Pericardial Disease Flashcards Preview

Clin Med I- CARDIO > Pericardial Disease > Flashcards

Flashcards in Pericardial Disease Deck (33)
Loading flashcards...
1
Q

Layers of pericardium

A

Fibrous pericardium, serous parietal, and serous visceral

2
Q

Normal amount of pericardial fluid

A

5-10 ml

3
Q

What is the most common disorder involving the pericardium?

A

Acute pericarditis- inflammation of the pericardial sac

4
Q

Acute pericarditis causes

A

Infection, autoimmune, CT disease, Neoplasms, radiation, chemo, cardiac surgery, post MI

5
Q

Example of post-MI pericarditis

A

Acute pericarditis, Dressler’s syndrome- acute illness occurring weeks to months after an MI

6
Q

Major clinical manifestation of acute pericarditis

A

Pleuritic Chest pain- sharp and pleuritic, often sudden in onset and over anterior chest, also pericardial friction rub

7
Q

What would you suspect if you heard superficial scratchy or squeaking sound with diaphragm over Left sternal border

A

Pericardial friction rub- a major characteristic of acute pericarditis

8
Q

Male patient 40 years old presents with pleuritic chest pain, described as sharp and sudden.” With stethoscope, you hear a squeaking sound over the left sternal border. Cardiac biomarkers are elevated, including troponin I and T. ECG shows ST elevation and PR depression. CXR and Echocardiography are normal. You check WBC, ESR, and Serum C-reactive protein, tuberculin test, and antinuclear antibody titer. What do you suspect?

A

Acute pericarditis

9
Q

When would echocardiography not be normal in acute pericarditis?

A

if associated pericardial effusion. Definitely order if cardiac tamponade suspected

10
Q

What organism is most often responsible for bacterial pericarditis?

A

Staph aureus

11
Q

You suspect acute pericarditis in patient but are unsure of whether it is bacterial or viral. Why is it important to differentiate?

A

Affects treatment options. Viral usually resolves within 1 month with bed rest and analgesics. Bacterial pericarditis- requires decompression of the pericardial space, IV Abx therapy for 1 month, supportive therapy

12
Q

Why should hemorrhagic pericarditis with effusion accumulation secondary to trauma be drained?

A

Because of risk of subsequent development of constrictive pericarditis

13
Q

Different types of recurrent pericarditis include

A

Rheumatolic, Uremic pericarditis, neoplastic pericarditis

14
Q

Rheumatologic pericarditis tx

A

corticosteroids and/or salicylates

15
Q

Urmic pericarditis tx

A

dialysis, pericardiotomy

16
Q

Neoplastic pericarditis tx

A

Treat primary disease, pericardiocentesis if indicated

17
Q

Type of fluid in pericardial effusion

A

Serous fluid, serosanguinous fluid, blood, pus, chyle

18
Q

Patient presents with persistent pain in chest. He had viral pericarditis 1 month ago which seems to have resolved. You hear muffled heart sounds and dullness and decreased breath sounds over L posterior lung (Ewart’s sign). You suspect…

A

Pericardial effusion

19
Q

What is Ewart’s sign and what is it associated with?

A

Dullness and decreased breath sounds over posterior L lung due to compression by large pericardial sac- seen in pericardial effusion

20
Q

Diagnosis of pericardial effusion

A

History, PE, ECG, CXR. Very similar to pericarditis. Cardiomegaly may occur due to pericardial effusion.

21
Q

Patient presents with dyspnea, fatigue, cough, and shock. PE shows pulsus paradoxus. ECG- electrical alternans. Beck’s triad also present. Diagnosis?

A

Cardiac Tamponade

22
Q

Beck’s triad

A

Elevated venous pressure, hypotension, quiet heart- seen in cardiac tamponade

23
Q

Pulsus paradoxus

A

exaggerated drop in SBP with inspiration

24
Q

Tx of cardiac tamponade

A

pericardiocentesis, pericardial window

25
Q

Tx of constrictive pericarditis

A

Pericardiectomy

26
Q

Patient presents with Kussmaul’s sign, dyspnea, ascites, edema, and pericardial KNOCK. Diagnosis and what do you suspect?

A

Suspect constrictive pericarditis. Xray- calcified pericardium. CT scan, MRI- thickened pericardium. Pericardial biopsy, cardiac cathetirization- restricted filling pattern in RV

27
Q

Pericardial KNOCK

A

Abrupt cessation of early diastolic inflow. often best heart during inspiration.

28
Q

What is classic in constrictive pericarditis

A

Pericardial Knock

29
Q

What type of pericarditis is very similar to Restrcitive cardiomyopathy?

A

Constrictive pericarditis

30
Q

Abnormal diastolic filling pattern in both constrictive pericarditis and cardiac tamponade. Reasons..

A

Cardiac tamponade- increased accumulation of fluid in pericardial sac causes increased intra-pericardial pressure which causes less diastolic filling. In constrictive pericarditis, pericardium becomes fibrous, thickened so ventricles are unable to open up as much

31
Q

Tx of constrictive pericarditis vs. cardiac tamponade

A

constrictive pericarditis- pericardioectomy. cardiac tamponade- pericardiocentesis, pericardial window

32
Q

Patient just had a MI. Is now experiencing pericardial friction rub, pleuritic pain, fever. What do you suspect?

A

Dressler’s syndrome (Post-MI pericarditis)

33
Q

You are trying to figure out if patients sharp chest pain is due to pericarditis. What do you ask them?

A

Does you pain improve when you sit up and lean forward? Does it improve upon inspiration? If yes, then diagnosis more favored.