| How is the normal functional pericardium? | Double-layered sac (serous membrane separated by 15-50ml of fluid coming from fibrous parietal pericardium)
Prevents sudden dilation of cardiac chambers, especially right atrium and ventricle, during exercise and hypovolemia.
Restricts anatomic position of the heart and retards the spread of infections from lungs and pleura to the heart |
| What are the classifications of pericardial diseases? | Acute pericarditis (<6 weeks, fibrinous/effusive (serous))
Subactue pericarditis (6 weeks- 6months, effusive-constrictive/constrictive)
Chronic pericarditis (>6 months, constrictive/effusive/adhesive nonconstrictive) |
| What are the etiologies causing pericarditis? | Infectious (viral [coxsackie, echo, mumps, adeno, hep, HIV], pyogenic [pneumococcus, strep, staph, neisseria, legionella], TB, Fungal [histoplasm, coccidio, candida, blastocyto], others [syphilis, protozoa, parastie])
Non-infectious (acute MI, Uremia, Neoplasia [primary/secondary metastasis], myxedema, cholesterol, chylopericardium, trauma, aortic dissection leak to sac, FMF [Mulibery nanism], acute idiopathic, Whipple's, sarcoidosis)
Hypersensitivity/Autoimmune pericarditis (RF, collagen vascular disease, drug induced, postcardiac injury (MI/pericardiotomy/trauma)) |
| What are the principal diagnostic features of acute pericarditis? | Chest pain (acute infectious pericarditis and HS, severe, retrosternal and left precordial refferred to neck, arms or left shoulder. frequently pleuritic if accompanied with pleural inflammation. relieved by sitting up and leaning forward and intensified by supine position, absent in TB, post-irradiation and neoplastic, uremic, constrictive pericarditis)
Pericardial friction rub (Audible 85%, 3 components (high-pitch, rasping/scratching, end-expiration upright pt))
ECG (4 stages, 1: ST elevation widespread and PR depressed, 2: ST normal, 3: T wave inversion, 4:normal)
Effusion (short time and may lead to tamponade, fainter sounds with effusion, CXR shows enlargment of cardiac silhoutte watter-bottle configuration, may be normal) |
| What are labs done for acute pericarditis? | TTE (sensitive, specific, simple, noninvasive, localizes and indentifies quantity of effusion)
CT and MRI (superior to echo detecting loculated effusions, thickening, and pericardial masses) |
| How is the dx algorithm for pericarditis? | . |
| How is tx of acute pericarditis? | No specific tx for idiopathic, symptomatic (bed rest, anti-inflammatory and aspirin, NSAIDs ibuprofin, tx for 1-2 weeks)
Unresponsive and recurrency (colchicine, corticosteroids)
Avoid anticoagulants |
| What is cardiac tamponade? | Accumulation of fluid in pericardium in quantity causing obstruction of inflow of blood to ventricles, most common causes are idiopathic pericarditis and neoplatic pericarditis.
May result in bleeding into pericardial space after leakage (from aortic dissection, cardiac operations, trauma, tx of pt with pericarditis with anticoagulants)
3 principal features (Beck's triad: Hypotension, Soft heart sounds and jugular vein distention w/x descent and no y)
Quantity of fluid to produce tamponade 200ml acute and >2000 chronic |
| How is paradoxical pulse in tamponade? | greater than normal (10mmHg) inspiratory decline in systolic arterial pressure, enlargement of right ventricle compresses LV volume and buldges wall to left reducing the LV cavity, occurs in 1/3 of pt w/constrictive pericarditis, hypovolemic shock, acute and chronic obstructive airway diseases, pulmonary embolism |
| How is dx and tx of tamponade? | Dx (TTE, CT and MRI, pericardial fluid analysis (from an effusion often is exudative, bloody if due to neoplasm, renal failure, dialysis, TB, RF, cardiac injury, MI, transudate in HF/ we should look for RBC and WBC, cytology, cultures, PCR TB)
TX (pericardiocentesis, surgical drainage through limited subxiphoid thoracotomy) |
| What is post-cardiac injury syndrome/ Dressler's Syndrome? | Post MI with blood in pericardial cavity, syndrome may develop after cardiac op, blunt/penetrating trauma, pereforation of heart with a cath.
Mimics acute viral/idiopathic pericarditis, symptom is pain of acute pericarditis 1-4 weeks after injury but earlier 1-3 days pre MI, recurrences common up to 2 years or more following the injury, fever, pleuritis, pneumonitis are features, and illness subsides 1-2 weeks.
Result from HS reaction to Ag originates from injured myocardial tissue and pericardium.
No tx aside from aspirin and analgesic |
| How is DD of pericardial effusion? | Acute idiopathic pericarditis (exclusion dx)
R/O AMI
Pericarditis post MI/cardiac injury, due to collagen vascular...
Chronic pericardial effusions (TB/myxedema) |
| What is chronic constrictive pericarditis? | • This disorder results when the healing of an acute fibrinous or serofibrinous pericarditis or the resorption of a chronic pericardial effusion is followed by obliteration of the pericardial cavity with the formation of granulation tissue.
• The latter gradually contracts and forms a firm scar encasing the heart, which may be calcified
• The basic physiologic abnormality in patients with chronic con strictive pericarditis is the inability of the ventricles to fill because of the limitations imposed by the rigid, thickened pericardium |
| How is dx of chronic contrictive pericarditis? | Clinical (Righ HF, exertional dyspnea), Labs (ECG low QRS and flattened/ inverted T wave, TTE, CT, MRI)
Tx pericardial resection only definitive tx should be as complete as possible) |
| What are differences between constrictive pericarditis and restrictive cardiomyopathy? | . |
