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53 Cards in this Set
- Front
- Back
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What is the normal volume of pericadial space?
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15-50ml
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Parietal or visceral pericardium?
- fibrous |
parietal
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Parietal or visceral pericardium?
- serous |
visceral
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Functions of pericardium.
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- maintains heart in relatively fixed position
- reduce friction between heart and surrounding organs - barrier against spread of infection - prevent sudden dilation of cardiac chambers during volume loading |
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What is this disease?
chest pain: - sharp, stabbing - relieved by sitting up, aggrevated by deep inspiration and coughing or recumbency - dyspnea - fever |
acute pericarditis
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Interpret this ECG.
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acute pericarditis
- ST elevation, PR depression (see v2-v6) - T wave inverted after ST normalized (see v1) |
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How to treat acute pericarditis?
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- bed rest
- NSAIDs: ASA - steroid only if relapsing - treat etiology |
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Etiology of acute pericarditis.
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- 90% viral
- MI - connective tissue disorder - uremia - drug induced (serous) |
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What is this disease?
pericardial frictional rub - high pitch, scratchy, leathery - best heard during expiration - inconstant |
acute pericarditis
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Etiology of pericardial effusion.
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- viral, idiopathic
- neoplasms - infections (TB, bacterial) - uremia |
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What is this disease?
physical exam - muffled heart sound - Ewarts sign: dullness to percussion, egophony |
pericardial effusion
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What is this disease?
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pericardial effusion
- "water bottle" heart |
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What is this disease?
- dyspnea, cough, hoarseness - dysphagea - sense of abdominal fullness - see above ECHO |
pericardial effusion
- compression on esophagus and trachea |
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What is this disease? Etiology?
- ECHO: exudates in pericardial spave |
percardial effusion caused by TB
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What is this disease? etiology?
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pericardial effusion caused by bacterial infection
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When should to drain fluid in pericardial effusion?
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- if there is cardiac temponade or infection
- if large effusion (>20ml) for more than 1 month or right sided collapse |
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Etiology of cardiac temponade.
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- neoplasm
- uremia - viral or idiopathic - post MI rupture |
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What is this disease?
- decreased arterial pressure - increased venous pressure - quiet/distant heart sound |
cardiac temponade
- Beck's triad |
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What is this disease?
- pulsus paradoxus: pulse becomes stronger during expiration and weaker during inspiration. Heart beat present but no radial pulse. - Becks triad |
cardiac temponade
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What can cause pulsus paradoxus?
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- cardiac temponade
- COPD - pulmonary embolism - constrictive pericarditis - cardiogenic shock - restrictive cardiomyopathy |
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Interpret this ECG.
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cardiac temponade
- elestrical alteransL QRS amplitude alternates (swinging of heart) |
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What is the treatment for cardiac temponade?
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- pericardiocentesis
- IV fluids and pressor agents |
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Etiology of constrictive pericarditis.
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- viral or idiopathic
- post trauma, post cardiac surgery - neoplasm - radiation - TB (in AIDs patients) |
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What is this disease?
- chronic edema, wt gain - dyspnea, fatigue - hepatomegaly - Kassmaul sign: jugular venous pressure increase when deep breath - pericardial knock |
constrictive pericarditis
- figure shows pericardial knock |
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What is this disease?
- ECG: wide bifid p wave in sinus rhythm - x-ray: calcification of pericardium - ECHO: thickened pericardium |
constrictive pericarditis
- figure shows calcification of pericardium |
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What is the treatement for constrictive pericarditis?
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pericardiectomy
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What is this disease?
- equal end-diastolic pressure - RV diastolic pressure <50mmHg - ratio of RV end-diastolic pressure to RV systolic pressure > 0.33 - height of LV rapid filling wave >7mmHg |
constrictive pericarditis
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What is this disease?
- LV end-diastolic pressure is 5mm greater than RV end-diastolic pressure - RV diastolic pressure > 50mmHg - ratio of RV end-diastolic pressure to RV systolic pressure < 0.3 |
restrictive cardiomyopathy
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What is this disease?
- carditis - migratory polyarthritis - fever |
Rheumatic fever (JONES criteria)
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How to treat acure rheumatic fever?
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- PCN for 10 days
- daily PCN prophylaxis |
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How to treat chronic rheumatic heart disease?
