) 

5

incessant pericarditis

persistent or those with symptom free intervals of less than six weeks

6

hemopericardium 

blood in pericardial sac - trauma or heart/aorta, myocardial rupture post-MI

7

symptoms acute pericarditis

chest pain - always present

better sitting forward, worse lying down

sharp, pleuretic

trapezius, ubsternal epigastric area

dyspnea, cough, hiccups, fever

8

physical exam acute pericarditis

fever,

tachycardia

anxiety

Pericardial friction rub (3 components) at LSB (best when pt leaning forward) (dynamic)

9

ECG findings acute pericarditis

dynamic

ST elevation (diffuse, not in aVR, V1)

ST segemnt concave

no reciprocal changes

Upright Twaves

PR depression (elevation in AVR)

9

echocardiogram acute pericarditis

small silent effusion

10

Stages of ECG findings acute pericarditis

1 - diffuse concave ST elevation

2 - ST normalizes, T decreases, PR depression (looks like ST elevation)

3 diffuse T wave inversions, symmetric, deep

4. Normalizes, T wave inversions may be permanent

11

most common cardiac manissfestation of HIV 

pericardial effusion 

 

(capillary leak syndrome - serro-effusive process)

13

fluid volume of normal pericardial space

50ml

14

Diagnostic criteria acute pericardiits

2:

Typical chest pain (sharp, pleuritic, improved by sitting forward)

pericardial friction rub

ECG - widepread ST elevatior or PR depression

New or worsening pericardial effusion

16

Treatment Pericarditis

Colchine with Naids (or as alternative) 

Steroids (avoid corticosteroids - relapse)

17

hydropericardium

accumulation of serous transudate in pericardial space. Asc with CHF< hyopantremia or chronic kidney/liver disease

18

CXR Acute pericarditis

usually normal