Term
| Characteristics Acute pericarditis |
|
Definition
-Inflammation of pericardial sac
Isolated finding or part of underlying disorder or generalized dz |
|
|
Term
| Causes Acute pericarditis |
|
Definition
1. Idiopathic- likely post-viral
2. Infections - Viral (COXSACKIEVIRUS), bacterial (TB), fungal, toxoplasmosis
3. Acute MI, Dressler's Syndrome
4. Uremia
5. Collagen vascular Dz
6. Drug induced lupus syndrome, radiation, trauma
7. Post- Sx |
|
|
Term
|
Definition
-Majority recover in 1-3 weeks
-Complications - Pericardial effusion or cardiac tamponade |
|
|
Term
| Presentation of A Pericarditis |
|
Definition
-Chest pain most common, often severe and PLEURITIC, positional (relieved by sitting up and forward), often localized to retrosternal and radiates
-Fever and leukocytosis |
|
|
Term
|
Definition
-Symptoms of preceding illness, cough, diarrhea
-Pericardial friction rub- not always but very specific
-May have atrial systole, ventricular systole, early diastole |
|
|
Term
|
Definition
-ECG- 4 specific findings
-Echo- if effusion suspected, otherwise usually normal |
|
|
Term
| EKG finding Acute Pericarditis |
|
Definition
1. **Diffuse ST Elevation and PR Depression **
2. ST segment returns to normal about 1 week
3. T wave inverts in some pts
4. T wave returns to normal |
|
|
Term
|
Definition
1. Most self limiting and resolve 2-6 weeks
2. Tx underlying cause if known
3. NSAIDS
4. Glucocorticoids if pain, but should be avoided if possible |
|
|
Term
| Characteristics Pericardial Effusion |
|
Definition
-Any cause of Acute Pericarditis that can lead to exudation of fluid into space
-Association w/ ascites, pleural effusion in CHF, cirrhosis and nephrotic syndrome
-Often asymptomatic
-Acute or Chronic |
|
|
Term
| Presentation of Pericardial Effusion |
|
Definition
-All non-specific
1. Muffled heart sounds
2. Soft PMI
3. Dullness at Left Lung Base
4. May have pericardial friction rub |
|
|
Term
|
Definition
1. **Echo- 1st choice, confirms presence or absence
2.CXR- can show enlarged heart if >250mL fluid, silhouette "water bottle" , especially if seen w/o pulm congestion
3. ECG- low QRS volt, Twave flat, not good for Dx
-If electrical alternans = w/ tamponade
4. Fluid analysis- find cause of effusion |
|
|
Term
|
Definition
-Depends on Hemodynamic stability
-Pericardiocentesis only if evidence of tamponade
-If small and insignificant, repeat echo in 1-2 weeks |
|
|
Term
| What is Cardiac Tamponade |
|
Definition
-accumulation of pericardial fluid
-rate of fluid accumulation important, not amount |
|
|
Term
| Characteristic of cardiac tamponade |
|
Definition
>200 mL fluid accumulates rapidly
-2L fluid accumulates slowly (can stretch and adapt) |
|
|
Term
| Pathology Cardiac Tamponade |
|
Definition
-Pericardial effusion that mechanically impairs diastolic filling
-elevation and equalization of pressures of RV, LV, RA, LA, pulm artery, and pericardium during diastole
**Impaired ventricular filling during diastole = Dec. SV, CO |
|
|
Term
| What is Cardiac Tamponade |
|
Definition
-accumulation of pericardial fluid
-rate of fluid accumulation important, not amount |
|
|
Term
| Characteristic of cardiac tamponade |
|
Definition
>200 mL fluid accumulates rapidly
-2L fluid accumulates slowly (can stretch and adapt) |
|
|
Term
| Pathology Cardiac Tamponade |
|
Definition
-Pericardial effusion that mechanically impairs diastolic filling
-elevation and equalization of pressures of RV, LV, RA, LA, pulm artery, and pericardium during diastole
**Impaired ventricular filling during diastole = Dec. SV, CO |
|
|
Term
| Causes of cardiac tamponade |
|
Definition
1. Penetrating trauma to thorax, gunshot/stab wound
2. Iatrogenic- central line placement, pacemaker insertion, etc.
3. Pericarditis - Idiopathic, neoplastic, or uremic
4. Post-MI w/ free wall rupture |
|
|
Term
| Presentation Cardiac Tamponade |
|
Definition
**Elevated JVD- most common
-Narrrowed pulse pressure
- Pulsus Paradoxus (large dec. arterial pressure during inspiration), but strong pulse during expiration
-Distant/muffled Heart sounds
-Tachypnea, tachycardia, hypotension |
|
|
Term
|
Definition
1. Echo - diagnostic, most sensitive and specific
2. CXR- enlargement of cardiac silhouette w/ >250mL, clear lung fields
3. ECG- electrical alternans, not diagnostic
4. Cardiac cath - equalization of pressures in all chambers, elevated right atrial pressure |
|
|
Term
| Tx Cardiac tamponade- Non hemorrhagic |
|
Definition
-If hemodynamically stable- monitor closely
-If known renal failure - dialysis most helpful
-If not Hemo stable = Pericardiocentesis |
|
|
Term
| Tx Cardiac tamponade- Hemorrhagic |
|
Definition
-Emergent Sx if bleeding unlikely to stop on own
-Pericardiocentesis temporizing measure |
|
|
Term
| Classic Triad on physical exam for cardiac tamponade |
|
Definition
Beck's triad :
1. distant heart sounds
2. elevated venous pressure
3. Hypotension |
|
|
Term
| Cause Constrictive Pericarditis |
|
Definition
-Fibrous scarring of pericardium = rigidity and thickening w/ obliteration of cavity
-restricts diastolic filling
-Idiopathic in most pts or related to previous viral infection
-Other causes uremia, radiation, TB, chronic pericardial effusion, tumor, connective tissue disorder, Sx |
|
|
Term
| Clinical features Constrictive Pericarditis |
|
Definition
*Pts appear very ill
1. W/ symptoms of fluid overload such as edema, ascites and pleural effusions OR
2. Symptoms of dec. CO such as dyspnea, fatigue, dec. exe tolerance, cachexia
3. OR symptoms of both |
|
|
Term
| Signs of Constrictive Pericarditis |
|
Definition
**JVD
-Kussmaul's sign - JVD doesn't dec. on inspiration
-Pericardial knock
-Ascites
-Dependent edema |
|
|
Term
| Cause Constrictive Pericarditis |
|
Definition
-Fibrous scarring of pericardium = rigidity and thickening w/ obliteration of cavity
-restricts diastolic filling
-Idiopathic in most pts or related to previous viral infection
-Other causes uremia, radiation, TB, chronic pericardial effusion, tumor, connective tissue disorder, Sx |
|
|
Term
| Clinical features Constrictive Pericarditis |
|
Definition
*Pts appear very ill
1. W/ symptoms of fluid overload such as edema, ascites and pleural effusions OR
2. Symptoms of dec. CO such as dyspnea, fatigue, dec. exe tolerance, cachexia
3. OR symptoms of both |
|
|
Term
| Signs of Constrictive Pericarditis |
|
Definition
**JVD
-Kussmaul's sign - JVD doesn't dec. on inspiration
-Pericardial knock
-Ascites
-Dependent edema |
|
|
Term
| Evaluation of Constrictive Pericarditis |
|
Definition
1. ECG - non-specific low QRS volt, T wave flat,, LA abnormalaties
-Afib in advanced disease
2. Echo - inc. pericardial thickness, halt in ventricular diastolic filling, atrial enlargement
3. CT/MRI - pericardial thickening
4. Cardiac Cath- elevated and equal pressures in all chambers |
|
|
Term
| Management of constrictive Pericarditis |
|
Definition
**Tx underlying cause
-Diuretics may be helpful in fluid overload
-Monitor and tx for coagulopathy |
|
|
