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Flashcards in Pericarditis Deck (44)
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1

What can chronic pericardial inflammation lead to

rigid, thickened, calcified pericardium

2

What are the causes of pericardial disease

Viral
Bacterial
Fungal
Parasitic
Systemic inflammatory dz (SLE)
Malignancy
Uremia

3

Why is the epidemiology of pericarditis

in 0.1-0.2% of hospitalized patients
up to 5% of ED patients with non-ischemic CP

4

What is the most common cause of acute pericarditis

Idiopathic
(most are undiagnosed VIRAL infections; coxsackie B, Influenza)

5

What is the most common presenting symptom in acute pericarditis

CHEST PAIN; sharp and pleuritic, improves by leaning forward, exacerbated by cough

6

Describe pericardial CP vs ischemic CP

Pericardial: sudden one, anterior chest, sharp, pleuritic, improves leaning forward, worse with cough inspiration or lying flat
Ischemic: radiates, relieved with nitro

7

What is common to see on pericarditis PE

Pericardial friction rub; squeaky, scratchy over LSB

8

What are characteristic ECG findings for pericarditis

Diffuse ST elevation (concave upward) and PR segment depression
Stage 1: diffuse ST elevation and PR depression
Stage 2: normal
Stage 3: diffuse deep T wave inversion
Step 4: normal

9

What other diagnostic tests should you get

CT (shows thick pericardium)
Cardiac MRI
Echo (normal unless effusion present)

10

Are pericardiocentesis and pericardial biopsy used in acute pericarditis

Rarely, they are low yield
but can be therapeutic and diagnostic
Pericardiocentesis if refractory to med therapy or in hemodynamic compromise
Biopsy if illness >3 weeks, or recurrent

11

What lab tests would be elevated in acute pericarditis

Troponin
High CRP, ESR, and WBC can help support the diagnosis
(if patient is febrile check blood cultures)

12

What further work up should you consider if patient isn't improving

ANA, rheumatoid factor
TB testing
HIV serology
Malignancy work up

13

What is the diagnostic criteria for acute pericarditis

Need TWO of the following:
1. Typical CP
2. Pericardial friction rub
3. Characteristic ECG changes
4. Pericardial effusion

14

What is pericarditis admittance criteria

Fever
immunocompromised
subacute onset
Hemodynamic compromise
Oral anticoagulants (hemorrhagic effusion)
trauma

15

How do you medically manage acute pericarditis

NSAIDs +/- Colchicine (reduce sx and decrease rate of recurrence) 2 weeks or less
-If pt can't take NSAIDs, give glucocorticosteroids

-Activity restriction until Sx resolved and biomarkers normalize

16

How long until a patient shows improvement with medical management of pericarditis

within one week
if Sx persist, may need more workup

17

What is a pericardial effusion

amount of fluid in pericardium more than normal (15-50 ml) secondary to injury to pericardium
acute, subacute, or chronic

18

What kind of effusion progression is better

Slower development; the pericardium has more time to stretch and adapt

19

How does a pericardial effusion usually present

Asymptomatic!
May have CP/pressure/discomfort relieved by sitting up or leaning forward
Syncope, light headed, palpitations, Resp. Sx

20

What can you find on pericardial effusion PE

Usually none unless hemodynamically significant
**Pulsus Paradoxus (SBD decrease >10 with inspiration) = falling CO during inspiration

21

How do you measure Pulsus Paradoxus

When taking BP, listen for first korotkoff sound only on expiration, deflate cuff until you hear during inspiration and expiration
If difference >10, positive test

22

What is characteristic of an ECG for pericardial effusion

Low voltage QRS
*Sinus tachy
**Electrical alternans (normal then abn QRS)
* + **= highly specific for pericardial effusion

23

What is a characteristic CXR finding for pericardial effusion

Enlarged cardiac silhouette

24

What is your imaging modality of choice for pericardial effusion

ECHOCARDIOGRAM (large effusion= >20 mm)

25

What diagnostic exam is low yield for pericardial effusion

Pericardiocentesis
Indicated if impending hemodynamic compromise, suspected infectious, or uncertain etiology

26

How do you treat pericardial effusion

NSAID +/- Colchicine if with pericarditis
treat underlying cause
refractory cases need recurrent pericardiocentesis

27

What is a chronic pericardial effusion

Present for >3 months, asymptomatic, hemodynamically tolerated
Pericardectomy needed if fluid reaccumulates despite repeat pericardiocentesis

28

What is a hemorrhagic pericardial effusion

When blood fills the pericardial space, most likely due to malignancy (can also be Iatrogenic, MI complication like free wall rupture)

29

What is cardiac tamponade

compression of heart chambers due to increased pericardial pressure (pericardium has reached max capacity)

30

How does blood flow in the heart change with cardiac tamponade

Diastolic compliance reduced (less room)
RV bows into LV during inspiration and decreases filling more causing decrease in CO and BP