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30 Cards in this Set

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What happens to the pericardium that causes it to become constrictive?
It becomes:
thickened
adherent
calcified
What hemodynamic effects does constrictive pericarditis have?
Limits diastolic filling, acts like a straight jacket.
When does fibrous scar formation occur?
After the layers fuse together.
What one finding, although rare, makes diagnosis relatively easy?
Calcification. 23%
Seen on x-ray.
Who is at risk for constrictive pericarditis?
Post cardiac surgery patients.
After repeated episodes of pericarditis (they may not know)
Radiation therapy.
Why is constrictive pericarditis difficult to diagnose?
Clinical presentation mimics more common diseases.
No one diagnostic test alone confirms diagnosis.
Which tests are best to diagnose constrictive pericarditis?
MRI, CT
9 Patient presentations
Dyspnea
Ascites
Pleural effusion
Anasarca
JVD
Kussmaul sign
Pericardial knock
Hepatomegaly
What is it called when there is fluid in the tissues?
Anasarca
What is a pericardial knock?
Murmur caused by abrupt cessation of ventricular filling.
Occurs early in diastole, after S2
What is a Kussmaul sign?
JVD upon inspiration.
Why is distolic function affected?
The ventricle expands quickly during filling, and quickly reaches the limit imposed by the constrictive pericardium. At this point, venous return to the heart ceases.
Why do you see signs of right heart failure in constrictive pericarditis?
When the ventricles reach their limit, filling ceases, systemic venous P rises and signs of RHF ensues.
Is systole affected in constrictive pericardittis?
No, systolic function is normal.
What happens to SV and CO in constrictive pericarditis?
Reduces, leading to low BP.
How does Kussmmaul sign happen?
Inspiration draws blood into the thorax, where it cannot be accommodated by the constricted right side, causing blood to accumulate in the intrathoracic veins.
Why is hepatomegaly a problem?
Elevates liver enzymes and abdominal symptoms present, steers diagnosis away from constrictive pericarditis.
When does Kussmal sign happen?
Inspiration.
Describe diastole in constrictive pericarditis?
Early diastolic filling is rapid with an abrupt cessation when the ventricle hits the wall.
2D findings in constrictive pericarditis?
(9)
Thickened pericardium
Normal to small LV
Normal systolic findings
RAE, LAE
Flattened diastolic wall motion
Respiratory variation in ventricular size and filling.
Bound down appearance of ventricular walls
No pericardial slide
Dilated IVC and hepatic veins
M mode findings of constrictive pericarditis?
Flap PW - minimal motion early to late diastole.
Strong pericardial reflection
Abnormal septal motion.
With constrictive pericarditis, septum may have several patterns, what are they?
Ventricular septal bounce.
Abrupt posterior motion in early diastole, and abrupt anterior motion.
Reynolds "Spanish Notch" - Square root sign.
Difference between Tamponade and constrictive pericarditis?
One has an effusion.
Doppler findings in constrictive pericarditis?
Respiratory variation.
IVRT increases with inspiration. (20%)
When does IVRT increase in constrictive pericarditis?
Inspiration, 20%
What happens to hepatic flow upon inspiration?
S, D increase.
What happens to hepatic reversal with expiration?
Increase.
Normal wall width?
less than 2 mm
How do you rule out RCM?
Endomyocardial biopsy.
Mortality rate of pericardiectomy?
5-15%, because of infections.