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Flashcards in Pericardial Dz Deck (10)
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1

Acute pericarditis
-what is this?
-causes
-clinical findings (sx and PE)
-Dx findings

What is this:
-sudden inflammation of the pericardium from a variety of conditions.

Causes:
-infectious**
-Metastatic Neoplasm
-Medications (Procainamide & hydralazine)
-Bacterial
-Systemic dz
-Radiation
-Dressler Syndrome

Clinical findings:
-chest pain
-dyspnea
-febrile
-Pericardial friction rub

Dx Findings:
- Leukocytosis
-elevated sed rate (ESR)
-Troponin (will remain steady, whereas in MI it will spike up and then go down over the next 24hrs)
-CXR
-EKG

2

Acute Pericarditis EKG findings

-PR depressions
-ST elevations
*on the same lead

3

Acute Pericarditis Tx

-Treat underlying cause*
-NSAID and Aspirin
-Colchicine
-Systemic Corticosteroids ( severe sx, refractory, autoimmune disorders)

4

When to hospitalize Acute Pericarditis

-fever and leukocytosis
-evidence of cardiac tamponade
-anticoagulation
-failure to respond within 7 days to NSAID therapy

5

Chronic/Recurrent Pericarditis
-what is this?
-common cause
-clinical findings
-Imaging
-Treatment
-predictor of recurrence

What is this:
-syndrome in which acute pericarditis recurs after the agent causing the acute attack has been treated or disappears. Usually occurs 6weeks-18mo after acute attack.

Most Common cause
-autoimmune

Clinical Findings:
-pleuritic chest pain +/- exertion
-Dyspnea

-Imaging:
-EKG
-Echocardiogram
-CXR

Tx:
-Combo of NSAIDS and Colchicine
-Glucocorticoids
-Activity restrictions
-pericardiectomy


Predictor of recurrence:
-glucocorticoids use initially for acute pericarditis

6

Pericardial effusion
-what is this?
-causes
-what is the normal fluid volume in the pericardial sac?
-4 types of pericardial fluid

What is this:
-abnormal accumulation of fluid in the pericardial sac

Cause:
-develops during any inflammatory pericardial dz
-disturbance in the equilibrium between the production and reabsorption of pericardial fluid.

Volume:
-15-50ml of fluid is the usual amount of fluid within the pericardium.

Types:
-transudative(CHF)
-exudative(TB)
-Hemorrhagic
-Malignant

7

Pericardial effusion
-sx
-imaging
-tx

sx:
-+/- pain
-dyspnea
-cough
-pericardial rub

Imaging:
-CXR: enlarged cardiac sillhouette, "Water bottle heart"
-EKG: electrical alternans with sinus tachycardia
-echo: imaging of choice

Tx:
-treat underlying cause
-small effusion can be followed
-large effusions and tampanode drainage is done through pericardiocentesis
-pericardiectomy

8

Cardiac Tamponade
-what is this?
-causes
-signs and sx
-Imaging
-Tx

What is this:
-increase pressure on the heart muscle when the pericardial space fills up with fluid faster than the pericardial sac can stretch. *increased pressure causes elevation of intrapericardial pressure which restricts venous return and ventricular filling.

Cause:
-inflammatory processes
-disturbance between production and reabsorption of pericardial fluid
-Left ventricular free wall rupture
-Hemorrhagic pericarditis

Signs and sx:
-cough
-dyspnea
-tachycardia
-tachypnea
-pulsus paradoxus
-Becks Triad: hypotension, JVD, Muffled heart sounds.

Imaging:
-EKG; electrical alternans
-Echo: test of choice

Tx:
-urgent pericardiocentesis
-recurrent flud may require pericardial window or partial pericardiectomy

9

Constrictive pericarditis
-what is this
-causes
-signs and sx
-Imaging
-Tx

What is this:
-inflammation that leads to the pericardium becoming fibrotic, thickened, and adherent and restricts diastolic fillings and produces chronically elevated venous pressure.

Causes:
-radiation
-cardiac surgery
-viral pericarditis
-idiopathic

Signs and Sx:
-slowly progressive dyspnea
-fatigue and weakness
-chronic edema
-elevated jugular venous pressure
-Kussmauls sign

Imaging:
-CXR; egg shell around the heart.
-Echo* (Test of choice)
-Cardiac Cath

tx:
-diuretics DOC
-surgical removal (pericardectomy)

10

Pericardiocentesis
-procedure

-pt supine with HOB 30-60 degrees
-Ultrasound guidance
-5th-6th intercostal space at the left sternal border at the cardiac notch of the left lung OR at the infrasternal angle.