Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ICM Exam 3 Cardiology > Pericardial Disease - Tubin > Flashcards

Pericardial Disease - Tubin Flashcards

1
Q

Pericardium - amt of plasma ultrailtrate

A

15-50 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pericarditis can be ___ or ____

A

acute or recurrent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute Pericarditis - most common cause

A

idiopathic

(always say “viral”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of acute pericarditis (5)

A
  1. Radiation
  2. Neoplasm (primary, met, or paraneo)
  3. Trauma
  4. AI
  5. Metabolic (Hyperthyroid, Uremia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In trauma-induced pericarditis, inflammation in the chest will be accompanied by

A

effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Infecirious causes of pericarditis

A

Viral = Cox AB, Echo, mumps, adeno, HIV

Bacterial = TB, Pneumococcus, strep, staph, legionella

Fungal = histo, coccidio, candida, blasto

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Infectious pericarditis rarely caused by

A

syphillis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

____ pericarditis d/t TB

A

Purulent

(PICTURE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pericardial effusion can cause partial _________

A

collapse of atria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cardiac causes of Pericard.

A

Early infarction

late post cardiac injury (dresslers)

Myocarditis

Dissecting aortic aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dressler’s syndrome =

A

late post cardiac injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Difficult to tell _______ with echo

A

nature of effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Unstable pericardial effusion - what not to do

A

immediately drain- have to rule out aortic dissection because if present, you’ve just opened up a space for blood to enter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Blood clots forming in P. effus. may appea ____ on echo

A

strand-like

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drug induced pericarditis caused by…

A

Procainamide

Isoniazid

Hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Usually fluid is ______

Look for what?

Sometimes you’ll see ____ in bact. infection

A

serous

bacterial or tumor cells

Purulent pericarditis – need aggressive Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Fluid in PEff may…

A

resolve or form adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Clinical features of pericarditis

A
  • CHEST PAIN (main)
  • Friction rub
  • ECG changes
  • Pericrdial effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Friction rub is

A

3 component rub

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Best diagnostic tool for acute pericarditis

A

ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Chief complaint for pericarditis

A

Chest pain unrelated to exertion

(nonspecific complaints = Fatigue, dyspnea, malaise, fever)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Differentiate from MI in complaint

A

MI doesn’t tend to have many preceding symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Chest pain is present in ____

A

95% of cases

more comon with infection, less common with uremic or rheum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Chest pain locaiton

A

anterior chest wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Chest pain description

Better/worse when…

A

Sudden onset

Sharp, pleuritic in nature

  • Worse when laying flat, inspiration, or coughing,
  • Better when seated or leaning forward.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Rub is d/t

A

friction between visceral and parietal layers of pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

3 parts of rub

A

First == systole

Second = ventricular diastole

Third = atrial systole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Rub description

A

triphasic (50-60%)

Biphasic (30%)

scratchy/leathery sound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Eval for acute (8)

A
  1. History, exam, ECG
  2. ESR, CBC, chem
  3. Troponin
  4. CXR
  5. Echo (if suspected effusion)
  6. NO viral studies
  7. AI serologies
  8. Pericardiocentesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

CXR in acute pericarditis is…

A

usually normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When do you do an echo with acute pericarditis

A

if suspected concurrent effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

____ helps you decide urgency /necessity of hospitalization

A

troponin

(rule out MI)

33
Q

May see _____ in echo which is relatively ______

A

increase in brightness

nonspecific

34
Q

ECG findings with acute pericarditis

A

ST segment (esp in aVr)

PR segment

35
Q

Type of ST change we are looking for in AP

A

diffuse ST concavity

(vs ischemic change which would be very location specific depending on the occluded vessel)

36
Q

PR change we look for in AP

A

PR depression

37
Q

Changes in aVr are ______

A

Inverse

**impotant, will show ST depressions and PR elevations**

38
Q

Stadium 2 =

A

Smaller PR

39
Q

Stadium 3

A

T wave inversion

40
Q

In Early repolarization slide, J point and ST elevtion is most prominent in

A

V4-6

41
Q

Ddx

A
  • Acute coronary syndrome
  • myocarditis
  • pleurisy
  • PNA
  • PE
  • Aoritc dissection
  • Pneumothorax
  • Musculoskeletal
  • Esophageal
42
Q

Medical therapy

A

Combo of NSAID and Colchicine

Colchicine = 3 months

NSAIDS = indometh, ibuprofen for 1 month (and titrate down before stopping)

43
Q

Would not use ibuprofen after…

A

MI

use high dose aspirin instead

44
Q

Colchiine AE

A

diarrhea

P450 metabolism (DDI)

45
Q

Colchicine not good with

A

severe renal or liver disease

blood dyscrasias or GIT motility problems

46
Q

Cautions use of NSAIDS with

A

renal insufficiency

47
Q

Glucocorticoids for

A

refractory symptoms

Acute pericarditis due to connective tissue or uremic

48
Q

P effusion creates

A

tamponade

if starts pushing on heart

49
Q

Types of effusion

A

fast and small

slow and large

50
Q

3 Complications of AP

A

effusion and tamponade

constrictive pericarditis (late)

