Pericardial disease Flashcards Preview

Cardiology > Pericardial disease > Flashcards

Flashcards in Pericardial disease Deck (29):
1

What is the normal pericardium?

A fibroelastic sac containing a thin layer of fluid (50mL) that surrounds the heart and roots of the great vessels

2

What are the most common causes of acute pericarditis?

Most commonly due to viral infection- Coxackie B, echovirus, HIV infection- or following on from MI

3

What are the other causes of acute pericarditis?

Uraemia
Autoimmune rheumatic disease
Trauma
Bacterial/tuberculosis/fungal infection
Malignancy- breast, lung, leukaemia and lymphoma

4

What is the characteristic pain of acute pericarditis? How is it relieved? What exacerbates the pain?

Sharp retrosternal chest pain which is characteristically relieved by leaning forward. Worse on inspiration

5

Where does the pain of acute pericarditis radiated?

The neck and shoulders

6

What is heard on auscultation of a patient with acute pericarditis?

Pericardial friction rub

7

How is acute pericarditis diagnosed?

ECG?

8

What does the ECG look like in a patient with acute pericarditis?

Global, saddle shaped ST elevation

9

How is a pericardial friction rub best heard?

Lower left sternal edge with the patient leaning forward

10

How is acute pericarditis managed?

Treatment of underlying disorder + NSAIDs
Systemic corticosteroids are used in resistant cases

11

When should NSAIDs not be used to treat acute pericarditis? Why?

In the first few days following MI. This is because they are associated with a higher rate of myocardial rupture

12

What are the complications of acute pericarditis?

Pericardial effusion
Chronic pericarditis (>6-12 months)

13

What is pericardial effusion?

An accumulation of fluid in the pericardial sac

14

What causes pericardial effusion

Any of the causes of acute pericarditis
Hypothyroidism also causes pericardial effusion

15

What is pericardial tamponade?

A medical emergency which occurs when a large amount of pericardial fluid which has often accumulated rapidly restricts diastolic ventricular filling and causes a marked reduction in cardiac output

16

What is the main clinical feature of pericardial effusion?

The effusion obscures the apex beat and heart sounds are soft

17

What are the signs of pericardial tamponade?

Hypotension
Tachycardia
Elevated JVP which rises with inspiration
Pulsus paradoxus

18

What is seen on an X ray in pericardial effusion?

Large globular heart

19

What is seen on an ECG in pericardial effusion?

Low voltage complexes

20

What is the diagnostic test for pericardial effusion? What does it show?

Echo
Shows an echo free space around the heart

21

When are invasive tests to establish the cause of a pericardial effusion necessary?

If the effusion is persistent
If a purulent or tuberculosis effusion is suspected
If the effusion is not known to be secondary to an underlying illness

22

What invasive tests might be used to establish the cause of a pericardial effusion?

Percardiocentesis: aspiration of fluid under echocardigram guidance
Pericardial biopsy for culture, cytology/histololgy and PCR (for TB) give a greater diagnostic yield with larger effusions

23

How is cardiac tamponade treated?

Emergency pericardiocentesis
Pericardial fluid is dained percutaneously by introducing a needle into the pericardial sac. If the effusion recurs, in spite of treatment of the underlying cause, excision of a pericardial segment may be necessary. Fluid is then absorbed through the pleural and mediastinal lymphatics

24

What is constrictive pericarditis?

The heart becomes encased within a rigid fibrotic pericardial sac which prevents adequate diastolic filling of the ventricles.

25

What are the clinical features of constrictive pericarditis?

The clinical features resemble those of right-sided heart failure:
Jugular venous distension
Dependent oedema
Hepatomegaly
Ascites
Kaussmaul's sign
Pulsus paradoxus
Atrial fibrillation
Pericardial knock on auscultation (caused by rapid ventricular filling)

26

What is Kussmaul's sign?

JVP rising paradoxically with inspiration. Indicative of impaired right ventricular filling due to heart failure

27

What other condition can constrictive pericarditis not be distinguished from clinically?

Restrictive cardiomyopathy

28

How is diagnosis of constrictive pericarditis made?

CT or MRI which show pericardial thickenick and calcification

29

How is constrictive pericarditis treated?

Surgical excision of the pericardium