Pericardial Disease

Question 1

Causes of pericarditis

Answer 1

Mostly idiopathic/viral
Infectious
Metabolic (uremia is common)
Post-MI, post-cardiac surgery

Question 2

Triad of acute pericarditis

Answer 2

Chest pain (pleuritic, better when leaning forward)
Friction rub
ECG changes

+/- fever, malaise

Question 3

ECG signs of pericarditis

Answer 3

Diffuse ST elevations (concave up)

PR depressions

Question 4

CXR of pericarditis

Answer 4

normal heart size

pulmonary infiltrates

Question 5

ECHO for pericarditis

Answer 5

Looking for pericardial effusion

Question 6

Treatment of acute pericarditis

Answer 6

Treat underlying cause

NSAIDs, steroids if severe, analgesia

Question 7

Causes of pericardial effusion

Answer 7

Transudative: CHF, hypoalbuminemia

Exudative: Infection (similar to pericarditis), hemopericardium following trauma, necrosis, etc.

Question 8

Signs and symptoms of pericardial effusion

Answer 8

Asymptomatic or similar to acute pericarditis

Elevated JVP
Distant heart sounds
Dyspnea, cough

Question 9

ECG of pericardial effusion

Answer 9

Low voltage
Flat T waves
Electrical alternans (varying QRS height)

Question 10

Echo of pericardial effusion

Answer 10

Fluid in pericardial sac

Question 11

CXR of pericardial effusion

Answer 11

Cardiomegaly

Question 12

Treatment of pericardial effusion

Answer 12

Serial echos to observe
Treat underlying cause
Anti-inflammatory agents

Treat as tamponade if severe

Question 13

Causes of cardiac tamponade

Answer 13

Rapidly accumulating pericardial effusion

Any cause of pericarditis (esp. trauma, malignancy, uremia, proximal dissection with rupture)

Question 14

Diagnosis of cardiac tamponade

Answer 14

Clinical diagnosis

Question 15

Beck’s Triad of cardiac tamponade

Answer 15

Hypotension
Elevated JVP
Muffled heart sounds

Question 16

Quartet of cardiac tamponade

Answer 16

Beck’s triad (high JVP, HoTN, muffled HS)

PLUS pulsus paradoxus

Question 17

Signs/symptoms of cardiac tamponade

Answer 17

Tachypnea, dyspnea, shock, muffled heart sounds
Pulsus paradoxus (inspiratory fall in sBP>10)
Hepatic congestion/peripheral edema

Question 18

ECG of cardiac tamponade

Answer 18

electrical alternans (pathognomonic variation in R wave amplitude)
low voltage

Question 19

Echo of cardiac tamponade

Answer 19

Pericardial effusion

Compression of cardiac chambers in diastole

Question 20

Treatment of cardiac tamponade

Answer 20

Pericardiocentesis
Pericardiotomy

Avoid diuretics and vasodilators (decreases preload in already underfilled RV, reduces CO)

Treat underlying cause