Pericardial Disease

Question 1

Hemodynamic findings in tamponade

Answer 1

Equalization of LV and RV pressures

Question 2

If pt has breast CA, what cardiac issues should you think of?

Answer 2

CM, constriction or tamponade

Question 3

Where can pericarditis pain radiate to?

Answer 3

Trapezius

Question 4

What is the yield of serologic studies in acute pericarditis?

Answer 4

Low

Question 5

COPE trial results for acute pericarditis

Answer 5

Colchicine reduced recurrence rates vs placebo

Question 6

2 side effects of colchicine

Answer 6

Diarrhea

Bone marrow suppression

Question 7

Can colchicine be given in renal or hepatic dysfxn?

Answer 7

No

Question 8

In what case are colchicine’s side effects pronounced?

Answer 8

Interaction with CYP3A4 drugs (CCB, Amio, cyclosporine)

Question 9

Steroids should be avoided in acute pericarditis unless …?

Answer 9

Contraindications to colchicine
Connective tissue dz
Uremic pericarditis

Question 10

Diagnostic criteria for post-pericardiotomy syndrome?

Answer 10

2 of the following:

Pleuritic CP, friction rub, pleural effusion, new or worsening pericardial effusion, fever > 1wk postop

Question 11

Definition of myopericarditis

Answer 11

Elevation of cardiac enzymes or new LV dysfxn

Question 12

What population is prone to get myopericarditis?

Answer 12

Male age<40

Question 13

definition of pulsus paradoxus (Tamponade)

Answer 13

inspiratory decrease in SBP >10

Question 14

what causes false positive results for pulsus paradoxus, making you think there is tamponade?

Answer 14

COPD, PE, constriction

Question 15

what causes false negatives for pulsus paradoxus?

Answer 15

LVH, AI, ASD, vent, localized effusion, severe hypotension

Question 16

Rx of tamponade

Answer 16

IVF, inotropes/vasopressors if hypotension persists, pericardiocentesis, avoid vent

Question 17

what is appearance of Y-descent in constrictive pericarditis?

Answer 17

prominent

Question 18

inc’d RAP, prominent y-descent, tachycardia. Most likely Dx?

Answer 18

constrictive pericarditis

Question 19

description of constrictive pericarditis

Answer 19

obliterated pericardial space and adhesive pericarditis

Question 20

top 5 etiologies behind constrictive pericarditis

Answer 20

idiopathic, prioir cardiac Sx, pericarditis, mediastinal radiation, CTD

Question 21

what sxs will pt get in constrictive pericaditis if RA = LA are 10mmHg?

Answer 21

hepatomegaly, edema

Question 22

what sxs will pt get in constrictive pericaditis if RA = LA are > 18mm Hg?

Answer 22

dyspnea, orthopnea

Question 23

what stage of cardiac cycle do restrictive and constrictive CM effect mainly?

Answer 23

diastole

Question 24

what is the systolic function (usually) in constriction or restriction?

Answer 24

normal

Question 25

what is the Kussmaul sign and what dz state is it seen in?

Answer 25

- elevated JVP on inspiration | - constrictive pericarditis

Question 26

what is Friedrich's sign and what dz state is it seen in?

Answer 26

- prominent Y descent | - constrictive pericarditis

Question 27

what do you see on mitral and tricuspid inflow velocities on echo (E wave) in constrictive pericaditis?

Answer 27

respiratory flow variation

Question 28

on echo in constrictive pericarditis, what is the septum doing?

Answer 28

diastolic bounce

Question 29

what do the atria look like on echo in constrictive pericarditis?

Answer 29

dilated despite TR/MR

Question 30

what is an abnormal pericardial thickness?

Answer 30

>4mm

Question 31

ventricualr interdependence

Answer 31

constriction

Question 32

what is the PASP usually in constrictive pericarditis? restrictive?

Answer 32

constrictive PASP < 50 | Restrictive PASP > 80

Question 33

the number one reason to suspect constriction

Answer 33

LV/RV interdependence

Question 34

what pattern will MV inflow have on echo in constrictive pericarditis?

Answer 34

restrictive pattern

Question 35

3 factors that deme a worse prognosis s/p pericardiectomy for constriction

Answer 35

age, NYHA class, post-radiation as cause

Question 36

First line agents to treat acute pericarditis

Answer 36

NSAIDs and colchicine

Question 37

when do you give corticosteroids for acute pericarditis? why?

Answer 37

- refractory cases or contraindications to first line therapy - b/c of higher rate of recurrent pericarditis

Question 38

dissociation of intra-thoracic and intra-cardiac pressures

Answer 38

constrictive pericarditis

Question 39

what is LVEDP-RVEDP in constriction?

Answer 39

<5mmHg

Question 40

what is PASP in constriction?

Answer 40

<55mmHg

Question 41

RVEDP/RVSP in constriction

Answer 41

> 1/3

Question 42

if LVEDP-RVEDP > 5mmHg and RVEDP/RVSP < 1/3 and PASP > 55, is it constriction or restriction?

Answer 42

restriction

Question 43

Jugular venous exam finding in tamponade

Answer 43

Blunted or absent y descent