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Flashcards in Pericarditis Deck (32):
1

Layers of the normal pericardium

Outer fibrous layer -- no vital function
Inner serous layer -- lubricates, anchors the heart. Has two layers -- visceral and parietal.

2

Cause of acute pericarditis

Viral: Coxsackie, Echovirus
TB
Bacterial

Non infectious: Post MI
Severe hypothyroidism
Cardiac surgery
Trauma
Mediastinal radiation
Drugs and Toxins
SLE, RA

3

If pericarditis is caused by an MI, how big is the lesion?

It's related to infarct size.

4

Early post-MI pericarditis vs late post-MI pericarditis

Inflammatory, but weeks to months later mostly immune mediated process.

5

Post cardiac injury syndrome

Months to weeks after MI, immune mediated pericarditis

6

Symptoms of acute pericarditis

Retrosternal chest pain due to friction. Related to position.

Rare fever, dyspnea

7

Signs of pericarditis on exam?

Peristernal friction rub -- highly specific. Best heard when patient is sitting and expiring.

8

EKG findings of acute pericarditis?

Don't worry about it now. But know that there's universal ST elevation.

9

How to treat acute pericarditis

Aspirin
Colchicine
Steroids if recurrent

10

Complications of acute pericarditis

Constriction from scarring and loss of elasticity.

Cardiac tamponade, accumulation of pericardial fluid under pressure.

Recurrent pericarditis

11

Etiology of pericardial effusion

Viral, bacterial, tb

Malignancy, uremia, radiation, trauma, dissecting aneurysm

12

Symptoms of pericardial effusion

Sometimes asymptomatic
Dyspnea, cough, hoarseness, abdominal fullness

13

Signs of pericardial effusion on exam

Muffled heart sounds, Ewart's sign.

14

Ewart's Sign

Dullness to percussion of subscapular area. Sign of pericardial effusion

15

How does pericardial effusion appear on x-ray?

Flask like appearance of heart -- water bottle.

16

How to treat effusions?

Drain them with a needle, unless it's an aortic dissection

17

Cardiac tamponade

Hypotension, tachycardia

Occurs when intrapericardial pressure exceeds intracardiac pressure. Ventricles cannot contract and low SV.

18

What is development of tamponade based upon?

Time of development, not amount of fluid.

19

Effect of breathing on heart in tamponade

During inspiration, large volume of blood floods right side. Because heart can't expand out, the septum will push and expand to the left side of the heart, which diminishes filling. Decreased SV.

During expiration, the septum will push on the right side of the heart.

20

Pathophysiology of cardiac tamponade and constrictive pericarditis

Impaired diastolic filling of ventricles leads to elevated venous pressures (causing pulmonary congestion and systemic congestion), and impaired stroke volume-- decreases CO.

21

Symptoms of cardiac tamponade

Dyspnea, orthopnea, fatigue

22

Beck's Triad

Decreased arterial pressure, increased venous pressure, distant heart sounds

23

Other signs of cardiac tamponade that aren't decreased arterial pressure, increased venous pressure and decreased heart sounds.

Tachycardia
Pulsus paradoxus
Increased JVP
Decreased systolic blood pressure with narrow pulse pressure
Muffled heart sounds
Ewart's Sign

24

Pressure tracing of RA or JVP with tamponade or constriction

Tamponade: Very shallow Y descent because right ventricle is compressed.

Constriction: Deep Y descent because higher atrial pressures without ventricles being too constricted.

25

Pulsus paradoxus

Exaggerated drop in systemic blood pressure with inspiration because RV expands into LV and impairs filling so SV decreases.

Septum must be intact to occur

26

How to treat tamponade

Pericardiocentesis along with IV fluids and pressor agents

27

Constrictive pericarditis effect on heart

Impedes diastolic filling of the heart. No effect on systolic function.

28

What happens in constrictive pericarditis

Diastolic heart failure -- exertional dyspnea, R>L CHF, peripheral edema

29

Causes of constrictive pericarditis

Heart surgery, radiation, connective tissue diseases (RA, SLE), infection, malignancy

30

Kussmaul's sign

Distention in jugular veins with inspiration. This is paradoxical. Seen when ventricles resist filling. Seen in tamponade more than constriction because of the lack of a y descent.

31

How to treat constrictive pericarditis?

Remove it

32

Pericardial Knock

When ventricle fills during diastole (S3). Increase.