Relapse

51
Q

9 Causes of Pericard eff

A
  1. Acute pericarditis
  2. Radiation
  3. Malignancy
  4. Cardiac perforation
  5. Hypothyroidism
  6. Connective Tissue disease
  7. Post-MI
  8. Chronic Renal failure
  9. Aortic dissection
52
Q

CXR appeaerance of Peri effusion

A

Highly enlarged shadow

53
Q

Main tool for pericardial effusion

A

Echo

54
Q

Presentation of Tamponade

A

(depends on chronicity)

  • CHF Sx – Dyspnea, fatigue (but clear lungs)
  • Unexplained RHF symptoms (Edema, JVP)
  • New cadiomegaly on CXR
  • Sinus Tach, Low voltage electrical alternans
55
Q

ECG finding in P effusion/tamponade

A

Electrical alternans

56
Q

Tamponade pathophys (6)

A
  1. Increased Intrapericardial pressure (impees diastolic filling of LV)
  2. Diastolic pressure rises in RV and LV
  3. SO and CO decrease
  4. BP drops
  5. Narrow PP
  6. HR increases
57
Q

Pulsus paradoxus

A

Fall of systolic BP >10 mmHg with inspiration

(Exaggerated drop in systemic BP during inspiration)

58
Q

Inspiration causes diaphragm to fall and

A

RV to fill passively and expand (to an extent)

59
Q

If heart is constrained, the venous return causes

A

Septal shift to compress/impinge on the LV volume

–>Pulsus paradoxus

60
Q

How to check for pulsus paradoxus

A
  1. Get BP regularly
  2. Slowly pump up cuff 20mm above first korotkoff sound
  3. Slowly deflate and let breathe naturally
  4. Hear occasional waves that get through
  5. Start hearing more frequent sounds as cuff sounds (until hearing every heart sound)
  6. Pulsus paradoxus difference will be more than 10
61
Q

Tamponade findings (5)

A
  • Tachycardia + Tachypnea
  • Hypotension with narrow PP
  • Elevated JPV with loss of Y descent
  • Peripheral Edema
  • Pulsus Paradoxus
62
Q

JVP components

A

A = atrial contract

V = Passive filling

X trough = Drop in atrial pressure after active contraction

Y trough = ventricle filling after mitral opening

63
Q

Eval for Tamponade

A

History/Exam

ECG + CXr

Echo with doppler

RIght heart cath (to equalize pressure)

64
Q

Treatment for Tamponade

A

*Medical emergency*

  • IVF (temporizing)
  • Vasopressors as needed
  • Pericardiocentesis
  • Pericardial window
65
Q

Avoid what in tamponade treatment

A

diuretics, vasodilators, etc.

last thing you want to do is decrease the vascular volume

66
Q

Three ECG findings for Tamponade

A

Sinus tach

low voltage

Electrical alternans

67
Q

Pericardial fluid analysis (5)

A
  • Gram stain and bacterial/fungal culture
  • Cytology
  • AFB stain and mycobact culture with ADA, IFNg, or lysozyme
  • PCR
  • Protein, LDH, RBC/WBC
68
Q

Labs for Tamponade

A

Cardiac enzymes

Inflammatory (CRP, ESR)

Thyroid

Renal fxn

Body fluid cultures

PPD

69
Q

Constrictive pericarditis pathophys

A

Chronic thickening/scarring

encasement of heart and impaired diastolic fililng

EARLY DIASTOLIC FILLING IS OKAY

Chambers collide with constricted pericardium upon filling

70
Q

Signs for constric. pericarditis

A

Dip and Plateau sign

OR

Square root sign

71
Q

Causes of constritive peric.

A

idiopathic/viral

Surgery

Radiation

CT disease

TB, bact

misc

72
Q

Clinccal presentation of CP

A

Slow indolent process

Unexplained RHF

73
Q

Const. pericard is often misdiagnosed as..

A

cirrhosis

74
Q

Constrictive pericard physical findings

A

Elevated JVP (prominent X and Y)

Kussmaul’s sign

Pericardial knock

Systemic congestion

75
Q

Kussmauls sign =

A

Lack of an inspiratory decline in JVP

(JVP normally dips on inspiration, in kussmauls it is increased– because the blood that is pulled in has nowhere to go due to restriction, and it backs up)

76
Q

Tamponade vs Constriction JVP

A

No Y descent on tamponade

Constriction has prominent X and Y

77
Q

Constrictive Pericarditis evaluation (6)

A
  • H+P
  • CXR
  • Chest CT (pericardial thickening)
  • MRI
  • Echo
  • Simultaneous R and L heart hemodynamics (equalization of pressures)
78
Q

Constrictive pericarditis on XRAY

A

pericardial thikening and calcification that even hellen keller could see

79
Q

Therapy for constrictive pericarditis

A

Acute = diuresis (but don’t overdiurese, only until Sx relieved)

Long term = Pericardial stripping (surgery)

ICM Exam 3 Cardiology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions