Term
| 3 functions of pericardium |
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Definition
| 1) Fixes heart in mediastinum 2) Prevents extreme dilation of the heart 3) Barrier to limit infection spread from lungs |
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Term
| Can you live without the paricardium? |
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Definition
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Term
| What condition is an inflammatory process involving the pericardium that results in a triad of chest pain, pericardial friction rub, and changes in EKG? |
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Definition
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Term
| Is acute pericarditis more common in men or women? |
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Definition
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Term
| What is the most common etiology of dacute pericarditis? |
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Definition
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Term
| What is Dresler's syndrome? When does it occur? |
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Definition
| Recurrent pericarditis. 2-3 wks s/p MI or open heart surgery |
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Term
| What metabolic disorders can cause acute pericarditis? |
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Definition
| Uremia and hypothyroidism |
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Term
| What condition affecting the paricardium can occur after blunt trauma to the chest? |
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Definition
| Acute pericarditis - fills with blood |
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Term
| What is the main sx of acute pericarditis? |
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Definition
| Severe, sharp, retrosternal chest pain |
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Term
| When does the pain experienced in acute pericarditis improved? When is it worsened? |
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Definition
| Improved when sitting upright and leaning forward. Worsened when supine and with inspiration. |
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Term
| Name 2 other possible sx of acute pericarditis. |
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Definition
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Term
| What can be heard upon auscultation in a pt w/ acute pericarditis? Describe it. |
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Definition
| Pericardial friction rub. One systolic and 2 diastolic sounds - scratching or rasping sound |
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Term
| When would you need to order an Echo for acute pericarditis? |
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Definition
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Term
| What is seen on EKG in acute pericarditis? |
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Definition
| Diffuse ST elevation. Also PR depression in all leads, except AVR and V1 (elevation) |
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Term
| What 2 main things help to distinguish and EKG of acute pericarditis from an MI? |
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Definition
| Diffuse ST elevation (focal in MI) and concave ST elevation from S wave (convex in MI from R wave) |
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Term
| What meds are used to tx idiopathic or viral endocarditis? |
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Definition
| NSAIDS (asprin, indomethacin, or Ibuprofen) for sx tx |
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Term
| When is ibuprofen contraindicated in the tx of acute pericarditis? What should be used instead? |
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Definition
| Immediately s/p MI - use asprin first then ibuprofen later |
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Term
| What meds are given in acute pericarditis with severe pain and persistent symptoms? |
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Definition
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Term
| When is colchicine given to pts with pericarditis? How does it work? |
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Definition
| For recurrent pericarditis or steroid dependency. Anti-inflammatory effect on neutrophil fxn to reduce recurrence rate. |
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Term
| What is considered the most definitive tx for pericarditis? |
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Definition
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Term
| When is pericadiectomy indicated in pericarditis? What is the mortality rate? |
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Definition
| Pericardial constriction. 30 day mortality is 5%. |
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Term
| What is pericardial effusion? |
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Definition
| Accumulation of transudate, exudate, or blood in the pericardial sac |
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Term
| What 3 things determine the severity of sx in pericardial effusion? |
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Definition
| 1) Speed with which the pericardium fill with fluid 2) The volume of fluid 3) Compliance of the individual's heart tissue |
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Term
| What type of chest pain is described in pericardial effusion? |
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Definition
| Dull constant ache or pressure in left side of chest |
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Term
| Name 5 sx other than CP in pericardial effusion? |
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Definition
| Dysphagia, dyspnea, nausea, hoarseness, and hiccups |
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Term
| What causes hoarseness and hiccups in pericardial effusion? |
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Definition
| Hoarseness - laryngeal n. compression, hiccups - phrenic n. stim. |
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Term
| What is seen in the physical exam of a pt w/ a small pericardial effusion? |
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Definition
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Term
| What is seen in the PE of a pt w/ a large pericardial effusion? |
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Definition
| Muffled heart sounds and Ewart sign |
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Term
| What is the Ewart sign? In what condition is it seen? |
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Definition
| Dullness to percussion, bronchial breath sounds, and egophony below angle of (L) scapula. Pericardial effusion. |
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Term
| Can you see a pericardial effusion on CXR? |
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Definition
| Yes - if it is at least 250mL |
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Term
| What tx can be done for pericardial effusion? |
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Definition
| Diuretic, pericardiocentesis, or surgery |
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Term
| When does a pericardial effusion become a cardiac tamponade? |
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Definition
| When the fluid exerts a high pressure and compresses the cardiac chambers severely limiting filling of the heart. |
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Term
| Name 7 sx of cardiac tamponade. |
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Definition
| 1) Dyspnea 2) Chest discomfort 3) Weakness 4) Restlessness/agitation 5) Drowsiness 6) Oliguria 7) Anorexia |
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Term
| What 3 s/sx are called Beck's triad? In what condition is this considered pathognomonic? |
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Definition
| 1) JVD 2) Muffled heart sounds 3) Hypotension. Cardiac Tamponade. |
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Term
| What is pulsus paradoxus? Is it a specific finding in cardiac tamponade? |
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Definition
| Decrease in SBP >10mm Hg with inspiration. No - seen in several other conditions. |
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Term
| What test is the most useful and noninvasive for cardiac tamponade? |
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Definition
| Transthoracic echocardiography (TTE) |
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Term
| What is the definitive diagnostic procedure for cardiac tamponade? |
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Definition
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Term
| Name 3 tx's for cardiac tamponade. |
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Definition
| Pericardiocentesis, pericardial window, pericardiectomy |
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Term
| What is constrictive pericarditis? |
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Definition
| Thickened, fibrotic, adherent pericardium resulting in impaired ventricular filling and decreased cardiac output. |
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Term
| Name 4 etiologies of contrictive pericarditis. |
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Definition
| 1) Idiopathic 2) Radiation therapy 3) Cardiac surgery 4) Viral pericarditis |
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Term
| Name 3 sx of constrictive pericarditis. |
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Definition
| Slowly progressive dyspnea, fatigue, and weakness |
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Term
| Name 3 conditions that occur as a consequence of constrictive pericarditis. |
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Definition
| 1) Chronic edema 2) hepatic congestion 3) Ascites |
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Term
| What sign on PE is associated with constrictive pericarditis? |
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Definition
| Kussmaul sign - JVP elevates with inspiration instead of decreasing |
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Term
| What would you expect to hear on auscultation in a pt with constrictive pericarditis? |
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Definition
| muffled heart sounds and possible pericardial knock (early diastolic sound occurring immediately /p 2nd heart sound) |
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Term
| What arrythymia commonly occurs in constrictive pericarditis? |
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Definition
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Term
| What lab finding is expected in constrictive pericarditis? |
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Definition
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Term
| Name 2 treatments for constrictive pericarditis. |
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Definition
| Aggressive diuresis and pericardiectomy |
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Term
| What might you see on CXR in constrictive pericarditis? |
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Definition
| calcifications, bilat atrial enlargement, or effusion |
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Term
| What part of the cardiac endothelium does infective endocarditis usually affect? |
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Definition
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Term
| Name 4 risk factors for infective endocarditis. |
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Definition
| 1) Any structural HD (75%) 2) Immunosuppresion 3) IVDA 4) Catheter bacteremia |
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Term
| What is the most common cause of infective endocarditis in adults? |
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Definition
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Term
| Name the 1st and 2nd most common bacteria that cause endocarditis in a native valve. |
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Definition
| 1) Strep viridians 2) Staph aureus |
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Term
| What is the most common bacteria that causes endocarditis in IV drug users? What is the most common valve affected? |
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Definition
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Term
| What is the most common bacteria that causes endocaridits in the first 12 mths of placing a prosthetic valve? |
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Definition
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Term
| What sx do pts w/ endocarditis commonly present with? |
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Definition
| flu-like sx - dry cough, body aches, low-grade fever, night sweats, wt loss |
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Term
| What is the leading cause of death in pts w/ endocarditis? What % of pts w/ endocarditis get this complication? |
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Definition
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Term
| What skin lesions can be caused by infective endocarditis? |
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Definition
| Petechiae, splinter hemorrhages (vertical lines under nails), osler's nodes (red, painful, on fingertips/palm), janeway lesions (red spots on palms and soles), roth spots (retinal hemorrhages made of fibrin) |
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Term
| Do pts with infective endocarditis present with a murmur? |
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Definition
| Yes - usually mitral valve regurgitant type murmur |
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Term
| How can infective endocarditis affect other organs? |
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Definition
| Splenomegaly, encephalopathy, cerebral emboli, meningitis/abscess |
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Term
| What labs are altered in infective endocarditis? |
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Definition
| increased WBC, NCNC anemia, elevated ESR and CRP |
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Term
| What may show up on EKG in a pt w/ infective endocarditis? |
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Definition
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Term
| What test is used to dx infective endocarditis? |
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Definition
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Term
| What is the criteria used for dx of infective endocarditis? |
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Definition
| Duke criteria - requires 2 major, 1 major and 3 minor, or 5 minor criteria for dx |
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Term
| What are the major criteria in Duke's criteria? |
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Definition
| typical organism, persistent bacteremia, (+) Coxiella brunetti, (+) echo for vegetations, abscess, or valve |
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Term
| What are the minor criteria? |
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Definition
| valvular HD, h/o IVDA, >38C, vasculitis, skin lesions, suggestive echo results, single (+) blood culture |
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Term
| What is the tx for infective endocarditis? |
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Definition
| Beta lactam + aminoglycosides X 6 wks |
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Term
| What surgical procedure is indicated in ~25% of cases of infective endocarditis? |
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Definition
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Term
| When is tx for infective endocarditis considered a failure? |
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Definition
| fever or bacteremia after 7 days |
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Term
| What is the most common cause of infective myocarditis? |
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Definition
| acute viral infxn or post viral immune response (often follows a URI) |
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Term
| What is the most common virus to cause myocarditis? |
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Definition
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Term
| What are common clinical presentations for myocarditis? |
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Definition
| chest pain or signs of HF |
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