Pericarditis (Exam 1)

Question 1

Pericarditis

Answer 1

Inflammation of the heart covering

Question 2

What do you hear with pericarditis?

Answer 2

Pericardial friction rub

Question 3

Pericardium

Answer 3

Fibrous outside of the heart

Question 4

What are the layers of the pericardium? What is in between them?

Answer 4

Parietal (outer) and Visceral (inner)

Pericardial sack between them

Question 5

Who gets pericarditis?

Answer 5

Most often idiopathic - with a variety of suspected infective organisms

Post-myocardial infarction

Acute exacerbations of systemic connective tissue disease
(RA - lupus)

Question 6

Pericarditis Clinical Manifestations: Pain

Answer 6

-Substernal - Precordial radiates to left side of neck / shoulder / back

-Typically grating and oppressive

-Worse by breathing (inspiration), coughing, swallowing. Laying supine

Question 7

Pericarditis Pain is relieved by

Answer 7

Sitting up and leaning forward (helping minimize stretch)

Question 8

Pericarditis Pain is aggravated by

Answer 8

Breathing (inspiration), coughing, swallowing

Laying supine

Question 9

Pericarditis vs MI: Pain Onest

Answer 9

Pericarditis = Most often sudden substernal or left precordial

MI = Gradual - Crescendo. Same or confined to zones of radiation

Question 10

Pericarditis vs MI: Pain Quality

Answer 10

Peri = Sharp - Stabbing: Background ache or dull and oppressive

MI = Heavy - Pressure - Burning

Question 11

Pericarditis vs MI: Pain Duration

Answer 11

Peri = Persistent: may wax and wane

MI = Intermittent <30 min each recurrence. Longer for unstable angina

Question 12

Pericarditis vs MI: Pain Body movements and posture

Answer 12

Peri = Increased pain with body movements. Worse on recumbency, improved on sitting, learning forward

MI = No effect

Question 13

Pericarditis vs MI: Pain Nitro

Answer 13

Pericarditis = No effect

MI = Relief (usually)

Question 14

What is the hallmark finding of pericarditis?

Answer 14

Pericardial Friction Rub

Question 15

Where / How is pericardial friction rub best heard?

Answer 15

Place stethoscope at lower LSB

Patient lean forward; hold breath prn

Question 16

Two complications of pericarditis

Answer 16

1. Pericardial Effusion
2. Cardiac Tamponade

Question 17

Pericardial Effusion

Answer 17

Complication of Pericarditis
(collection of fluid surrounding heart)

-Build up of fluid in pericardium

Question 18

Someone with pericardial effusion may have

Answer 18

Cough

Tachypnea

Dyspnea

Distant / Muffled Heart Sound

Question 19

What the big deal with a pericardial effusion?

Answer 19

Heart begins to get squished and can not contract and squeeze

Decrease CO

Question 20

Cardiac Tamponade

Answer 20

-Develops as pericardial effusion increases in volume

Question 21

Someone with Cardiac Tamponade may have

Answer 21

Dyspnea

Chest Pain

Restless and anxious

Decrease CO

JVD (RSHF)

Muffled heart sounds

Narrowed pulse pressure

Pulsus paradoxus

Question 22

Classic Signs of Cardiac Tamponade

Answer 22

Narrow pulse pressure

Pulsus Paradoxus (most classic)

Question 23

Narrow Pulse Pressure

Answer 23

Systolic minus diastolic

This number will narrow

Question 24

Pulsus Paradoxus

Answer 24

Systolic BP 10 mm Hg (or more) higher on expiration than on inspiration.

Or may be defined as Systolic 10 mm Hg (or more) lower on inspiration than expiration

Question 25

How to perform Pulsus paradoxus

Answer 25

Inflate BP cuff beyond palpable blood pressure Deflate cuff gradually and note when sounds are first audible on expiration only Then identify when sounds audible on both inspiration and expiration If that number is greater than 10 mm Hg - indicates tamponade

Question 26

Pericarditis: Diagnostic Test

Answer 26

EKG changes (90%) of time Echocardiogram Labs

Question 27

Pericarditis EKG changes

Answer 27

Diffuse / widespread ST elevation (all leads) AMI = 2

Question 28

Why is echocardiogram done with pericarditis?

Answer 28

To determine if complication of either effusion or tamponade

Question 29

Pericarditis vs MI: EKG

Answer 29

Pericarditis -Diffuse widespread ST elevation MI 2 or more contiguous leads

Question 30

Labs associated with pericarditis

Answer 30

Increase WBC Increase ESR (chronic inflammation) Increase CRP (acute inflammation)

Question 31

Collaborative Care: Pericarditis

Answer 31

Bedrest w HOB 45% Antibiotics if bacterial pericarditis NSAIDS (treat itis) -naproxen -high dose ibuprofen -colchicine for recurrent pericarditis Prednisone taper (only if NSAIDS do not work) Pericardiocentesis

Question 32

Pericardiocentesis removal of 5-10 ml may increase SV by

Answer 32

25-50%

Question 33

Hallmark treatment of pericarditis

Answer 33

NSAIDS naproxen high dose ibuprofen colchicine