Flashcards in Tamponade/Pericarditis/Endocarditis Deck (28):
There are many many causes to pericaritis. Name some common ones.
infection (viral or bacterial); coxsackievirus, influenza virus, hepatis, measles, mumps
autoimmune or connective tissue disorders
other drug toxicity
who is pericarditis more common in?
men and under the age of 50
what are the primary presenting symptoms of acute pericarditis?
review book: pleuritic substernal radiating chest pain relieved by sitting upright and leaning forward; a friction rub is characteristic
pays book: several days of fever, myalgias, and malaise followed by the sudden onset of severe chest pain that worsens with respiratory movements an with lying down. pain may radiate to the back, it is generally felt in the anterior chest pain
What are the physical/Laboratory findings of acute pericarditis:
phys: low grade fever, sinus tachycardia, pericardial friction rub (heard at the apex & LLSB)
pays: EKG: depression of PR segments, diffuse ST segment elevation, flattening and inversion of the T waves
RB - LABS: often show elevated erythrocyte sedimentation rate, c reactive protein, and white blood cell count
***elevated white blood cell count = infection, therefore you must do blood and pericardial fluid cultures
ECHO: may show pericardial effusion
treatment of acute pericarditis
NSAIDS = colchicine as an adjunct
steroids / glucocorticouids if former doesn't work
\**do not use NSAIDS following an MI
what is secondary to pericarditis, uremia, or cardiac trauma) produces restrictive pressure on the heart?
What occurs when fluid compromises cardiac filling and impairs cardiac output?
1. pericardial effusion
2. cardiac tamponade
1. what are the clinical features of pericardial effusions?
What are the clinical features of cardiac tamponade?
1. painful or painless, often accompanied by **cough or **dyspnea. (horsneness, dysphagia)
2. tachycardia, tachypnea, narrow pulse pressure, and pulses paradoxus
review book: what are the laboratory findings of
1. pericadial effusions?
2. cardiac tamponade?
1. chest radiography or echo is useful to determine the extent of cardiac effusions and calcification
2. ECG chafes include nonspecific T-wave changes and low QRS voltage. ELECTRICAL ALTERANS is PATHOGNOMONIC OF EFFUSIONS
3. Echo, Doppler Untrasonography, CT, and MRI are helpful for more accurate diagnosis or before invasive procedure.
REview bOok: What is the treatment of Pericardial disorders?
1. In the presence of hemodynamic compromise, pericardiocentesis is necessary to relieve fluid accumulation.
2. strictly inflammatory conditions may be treated with steroids or NSAIDs
3. Infectious conditions require antibiotic infection is suspected
What are the 3 main causes of pericardial effusions:
2. Chylopericardium = accumulation of chylous from an injured thoracic duct
3. Hemopericardium = accumulation of blood in the pericardial space (often results from direct trauma, cardiac rupture after MI, and aortic dissection
1. transudate = serous effusion that develops with left heart failure, over hydration, or hypoporteinemia.
2. exudate = pericardial inflammation that with acute pericarditis, heart surgery, some chemo agents, autoimmune disorders such as SYSTEMIC LUPUS ERYTHEMATOUS **SLE***
3. Serosanguineous = tuberculosis, neoplasma UREMAI, or RADIATIO, or coagulation defects.
4. CHYLE LEAKS through the thoracic duct it may enter the pericardium and lead to cholesterol pericarditis
Physical Examination of Pericardial Effusion?
*if the effusion develops gradually, the pericardium can stretch to accommodate large quantities of fluid without compression the heart.
if effusion is large it may creat sufficient pressure to cause CARDIAC COMPRESSION aka CARDIAC TAMPONADE
-apical impulse may be difficult to palpate & heart sounds will be muffled
what is the danger of the pressure exerted by the pericardial fluid in relation to the right atrium and ventricle.
the pressure exerted may equal diastolic filling pressures within the heart chambers, thus PREVENTING CHAMBER FILLING during diastole.
right atrium nd ventricle rare first because their diastolic pressures are the lowest/
what does preventing filling in the right atrium cause?
