Pericardial Heart Disease & Tamponade

Question 1

define pericardial heart disease

Answer 1

inflammation and effusion of pericardium

Question 2

normal amount of pericardial fluid

Answer 2

15-50mL

Question 3

etiology of pericardial heart disease

Answer 3

• MC: viral (coxsackie A+B)

- 2nd MC: idiopathic/recurrent viral dz

Question 4

categories of pericardial heart disease per chronicity

Answer 4

• acute = less than 6wks
• subacute = 6wks to 6mo
• chronic = greater than 6wks
• recurrent

Question 5

What are the 3 subtypes of chronic pericardial heart disease?

Answer 5

• constrictive
• effusive
• adhesive

Question 6

What are the two types of recurrent pericardial heart disease?

Answer 6

• intermittent (asx intervals)

- incessant (resistant to anti-inflam tx)

Question 7

epidemiology of pericardial heart disease

Answer 7

• 20-50 y/o

- males more than females

Question 8

categories per pathology

Answer 8

• fibrous
• effusive
• constrictive

Question 9

What types of exudate can effusive pericarditis have?

Answer 9

• purulent

- hemorrhagic

Question 10

Which types of pericarditis do not have fluid?

Answer 10

• fibrous

- constrictive

Question 11

Which types of pericarditis can lead to tamponade?

Answer 11

• effusive

- constrictive

Question 12

describe constrictive pericarditis

Answer 12

• aka compressive syndrome
• occurs after acute
• impedes diastolic filling not contraction

Question 13

What are the 4 P’s of pericarditis? (i.e. for signs and symptoms)

Answer 13

• persistent
• pleuritic
• postural pain
• pericardial friction rub

Question 14

S+S of pericarditis

Answer 14

• low grade fever
• sudden onset, severe anterior chest pain, worsens with breathing + supine; present when sitting + leaning forward
• sinus tachycardia
• pericardial friction rub @ LSB + @ end of expiration
• pain does NOT respond to NTG

Question 15

diagnostics of pericarditis

Answer 15

• EKG
• labs
• CXR
• pericardiocentesis
• Echo

Question 16

EKG results of pericarditis

Answer 16

seen in all leads but esp V1-6

• ST elevations
• PR depressions
• no Q waves

Question 17

CXR results of pericarditis

Answer 17

• “water bottle” silhouette

Question 18

Echo results of pericarditis

Answer 18

• “swinging heart” = pericardial effusion

Question 19

What labs are ordered for pericarditis and what do they look for?

Answer 19

• CRP, ESR, and incr. WBC = systemic inflam

- troponin + BUN = MI ddx

Question 20

tx for pericarditis

Answer 20

• ASA or NSAIDs + colchicine
• prednisone + colchicine for severe
• systemic abx, ID consult, + culture
• pericardiocentesis
• pericardectomy for recurrent

Question 21

What are the criteria to admit pericarditis?

Answer 21

• fever 100+ x 7d
• leukocytosis (WBC over 11k)
• cardiac tamponade
• 20+mm effusion
• immune suppressed
• trauma
• does not respond to NSAIDs x7d
• incr. troponin –> myopericarditis

Question 22

What do complications of pericarditis depend on?

Answer 22

• rate of effusion

- pericardium expandability

Question 23

pathophysiology of tamponade

Answer 23

incr. intracardial pressure leads to:
- compressed/decr. chambers
- decr. diastolic compliance
- decr. venous return (i.e. +JVD)
==> decr. contraction

Question 24

clinical features of tamponade

Answer 24

• Beck’s Triad (JVD, hypotension, distant/absent heart sounds)
• tachycardia
• tachypnea

Question 25

define pulsus paradoxus

Answer 25

- more than 10mmHG decr in SBP with inspiration

Question 26

pathophysiology of pulsus paradoxus

Answer 26

- ventricular interdependence: RV fills more/faster which pushes in on LV inhibiting LV filling ==> decr. LV EDV == decr SV + decr SBP

Question 27

treatment of pulsus paradoxus

Answer 27

- *monitorJVP* - paradoxical pulses - serial echos - *pericardiocentesis*

Question 28

30 y/o M presents with T = 99.3, severe ant chest pain which worsens when he attempts naps & sleep. leather on leather heard at LSB, Echo = swinging heart, CXR = water ballon silhouette. What is the etiology of his dz? What is the dz? What is the tx?

Answer 28

- MC = viral, 2nd MC = idiopathic/recurrent - pericarditis - ASA or NSAIDs+ colchicine

Question 29

45 y/o M presents with BP = 102/54, HR = 158, RR = 25, JVD, and absent heart sounds. What else do you check for on exam? What is the dx? What is the tx? What are the pts s+s that clue you into the dx?

Answer 29

- pulsus paradoxus - cardiac tamponade - monitor + pericardiocentesis - Beck' Triad = JVD, hypotension, distant/absent heart sounds