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- for CHF: digoxin, diurectics
- for arthritis: high dose salisylates (ASA-like drugs) - bed rest |
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Pathogenesis of chronic rheumatic heart disease.
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Group A strep infection (upper respiratory tract) at age 5-15 -> acute rheumatic fever -> chronic rheumatic heart disease
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Etiology of mitral stenosis.
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- rheumatic valvular disease (most common)
- congenital - malignant carcinoid - amyloid |
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What is this disease?
Symptoms - dyspnea - pulmonary edema - atrial fibrillation - chest pain |
mitral stenosis
- dyspnea: reduced compliance of lung - pulmonary edema: backed pressure to pulmonary arteries from LA - atrial fibrillation: cause more edema (increased LA to LV pressure gradient due to increased HR) - chest pain: RV HTN -> RVH or embolization (pulmonary) |
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What is this disease?
Physical exam - normal/diminished arterial pulse - prominent jugular pressure: a wave (RA pressure) - palpation: inconspicuous LV, RV heave in pulmonary HTN - heart sound: accentuated S1, opening snap, diastolic murmur |
mitral stenosis
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What is this disease?
morphology - thickened mitral cusps, +/- calcium deposits - fusion of commissures - shortening of chordae |
mitral stenosis
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How to manage mitral stenosis?
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- PCN and SBE prophylaxis
- for symptomativ patients: digoxin, diuretics, activity restriction, beta-blockers - anticoagulant for LV>5.5cm, or embolism or atrial fibrillation - surgery if grade is above class III (dyspnea in less than usual activity) |
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Etiology of mitral insufficiency.
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- inflammation: rheumatic, SLE, slceroderma
- degenerative: myxomatous, marfan - infections - structural - congenital |
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T/F: Mitral insuffiency is usually asymptomatic till LV starts to fail.
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T.
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What is the change in heart in end stage mitral insufficiency?
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Right heart failure
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What is this disease?
- reduced impedance to ventricular emptying (LV decompress to LA) - reduced forward CO - increased total CO - normal LA compliance |
acute mitral insufficiency
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What is this disease?
- reduced impedance to ventricular emptying (LV decompress to LA) - reduced forward CO - increased total CO - low LA compliance |
chronic mitral insufficiency
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What is this disease?
physical exam - sharp carotid upstroke, rapid fall off - heart sound: soft S1, widely split S2, systolic ejection murmur, holosystolic murmur at apex ro axilla. |
mitral insufficiency
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What type of cardiomegaly do you see in people with mitral insufficiency?
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LV eccentric hypertrophy (volume overload)
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How to manage mitral insufficiency?
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- reduce afterload(impedance): ACE inhibitor, hydralzine
- for acute mitral insifficiency: IV nitroprusside (lower BP) - need to follow LV size and function - surgery when LV dimension > 5.5cm, ejection fraction <55% (reconstruction better than replacement) |
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Acquired etiology of aortic stenosis.
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- rheumatic fever
- degenerative: yrs of mechanical stress, diabetes, hyperlipidemia, calcium deposits at cuspal base. - atherosclerosis - calcific - rheumatoid |
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What is this disease?
- carotid pulse: pulsus parvus and tardus - heart sound: harsh systolic ejection murmur - gradual LVH (concentric) - increased afterload (impedance) |
aortic stenosis
- atrial contraction becomes important: atrial fibrillation may cause abrupt and severe symptoms |
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How to manage aortic atenosis?
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- operate when narrowing is less than 1cm2 (do not operate if asymptomatic even if the narrowing is less than 1cm2)
- endocarditis prophylaxis |
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Etiology of aortic insufficiency.
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- rheumatic fever
- infective endocarditis - congenital fenestration of cusps: marfan - traumatic rupture - ascending aoritc dissection - aortic root dilation - syphillis - ankylosing spondylitis |
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What is this disease?
- increased stroke volume - increased afterload (impedance) - LV dilation: cor bovinum |
aortic insufficiency
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What is this disease?
- awareness of heart beat - orthopnea - angina - edema |
aortic insufficiency
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What is this disease?
- bobbing head, jarring of body - arterial jack hammer pulse, capillary pulsations, widened pulse pressure - murmurs: diastolic high pitched blow, loud systolic aortic ejection murmur, diastolic rumble |
aortic insufficiency
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How to manage aortic insufficiency?
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- digoxin, diuretics
- afterload reduction: IV nitroprusside - surgery if symptomatic |
