pericarditis Flashcards
(40 cards)
do the part of the great vessels lie within the pericardium?
yes
the two layers of pericardium are continuous with each other, T of F?
true
what are the functions of the pericardium?
Fixes the heart in the mediastinum and limits its motion – this is due to its attachment to the diaphragm, the sternum and the tunica adventitia (outer layer) of the great vessels
Prevents overfilling of the heart – relatively inextensible fibrous layer
Lubrication – A thin film of fluid between the two layers of the serous pericardium reduces the friction generated by the heart as it moves within the thoracic cavity
Protection from infection – The fibrous pericardium serves as a physical barrier between the muscular body of the heart and adjacent organs prone to infection, such as the lungs.
what are the two main layers of pericardium called?
fibrous and serous
What layers is the serous pericardium divided into?
parietal and visceral
what is the alternative name given to the visceral pericardium?
epicardium
what are the layers of pericardium made from?
Each layer is made up of a single sheet of epithelial cells, aka mesothelium.
what is the transverse pericardial sinus?
it is located posteriorly to the ascending aorta, anterior to the SVC and superior tot he left atrium
it separates the arterial (aorta and pulmonary trunk) from the venous vessels (SVC and pulmonary veins)
this can be used to identify and ligate the arteries of the heart
explain the physiology of the pericardium and tamponade physiology
Small amount of volume added to space (ie the pericardial space) has dramatic effects on filling but so does removal of a small amount
the pericardium is initially stretchy and then become stiff at a higher tension, which restrains the filling volume of the heart
this means the pericardial sac has a small reserve volume
What happens in chronic pericardial effusion?
Chronic accumulation allows adaptation of the parietal pericardium
This compliance reduces the effect on diastolic filling of the chambers
What is acute pericarditis?
an inflammatory pericardial syndrome with or without effusion
What is the most common symptom of pericarditis?
chest pain
What is the most common cause of pericarditis?
viruses eg enteroviruses such as coxsackieviruses, echoviruses and herpesviruses
adenoviruses
parvovirus
what is the most common bacterial cause of pericarditis?
Mycobacterium tuberculosis
What are the non-infectious causes of pericarditis?
autoimmune neoplastic metabolic traumatic and iatrogenic other
give examples of autoimmune conditions that can lead to pericardtitis
Sjörgen’s syndrome
rheumatoid arthritis
scleroderma
systemic vasculitides
What are the causes of neoplastic related pericarditis?
secondary metastatic tumours such as lung, breast cancer and lymphoma
what are the metabolic causes of pericarditis?
uraemia
myxodema - swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands (can also happen in hyperthroidism)
what are the causes of traumatic or iatrogenic pericarditis?
direct injury - eg penetrating thoracic injury or oesophageal perforation
indirect injury- non-penetrating thoracic injury, radiation injury
post-cardiac injury syndromes eg due to MI or iatrogenic trauma like PCI, pacemaker lead insertion and radiofrequency ablation
What are some other causes of pericarditis?
Amyloidosis, aortic dissection, pulmonary arterial hypertension and chronic heart failure
What is the reason for 80-90% of pericarditis cases?
idiopathic!
what is the clinical presentation for the chest pain part of pericarditis?
severe chest pain
sharp and pleuritic pain
rapid onset of chest pain
pain in the left anterior chest or epigastrium
radiation of pain to arm ie trapezius ridge - due to irritation of PHRENIC nerve
relieved by sitting forward and exacerbated by lying down
what are the other symptoms of pericarditis other than chest pain?
dyspnoea
cough
hiccups (phrenic nerve irritation)
systemic disturbance - viral prodrome, fever, skin rash, joint pain, eye symptoms, weight loss
past medical history of cancer, rheumatological disease, pneumonia, cardiac procedure eg PCI and ablation and MI
what are the differential diagnoses of pericarditis?
MI or ischaemia Pneumonia Pleurisy Pulmonary Embolus Chostocondritis Gastro-oesophageal reflux Aortic dissection Pneumothorax Pancreatitis Peritonitis Herpes zoster (shingles)
