Pericarditis, Valve Prostheses, Cardiomegaly

Question 1

What are the subtypes of pericardial diseases?

Answer 1

Acute pericarditis
Effusion
Cardiac tamponade
Constrictive pericarditis

Question 2

What is pericarditis?

Answer 2

inflammation of visceral or parietal pericardium

Question 3

What is the most common etiologic agent of acute pericarditis as a sole pathology?

Answer 3

Virus (Coxsackie)

Question 4

32 year old patient presents with sudden, severe, substernal chest pain that refers to the back and shoulder. Enzyme levels are normal. The patients only recent medical history is a bout with flu-like symptoms two weeks prior to his visit today. Auscultation reveals a friction rub. What is the likely diagnosis?

Answer 4

Acute pericarditis

Question 5

What is pericardial effusion?

Answer 5

accumulations of excess fluid within the pericardial cavity, as either a transudate or an exudate

Question 6

What is a serous pericardial effusion?

Answer 6

Inflammatory exudate in the pericardial sac of the heart with few cells and a pale, straw-, amber-coloured fluid

Question 7

What is a common cause of a serous pericardial effusion?

Answer 7

Heart failure

Question 8

What is a chylous pericardial effusion?

Answer 8

lymphatic fluid accumulation in the pericardium due to lymphatic obstruction (eg. tumor)

Question 9

What is a seroanguinous pericardial effusion?

Answer 9

Inflammatory exudate in the pericardial sac of the heart with few cells and a red tinge
(serous + blood)

Question 10

What is a fibrinous pericardial effusion?

Answer 10

Inflammatory exudate in the pericardial sac that presents with clotting factors (fibrin) and a shaggy mayonnaise or buttery appearance
(eg. pericardial friction rub)

Question 11

What is hemopericardium?

Answer 11

Frank blood filling the pericardial sac around the heart

Question 12

What can cause a hemopericardium (cardiac tamponade)?

Answer 12

Tearing of the heart wall or aneurysm of a coronary artery or other blood vessel

Question 13

When is a cardiac tamponade most common?

Answer 13

One week post-MI

Question 14

Patient presents with acute substernal chest pain. He suffered an acute MI 8 days prior to this visit today. Needle aspiration of the pericardial sac reveals 350 ml of frank blood. Radiograph reveals a heart that resembles a wine flask or water bottle. What is the likely diagnosis?

Answer 14

Cardiac tamponade

Question 15

What radiographic feature is indicative of a cardiac tamponade?

Answer 15

Water bottle heart

Question 16

What is constrictive pericarditis?

Answer 16

Chronic fibrosing disease of the pericardium that compresses the heart and restricts inflow

Question 17

What is the etiology of constrictive pericarditis?

Answer 17

Prior radiotherapy to the mediastinum or Hx of cardiac surgery

Question 18

Describe the pathogenesis of constrictive pericarditis

Answer 18

• acute pericardial injury
• pericardial space becomes obliterated, and visceral & parietal layers become fused in a dense, rigid mass of fibrous tissue
• scarred pericardium thickens so that orifices of venae cavae are narrowed

Question 19

A patient presents with bilateral pitting edema of the lower limbs, ascites, and neck vein distension. What pathology do you suspect?

Answer 19

RSHF

Question 20

A patient with a history of cardiac surgery presents with a flushed face, and neck vein distension. What pathology do you suspect?

Answer 20

Constrictive pericarditis (SVC syndrome)

Question 21

What is a xenograft valve prosthesis?

Answer 21

A biological porcine (pig) or bovine (cow) aortic valve grafted onto a mechanical frame

Question 22

How long does a xenograft valve last?

Answer 22

5-10 years (NOT durable)

Question 23

A xenograft valve has good hemodynamic characteristics (TRUE/FALSE)?

Answer 23

TRUE

Question 24

What are contraindications to a mechanical valve prosthesis?

Answer 24

• Pregnant or young females anticipating pregnancy
• Patients with coagulation disorders

Question 25

A mechanical valve functions much longer than a xenograft valve (TRUE/FALSE)?

Answer 25

TRUE (excellent durability)

Question 26

A patient with a ____ valve is put on immunosuppressant medication for life (TRUE/FALSE)?

Answer 26

Xenograft

Question 27

A patient with a ____ valve is put on anticoagulant therapy for life

Answer 27

Mechanical (creates physical damage)

Question 28

An 85 year old patient would most likely receive with type of valve prosthesis?

Answer 28

Mechanical

Question 29

A 32 year old aspiring mother would most likely receive what type of valve prosthesis?

Answer 29

Xenovalve

Question 30

How is cardiomegaly assessed?

Answer 30

Cardiothoracic ratio = width of the thorax divided by width of heart shadow The heart should occupy less than 50% of the thorax (cardiothoracic ratio < 0.5)

Question 31

What are some causes of cardiomegaly?

Answer 31

- hypertension (anything that can cause HTN) - valvular disease - hypertrophic cardiomyopathy (or dilative) - acromegaly (due to GH secreting tumor) - anemia (not enough O2 to body, heart works harder)