Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
|
big picture diff b/w cardiac tamponade and constrictive pericarditis
|
cardiac tamponade has to do with the excessive filling with fluid of the pericardial sac. this puts pressure on the ventricles such that they cannot be filled correctly. this, in turn, leads to lower stroke volume and if not corrected, not enough blood is pumped to the body and shock occurs
constrictive pericarditis has more to do with the pericardium itself that somehow (perhaps by inflammation) becomes fibrotic and thickened. bc of this |
|
|
etiologies of cardiac tamponade
|
TRAMP
Trauma Rupture (of heart or vessels) Anticoagulants (ie. warfarin) Malignancies Pericarditis |
|
|
in which dz will you see a chest x-ray with a large global heart or a recent marked increase in heart size/cardiac silhouette: cardiac tamponade or constrictive pericarditis?
|
cardiac tamponade
|
|
|
in which of these -- cardiac tamponade or constrictive pericarditis -- can improper use of anticoagulants/fibrinolytics lead to dz?
|
cardiac tamponade
|
|
|
pt comes to you and says something's happened 2 hours ago in his chest and on ECHO you see fluid around the heart.
Dx? |
probably cardiac tamponade (becuase it's an acute process)
|
|
|
pt comes to you with gradually worsening sx's of chest pain and you see fluid around the heart on ECHO.
Dx? |
it's probably constrictive pericarditis (since it's a more chronic process)
|
|
|
name condition characterized by impairment of diastolic filling of heart caused by increase in intrapericardial pressure due to abrupt pericardial fluid accumulation.
|
cardiac tamponade
|
|
|
when you hear PULSUS PARADOXUS, what should you automatically think?
|
cardiac tamponade!!!
|
|
|
what are the fxns of the pericardium? (4)
|
- limits acute dilation
-maintains optimal pressure-volume relation in the cardiac chambers - favors ejection of similar stroke volume - shields the heart from infections |
|
|
in tamponade, what causes the steep x-descent on the atrial pressure waveform?
|
rapid early atrial filling: the elevated JVP will cause the atrium to try to relax abnormally quickly in order to rush more blood back into the atrium.
|
|
|
tell me about the hemodynamics of cardiac tamponade
|
an abrupt rise of pericardial pressure occurs, which leads to a sudden decrease in ventricular filling because they can't open up to the normal filling size. this raises ventricular diastolic pressure as well as atrial pressures to a point where there's an equalization of elevated pressures among all four chambers during diastole.
|
|
|
T or F. a steep x descent is characteristic of cardiac tamponade ONLY.
|
F. it's non-specific and present in ANY pericardial dz
|
|
|
T or F. the equalization of elevated IC pressures is characteristic of cardiac tamponade ONLY.
|
F. it's also non-specific and a hallmark of ANY pericardial dz causing impairment of diastolic filling
|
|
|
what is the ONLY hallmark of cardiac tamponade?
|
pulsus paradoxus = where there's an exaggerated inspiratory drop in SBP >10 mmHg due to increase venous return/RV size during inspiration, shifting septum from right to left so that LV side output is smaller... this means that SBP will be lower.
|
|
|
is pulsus paradoxus always present in cardiac tamponade cases?
|
no!! it won't show up in severe hypotensive (shock) or hypovolemic states...
|
|
|
what is the classic clinical triad of cardiac tamponade dx?
|
-increased jugular venous pressure
- low BP (hypotension) - small, quiet heart sounds |
|
|
what is the best test to document presence of pericardial fluid?
|
ECHO
|
|
|
what's the main diff b/w constrictive pericarditis and cardiac tamponade in terms of TIMING?
|
CP is impairment of diastolic filling due to CHRONIC thickening and/or calcification of the pericardium, whereas CT is ACUTE event where suddenly the pericardial sac is filled with excessive fluid
|
|
|
what is teh most frequent cause of constrictive pericarditis?
|
idiopathic
|
|
|
in which cancer types can you develop constrictive pericarditis?
|
breast and lung CAs
|
|
|
what's the pathophysiology for constrictive pericarditis?
|
-Impaired diastolic filling
-Elevation of LV diastolic pressure -Elevation of atrial pressure -Equalization of elevated IC pressure -Dip-and-plateau RV pressure -Kussmaul sign -Pericardial knock extra sound THE LAST THREE ARE SPECIFIC TO CONSTRICTIVE PERICARDITIS |
|
|
which dz has the characteristic dip-and-plateau RV pressure (aka. square root sign)? what accounts for this?
|
constrictive pericarditis
during early diastole, ventricles fill abruptly due to high atrial pressures (like people rushing into a store for a sale). this accounts for the steep diastolic "dip" seen on ventricular pressure curves. once the limit of distensibility of ventricles/pericardium is reached, the ventricular filling abruptly ceases and during the remainder of diastole there is a "plateau" in ventricular pressure curve. |
|
|
explain the pericardial knock - which is it a sign for: constrictive pericarditis or cardiac tamponade?
|
constrictive pericarditis
this is an early diastolic sound, that occurs shortly after the second heart sound due to a sudden cessation of early diastolic ventricular filling (due to CP) |
|
|
on physical examination of a pt with constrictive pericarditis, how does a JVP show up on tracing?
|
there's a steep y descent due to rapid early filling of ventricles
|
|
|
define: kussmaul's sign.
what two dz's can this be a sign of? |
NECK VEINS WILL BE MORE PROMINENT DURING INSPIRATION (aka. the "stubborn jugular vein sign"): paradoxical increase in jugular venous pressure during inspiration
Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity. Kussmaul's sign suggests impaired filling of the right ventricle due to either fluid in the pericardial space or a poorly compliant myocardium or pericardium. sign of: chronic constrictive pericarditis OR restrictive cardiomyopathy |
|
|
why aren't the steep Y descent or "dip-and-plateau" signs not present in cardiac tamponade?
|
tamponade is a pan-diastolic impairment of RV/LV filling (in other words, there is reduced filling throughout diastole), whereas constrictive pericarditis has enhanced/rapid early filling and sudden cessation of ventrcle filling
|
|
|
name the clinical triad for constricitve pericarditis
|
1) congestive HF signs and sx's (peripheral edema, hepatomegaly, ascites, inc JVP)
2) prominent Y descent in neck veins 3) small quiet heart |
|
|
tx of tamponade vs. constrictive pericarditis
|
tamponade = pericardiocentesis/pericardial tap to remove pericardial fluid
constrictive = pericardiectomy (pericardial stripping) |
