pericardial disease Flashcards Preview

songraphy theory > pericardial disease > Flashcards

Flashcards in pericardial disease Deck (27)
Loading flashcards...

Visceral Pericardium

moist outer cardiac membrane


Parietal Pericardium

Has two layers:
-Fibrous: outer layer, adjacent to pleura and diaphragm
-Parietal Serous: moist membrane that lines the outer fibrous layer
Fluid generally collects between the parietal and the epicardium



collapsed portion of lung (seen in pleural effusion)


Clinical Signs of Pericarditis

-Chest Pain (typically worse when supine and with inspiration)
-Widespread ST elevation on EKG
-Pericardial friction rub on auscultation
-New or increasing pericardial effusion

Other possible signs: dyspnea, tachy, palpitations, fever
Increased troponin seen in 50% of cases (especially if young, male, ST elevation, and associated effusion)


Otto Rating Scale for Pericardial Effusion

Based on the degree of separation between the parietal and visceral layer
-Small <0.5 cm
-Moderate 0.5 - 2.0 cm
-Large >2.0 cm


What quantifies tamponade?

RA collapse and swinging motion (A4)


Reynolds Rating Scale for Pericardial Effusion

-Small S/D posterior <1 cm
-Moderate S/D posterior/anterior <1 cm
-Large S/D posterior/anterior >1 cm


Pericardial Effusion VS Pleural Effusion

Pericardial: anterior to the DA
Pleural: posterolateral to the DA


Loculated Pericardial Effusion

Localized by adhesions to a small area of pericardial sac (or several small areas)
-look in multiple windows
-common post-op and in recurrent pericardial disease
-can be hemodynamically significant, percutaneous pericardiocentesis may not be possible


If echo free space is small and anterior to RV (PLAX) it is likely _________

epicardial fat pad


if isolated echo free space is superior to RA in A4 it is most likely ____________

pleural effusion


pericardial cysts

benign, echo free shell can compress atria leading to arrhythmia, syncope



common against RA post surgery



from myocardial rupture


Cardiac Tamponade

-occurs when pericardial effusion causes pressure in pericardium to exceed pressure in chambers impairing cardiac filling
-can occur with small amount accumulating quickly (perforations) or large amounts occurring over period of time (metastatic responsible for 32% of tamponades)


Signs and Symptoms of Cardiac Tamponade

-signs of low CO: dyspnea and tachy most common
-cough (overload to lungs)
-JVD (overload to venous)
-Hoarseness, difficulty swallowing (nerve compression)
-low voltage EKG, electrical alternans
-possible signs of pericarditis (CP, EKG changes, rub)


Auscultations of Cardiac Tamponade

-Distant heart sounds
-Pulsus Paradoxus: an inspiratory decline in systolic BP >10 mmHg; by palpation this is a weakening of the pulse during inspiration


Echo Findings for Cardiac Tamponade

-Large PE and swinging heart
-RA systolic collapse
-RV diastolic collapse
-LV may appear hyperkinetic as it seeks volume to circulate
-Reciprocal respiratory changes in ventricular volumes
-Reciprocal respiratory changes in ventricular inflow velocities
-Enlarged nonpulsatile IVC (plethora)


Using Doppler to rule in Cardiac Tamponade

-We look for respiratory variation in diastolic inflow velocities >25%
-WHY; total pericardial volume (heart chambers plus pericardial volume) is fixed so that respiratory changes are exaggerated
-PW at RVIT and LVIT; caliper many peak inflow velocities (sweep speed 25)
-changes will be similar at other heart locations


Treatment for Cardiac Tamponade

-Treat etiology of tamponade
-Volume expansion (IV fluids)
-Pericardiocentesis (echo guided to reduce complications) needle is in sack when bayonet sign is seen; can inject contrast to determine if in pericardial sack
-Pericardial Window


Constrictive Pericarditis

Visceral and Parietal layers become adherent, thickening and fibrotic impairing diastolic filling "acting like a rigid box" leading to decreased cardiac output


Signs and Symptoms of Constrictive Pericarditis

-Dx is often delayed, Sx subtle or occur late
-Malaise (generalized feeling of discomfort, illness, weakness)
-Peripheral Edema
-Low voltage EKG (more common in tamponade)


Auscultations in Constrictive Pericarditis

-Distant heart sounds
-Diastolic pericardial knock (as inflow abruptly stops)
-Pulsus Paradoxus (more common in tamponade)


Treatment for Constrictive Pericarditis

Pericardiectomy: stripping of pericardium with 5-15% early surgical mortality


2D Echo Findings for Constrictive Pericarditis

-Normal to dilated atria (due to chronic atrial pressure elevation)
-Dilated IVC/hepatic veins due to elevated atrial pressures
-Echogenic pericardial thickening may be evident
-Bouncing appearance at ventricular/pericardial border with lack of "pericardial slide"
-Septal shift with inspiration (bouncing)


M-Mode Echo Findings for Constrictive Pericarditis

-Multiple dense echoes posterior to LV "railroad track sign"
-Diastolic septal or "Spanish" notch
-LVPW: early diastolic descent followed by flattening (AKA square root sign)
-Exaggerated premature opening of PV


Doppler Echo Findings for Constrictive Pericarditis

-As in tamponade, respiratory variations in diastolic filling velocities >25%
-Respiratory changes will be similar at other right and left heart locations
-LV and RV inflow shows prominent E, rapid decal slope, and small A
-IVRT demonstrates respiratory changes with increased time in inspiration