-increased venous pressure
-systemic venous congestion
-sighns and symptoms of RIGHT HEART FAILURE (distention of JVP, edema, hepatomegally)
-decreaed atrial filling leads to decreased ventricular filling which decreases stroke volume, which reduces cardiac output HYPOTENSION!
What are the signs and symptoms of cardiac tamponade?
**DECREASED LV FILLING DURING INSPIRATION
dyspnea on exertion, JVD, cardiomegaly, and PULSUS PARADOXUS
muffled heart sounds, poorly palpable apical pulse, dull chest piano
---a chest roentgenogram may disclose a "water-bottle" configuration of the cardiac silhouette
--an echo can detect an effusion as small as 20 ml and is considered the MOST ACCURATE AND RELIABLE
--CT is commonly used
When do you drain the pericardial guild by percutaneous FNA
persisetnt (>2 weeks) pericardial effusion
analysis includes hematocrit and cell found determination - glucose proitn cholesterol and triglycerides
what do u do to examine for tuberculosis?
acid fast bacilli
what do u do to examine ofr chylous effusion in thoracic duct injurty?
triglceride levels should be up
high cholesterol suggests hypothyrodiism
What is pulse paradoxus
a decrease in the systemic systolic blood pressure of more than 10 mm Hg with inspiration
what on the EKG is PATHOGONEMONIC for effusion?
alteration of QRS complex amplitude or axis between beats and a possible wandering adeline
it is seen in cardiac tamponade and severe cardiac effusions and is thought to be related to the ventricular electrical axis due to fluid in the pericardium and the heart essentially wobbles in the fluid filled pericardiac sac!
What is the GOLD STANDARD for CARDIAC TAMPONAD for noninvasive assessment and demonstrates the pericardial effusion and its hemodynamic effects?
1. compression of the right atrium
2. compression of the right ventricle in diastole
3. increased flow into the right ventricle
4. leftward bulging of the intraventrular septum
5. decreased left ventricular filling during inspiration
inferior vena cava is often distended
right sided heart cath can also be used to determine the ehmodynamic significance of pericardial effusion
What is the immediate treatment of cardiac tamponade?
IV hydration, which increased preload and aids in filling of the cardiac chambers
2. vasopressors may be needed to support systemic blood pressures
3. definitive treatment is pericardiocentesis
for of pericardial disease that used to be mostly caused by tuberculosis, but now is more related to radiation, rheumatoid arthritis, uremia, or CABG.
_____ is when fibrous scarring with occasional calcification of the pericardium causes visceral and parietal pericardial layers to adhere, obliterating the pericardial davit. the Fibrotic lesions encase the heart in a rigid shell
***Disease is DIFFUSE & SYMMETRICAL
**Results in elevated and equalized diastolic pressure sin ALL FOUR CHAMBERS
**Early diastolic filling is NOT impaired but is slowed in mid & late diastole as the ventricles meet the resistance of the thickened pericardium.
does constrictive pericarditis occur suddenly?
because the onset of constrictive carditis is gradual, clinical manifestation seldom include ______. Symptoms tend to be what?
right heart failure, fatigue, dyspnea, abdominal pain, hepatic distention, as cities lower extremity swelling
what will physical examination find? for constrictive pericardiits
1. Jugluar veins are distended- the jugular pressure uirng inspiration stays the same of increases KUSSMAUL SIGN rater than falling
2. and early diastolic sound (pericardial knock) that follows the aortic component of the second heart sound ma be heard at the LLLSB
what are laboratory findings of constrictive pericaridits.
Echo = thickened pericardium with reduced mobility, dilation of inferior vena cava, and abnormalities of VENTRIULAR SEPTAL WALL MOTION
right sided heart cath CONFIRMS DIAGNOSIS
what is the sign on the diastolic ventricular pressure curve for constrictive pericardidtis?
low early diastolic pressure that rises quickly & plateus in late diastole has been called the dip and plateau sign or the square root sign