Pericardium diseases and cardiac neoplasms

Question 1

Chronic pericardial effusion

Answer 1

<500 mL and globular enlargement of heart shadow on CXR

Question 2

Pericardial fluid under pressure leading to impaired diastolic filling of ventricles and elevated venous pressures

Answer 2

Cardiac tamponade

Question 3

Scarred, rigid pericardium leading to impaired diastolic filling of ventricles, SV, and decreased CO

Answer 3

Constrictive pericarditis

Question 4

Pressure tracing change in cardiac tamponade

Answer 4

Flattening of y descent

Question 5

Decrease of SBP by >10 mmHg during normal inspiration, seen in cardiac tamponade

Answer 5

Pulsus paradoxus

Question 6

How to check for pulsus paradoxus

Answer 6

Find highest pressure at which first Korotkoff sound is heard. Then further deflate until sound is Korotkoff is heard in inspiration and expiration. Should be <10 mmHg difference.

Question 7

Clinical features of acute pericarditis

Answer 7

Fever
Severe CP, retrosternal
Sharp, pleuritic, and positional CP
Pericardial friction rub

Question 8

Movement of inflamed pericardial layers against one another heard on auscultation when pt leans forward and exhales.

Answer 8

Pericardial friction rub

Question 9

EKG findings in pericarditis

Answer 9

Diffuse ST segment elevation in majority of leads

Question 10

Possible cause of serous pericarditis

Answer 10

Rheumatic fever
SLE
Scleroderma
Tumors
Infection of tissues contiguous to pericardium
Uremia

Question 11

Exudate in serous pericarditis

Answer 11

Thin fluid secreted by mesothelial cells. Contains lymphocytes.

Question 12

Possible causes of fibrinous and serofibrinous pericarditis

Answer 12

Acute MI
Dressler syndrome
Uremia
Rheumatic fever
SLE
RA
Trauma

Question 13

Most frequent types of pericarditis

Answer 13

Fibrinous and serofibrinous

Question 14

Exudate in fibrinous pericarditis

Answer 14

Contains plasma proteins, including fibrinogen.

Question 15

Grossly rough, granular, dry, and shaggy appearance of pericardium

Answer 15

Fibrinous pericarditis

Question 16

Exudate in purulent or suppurative pericarditis

Answer 16

Thin and cloudy to frank pus
400-500 mL

Question 17

Complication of purulent or suppurative pericarditis

Answer 17

Constrictive pericarditis

Question 18

Exudate in hemorrhagic pericarditis

Answer 18

Blood mixed with a fibrinous or suppurative effusion

Question 19

Most common cause of hemorrhagic pericarditis

Answer 19

Spread of malignant neoplasm to pericardial space

TB

Question 20

Causes of chronic constrictive pericarditis

Answer 20

TB
Remote history of idiopathic or viral acute pericarditis
Prior radiation to L chest

Question 21

Pathogenesis of chronic constrictive pericarditis

Answer 21

Fluid undergoes organization and then fusion of pericardial layers. Followed by fibrous scar formation, which may calcify.

Question 22

Clinical features of chronic constrictive pericarditis

Answer 22

Reduced CO –> fatigue, hypotension, and reflex tachycardia
Elevated systemic venous pressures
Pulsus paradoxus, not prominent
Kussmaul sign

Question 23

Paradoxical increase in JVP during inspiration

Answer 23

Kussmaul sign

Question 24

Clinical findings of elevated systemic venous pressures

Answer 24

Jugular venous distension
Hepatomegaly with ascites
Peripheral edema

Question 25

Most common primary tumor of the adult heart

Answer 25

Myxomas

Question 26

Benign neoplasm of the heart that arises from primitive multipotent mesenchymal cells.

Answer 26

Myxomas

Question 27

Conditions associated with myxomas

Answer 27

McCune-Albright syndrome Carney complex

Question 28

Syndrome characterized by activating mutations in GNAS1 gene that encode a subunit of G protein

Answer 28

McCune-Albright syndrome

Question 29

Syndrome characterized by mutations in PRKAR1A that encodes a regulatory subunit of cAMP dependent protein kinase

Answer 29

Carney complex

Question 30

Cause of fever and weight loss in myxoma

Answer 30

Production of IL-6

Question 31

Clinical features of myxoma

Answer 31

Early diastolic tumor plop sound Syncope

Question 32

Most common locations of myxoma

Answer 32

90% in atria, L>R

Question 33

Position where myxoma may obstruct mitral flow more easily

Answer 33

Upright positon

Question 34

Platypnea

Answer 34

Dyspnea that improves with laying flat

Question 35

Single, sessile or pedunculated lesion in the LA. May be a globular hard mass mottled with hemorrhage OR a soft, translucent, papillary or villous lesion with gelatinous appearance.

Answer 35

Myxoma

Question 36

Microscopy of LA mass shows stellate or globular cells embedded within an abundant acid mucopolysaccharide ground substance. With peculiar vessel-like or gland-like structures

Answer 36

Myxoma

Question 37

Most frequent primary tumor of pediatric heart

Answer 37

Rhabdomyoma

Question 38

Obstruction of a valvular orifice or cardiac chamber discovered in first year of life. Associated with tuberous sclerosis in 50% of cases.

Answer 38

Rhabdomyoma

Question 39

TSC1 or TSC2 expression absent leading to myocyte overgrowth.

Answer 39

Rhabdomyoma associated with tuberous sclerosis

Question 40

Frequent major features of tuberous sclerosis

Answer 40

Facial angiofibromas Hypomelanotic macules Cortical tubers Subependymal nodules

Question 41

Common major features of tuberous sclerosis

Answer 41

Retinal hamartomas LAM Renal AML Cardiac rhabdomyomas

Question 42

Uncommon major features of tuberous sclerosis

Answer 42

Shagreen patches Ungual fibromas Subependymal giant cell tumors

Question 43

Frequent minor features of tuberous sclerosis

Answer 43

Multiple pits in dental enamel Hamartomatous rectal polyps

Question 44

Common minor features of tuberous sclerosis

Answer 44

Bone cysts Cerebral white matter radial migration lines Multiple renal cysts Gingival fibromas

Question 45

Uncommon minor features of tuberous sclerosis

Answer 45

Confetti skin lesions Retinal achromatic patches

Question 46

Cause of carcinoid heart disease

Answer 46

Bioactive compounds (like serotonin) released by carcinoid tumors

Question 47

Reason that carcinoid heart disease typically only occurs when there is a massive hepatic metastatic burden

Answer 47

Liver normally metabolizes circulating mediators before they reach the heart

Question 48

Pearl white fibrosis of the tricuspid valve with tricuspid regurgitation. Increased plasma levels of serotonin.

Answer 48

Carcinoid heart disease

Question 49

Reason that L heart is protected in carcinoid heart disease

Answer 49

Mediators are degraded in pulmonary vascular bed

Question 50

Serotonin metabolite excreted in urine in carcinoid syndrome

Answer 50

5-HIAA

Question 51

Single most important long-term limitation of cardiac transplant

Answer 51

Allograft arteriopathy

Question 52

Late, progressive, diffusely stenosing intimal proliferation in the coronary arteries leading to ischemic injury. Caused by production of growth factors that promote intimal smooth muscle cell recruitment and proliferation with ECM synthesis

Answer 52

Allograft arteriopathy in heart transplant

Question 53

Complications of allograft arteriopathy in heart transplant

Answer 53

Silent MI Progressive CHF Sudden cardiac death

Question 54

Timeframe for development of allograft arteriopathy in heart transplant pts

Answer 54

Within 10 yrs