Pericardial Disease

Question 1

Mono layer of mesothelioma cells and collagen and elastin fibers adherent to the pericardial surface of the heart

Answer 1

Visceral pericardium

Question 2

2mm thick, and largely acellular and contains collagen and elastin fibers

Answer 2

Fibrous parietal pericardium

Question 3

Fixes the heart within the mediastinum and limits its motion

Answer 3

Pericardium

Question 4

Pericardial inflammation of no more than 1 to 2 weeks duration that can occur in a variety of diseases but most cases are considered idiopathic

Answer 4

Acute pericarditis

Question 5

Most idiopathic pericarditis cases are presumed to be

Answer 5

Viral

Question 6

What are the 4 clinical features of acute pericarditis?

Answer 6

Pleuritic chest pain, pericardial friction rub, fever, and ECG abnormalities

Question 7

Relieved by sitting forward and worsened by lying down

Answer 7

Pleuritic chest pain

Question 8

Made up of three components, ventricular systole, early diastolic filling, and atrial contraction

Answer 8

Pericardial friction rub

Question 9

How do we treat relapsing and recurrent pericarditis?

Answer 9

NSAIDs, colchicine, and prednisone

Question 10

Up to 60% of infectious etiologies of pericarditis cause a late scarring complication called

-Uncommon after viral pericarditis

Answer 10

Constrictive pericarditis

Question 11

Most cases of pericarditis respond to treatment with an

Answer 11

NSAID and Colchicine

Question 12

Should be avoided in treating pericarditis

Answer 12

Glucocorticoids

Question 13

Idiopathic pericarditis or any infection, neoplasm, autoimmune, or inflammatory process that can cause pericarditis can also cause a

Answer 13

Pericardial effusion

Question 14

Collection of fluid between visceral and parietal pericardium

Answer 14

Pericardial effusion

Question 15

Soft heart sounds and reduced intensity of pericardial friction rub are the clinical features of

Answer 15

Pericardial Effusion

Question 16

Dullness over posterior left lung that is indicative of pericardial effusion

Answer 16

Edward sign

Question 17

An ECG characteristic of pericardial effusion is

Answer 17

Electrical alternans (an alternating between QRS amplitudes)

Question 18

When fluid accumulates in the pericardial space under high pressure, compresses the cardiac chambers, and comprises cardiac output

Answer 18

Cardiac Tamponade

Question 19

The primary effect of high pericardial pressure in cardiac tamponade is to impede filling of the

Answer 19

Right side of the heart

Question 20

Characterized by elevated and equal interactivity pressures w/ low transmural filling pressures and low cardiac volumes

Answer 20

Cardiac Tamponade

Question 21

Shows loss of the Y descent of right atrial or systemic venous pressure wave

Answer 21

Cardiac tamponade

Question 22

Pulses paradoxus is indicative of

Answer 22

Cardiac Tamponade

Question 23

Normally begins when the tricuspid valve opens, i.e. when blood is not leaving the heart

Answer 23

Y descent

Question 24

In cardiac tamponade, blood can only enter the heart when blood is also simultaneously

Answer 24

Leaving

Question 25

Therefore, in tamponade, inflow can not increase until blood is also leaving so we lose

Answer 25

Y descent

Question 26

Occurs during ventricular ejection

Answer 26

X descent

Question 27

Thus, in tamponade, because blood is leaving the heart, inflow can increase and thus

Answer 27

X is maintained

Question 28

The phenomenon of systolic BP declining slightly following inspiration

Answer 28

Pulsus Parodoxus

Question 29

In cardiac tamponade, both ventricles share a fixed volume due to the external compression by the tense pericardial fluid. This we see an exaggeration of

Answer 29

Pulsus Paradoxus

Question 30

Can be caused by pericarditis or acute hemorrhage into the pericardium

Answer 30

Cardiac Tamponade

Question 31

What are the two major features of cardiac tamponade

Answer 31

Beck’s triad and pulsus paradoxus

Question 32

What is Beck’s triad?

Answer 32

Hypotension, muffled heart sounds, and elevated JVP

Question 33

To treat cardiac tamponade, we want to perform and urgent or emergency closed

Answer 33

Pericardiocentesis

Question 34

Until pericardiocentesis can be performed, we want to give IV saline and

Answer 34

Isoproterenol

Question 35

The end stage of an inflammatory process involving the pericardium, resulting in dense fibrosis, calcification, and adhesion of parietal and visceral pericardium

Answer 35

Constrictive pericarditis

Question 36

The pathophysiological consequence of constrictive pericarditis is markedly restricted

Answer 36

Filling of Heart

Question 37

In constrictive pericarditis, almost all filling occurs early in

Answer 37

Diastole

Question 38

Results in systemic venous congestion which results in hepatic congestion’s, peripheral edema, ascites, anasarca, and cardiac cirrhosis

Answer 38

Constrictive pericarditis

Question 39

Failure of transmission of changes in intrathoracic pressure to the cardiac chambers is an important contributor to the pathophysiology of

Answer 39

Constrictive Pericarditis

Question 40

W/ constrictive pericarditis, the decrease in intrathoracic pressure on inspiration is transmitted to the pulmonary veins but not to the

Answer 40

Left side of the heart

Question 41

In constrictive pericarditis, the high systemic pressures and reduced cardiac output result in the kidneys retaining

Answer 41

Sodium and water

Question 42

Characterized by reduced CO, elevated systemic venous pressures, pericardial knock, and Kussmaul sign

Answer 42

Constrictive pericarditis

Question 43

An early diastolic sound heard best at the LLSB and or cardiac apex

Answer 43

Pericardial knock

Question 44

Inspiration increase in venous pressure

Answer 44

Kussmaul sign

Question 45

When differentiating between constrictive pericarditis and cardiac tamponade, what is highly indicative of cardiac tamponade?

Answer 45

Pulsus Paradoxus

Question 46

When differentiating between constrictive pericarditis and cardiac tamponade, what is highly indicative of constrictive pericarditis?

Answer 46

Kussmaul sign

Question 47

In JVP recordings, the 1. ) y descent is lost in? 2. ) y descent is normal in?

Answer 47

1. ) Tamponade | 2. ) Constrictive pericarditis

Question 48

We also must differentiate between constrictive pericarditis and

Answer 48

Restrictive cardiomyopathy (e.g. amyloid)