Pericardial Disease

Question 1

Treatment for chylopericardium

Answer 1

Diet with medium chain triglycerides first
Occurs from disruption of thoracic duct periop
If persistent surgery needed

Question 2

Constrictive pericarditis

Answer 2

dilated IVC
Mitral inflow E peak wave fall of >25% on inspiration
Expiratory flow reversal hepatic veins
Ventricular interdependence
RV pressure increases, LV pressure decreases during inspiration

Question 3

Pericarditis recurrence

Answer 3

Induced by steriod therapy

Colchicine REDUCES pericarditis recurrence

Question 4

Pulsus Paradoxus

Answer 4

> 10mm drop in SBP with inspiration

can also occur with COPD, PTX, OSA (all cause swings in intrathoracic pressure)

Question 5

Cardiac tamponade hemodynamics

Answer 5

JVP
Kusmal’s sign - inspiratory increase in JVP
Loss of Y descent on RA tracing
Pulsus Paradoxus

Question 6

SLE

Answer 6

pericarditis
Diffuse ST elev (concave up)
PR depression except AVR (PR elev and ST dep)
check TTE

Question 7

Cardiac Tamponade by Echo

Answer 7

>30% Mitral flow variation
>60% Tricuspid flow variation
IVC diliations (inc'd central venous pressure
Right heart diastolic collapse

Question 8

Tamponade

Answer 8

ECG
low votage
Electrical alternans

Question 9

Tamponade

Answer 9

tachycardia
Jugular distension
PEA arrest
Pulsus paradoxus >10 with inspiration
loss of y-descent (no filling of RV)
ventricular interdependence (dec SV with inspiration -> inc'd flow into RV -> septum bulges into LV)

Question 10

Constrictive pericarditis

Answer 10

impaired filling pressures, reduced ventricular fxn
inc’d pericardial thickness not required
fatigue, edema, +kusmal, JVD, abdomenal swelling
RHF
Risk factors - CT based surgery, mantle radiation, recurrent percarditis

Mantle radiation can cause ostial CAD and valvular dz

Sx pericardial effusion/tamponade would have pulsus paradoxus

Question 11

Acute pericarditis

Answer 11

ibuprofen 1-2 wks

colchicine 8-12 wks

Question 12

Myxedema pericardial effusion

Answer 12

high triglyceride

Question 13

Tuberculosis pericardial effusion

Answer 13

Adenosine deaminase >40, elevated protein, elevated LDH

Question 14

Pericardiocentesis

Answer 14

if unsure of where needle is - transduce needle…

Question 15

Etiology of pericardial effusion

Answer 15

pericarditis
myxedema (thyroid)
Dresslers
Radiation
uremia
malignancy
infections (TB)
autoimmune conditions
medications (hydralazine)