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79 Cards in this Set
- Front
- Back
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INFLAMMATORY OR INFECTIOUS PROCESS OF THE PARIETAL AND VISCERAL LAYERS OF THE PERICARDIUM |
PERICARDITIS |
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TWO TYPES BASED ON ONSET, FREQUENCY, AND SYMPTOMS: |
ACUTE AND CONSTRICTIVE |
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This type of pericarditis: -occurs within two weeks of causitive condition -may last 6 weeks -can be wet or dry |
ACUTE |
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TRUE/FALSE obstructed lymphatic drainage is used to describe a dry condition |
FALSE: WET - also described as inflammation and thickening WITH pericardial effusion |
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How can a DRY condition be described? |
-fibrinous -inflammation and thickening w/o PE -causes a painful friction rub -rubbing heard w/ stethoscope |
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ETIOLOGY OF ACUTE PERICARDITIS |
- acute injury - Fibrin, white blood cells and endothelial cells are released and cover pericardium - Thickening between layers of pericardium - Friction between layers causing irritation and inflammation |
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TRUE/FALSE: A thickened pericardium may be seen sonographically and is a reliable way of dx pericarditis. |
FALSE! |
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What test is required to evaluate for infection? |
Pericardiocentesis |
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SYMPTOMS OF ACUTE PERICARDITIS |
- CHEST PAIN - CHILLS - FEVER - SWEATING |
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If there is a bacterial infection the pericardial effusion may be comprised of ______________ |
Puss (purulent effusion)
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The thick fluid may compress the heart, leading to _______________ pericarditis |
CONSTRICTIVE pericarditis |
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COMPLICATIONS OF ACUTE PERICARDITIS |
- PERICARDIAL EFFUSION - TAMPONADE - CONSTRICTIVE PERICARDITIS |
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A thickened, fibrotic and adherent pericardium restricting diastolic filling of the heart is |
Constrictive pericarditis |
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Pericardium undergoes 3 things: |
-fibrotic thickening -calcification -fusion (like a scab or scar) |
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ETIOLOGY OF CONSTRICTIVE PERICARDITIS |
- IDIOPATHIC - TB - CHRONIC RENAL FAILURE - LUPUS - POST CARDIAC SURGERY/PERICARDIOTOMY - POST PERICARDIAL EFFUSION - TUMOR INVOLVEMENT |
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THE MOST COMMON CAUSE OF CONSTRICTIVE PERICARDITIS IN UNDERDEVELOPED COUNTRIES IS: |
TB |
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SIGNS AND SYMPTOMS- CONSTRICTIVE |
-JUGULAR VENOUS DISTENSION - PERICARDIAL KNOCK -"SQUARE ROOT SIGN" - WEAKNESS/FATIGUE - WEIGHT LOSS/ MUSCLE WASTING -ABDOMINAL DISTENSION -HEPATOMEGALY -PERIPHERAL EDEMA -DYSPNEA |
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WHEN JUGULAR PRESSURES RISE WITH INSPIRATION THIS FINDING IS KNOWN AS: |
KUSSMAUL'S SIGN |
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RAPID EARLY DIASTOLIC FILLING FOLLOWED BY PROMINENT HALT IN FLOW: |
PERICARDIAL KNOCK |
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2D FINDINGS OF CONSTRICTIVE PERICARDITIS (8) |
- LV SZ NORMAL - LAE DUE TO IMPAIRED FILLING - LV AND RV SYSTOLIC FX NORMAL - THICKENED PERICARDIUM - PERICARDIAL EFFUSION - DILATED HEPATIC VEINS AND IVC W/ NO COLLAPSE DURING INSPIRATION - SEPTAL BOUNCE - "BOUND-DOWN" APPEARANCE OF THE LATERAL WALLS OF THE HEART IN A4 |
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INTERATRIAL AND INTERVENTRICULAR SEPTAL BULGE TOWARD THE LEFT DURING INSPIRATION IS: |
SEPTAL BOUNCE |
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M-MODE FINDINGS: CONSTRICTIVE |
-LAE -THICKENED PERICARDIUM -PARADOXICAL SEPTAL MOTION - PREMATURE OPENING OF PV - FLAT POSTERIOR WALL MOTION IN DIASTOLE |
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DOPPLER FINDINGS: CONSTRICTIVE |
- MR AND TR PROBABLE - DIASTOLIC DYSFUNCTION - SHORTENED MV DECEL TIME - AFTER INSPIRATION: MITRAL VELOCITIES DECREASE TV VELOCITIES INCREASE - RESPIRATION FLOW VELOCITY VARIATIONS MV, PV, AND HEPATIC VEINS |
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COMPLICATIONS OF CONSTRICTIVE PERICARDITIS |
-DECREASED CARDIAC OUTPUT - CONGESTIVE HEART FAILURE |
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TREATMENT FOR CONSTRICTIVE PERICARDITIS |
PERICARDIECTOMY (PERICARDIAL STRIPPING) |
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WHAT IS THE MORTALITY RATE FOR CONSTRICTIVE PERICARDITIS? |
5-15% |
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SOMETIMES CONSTRICTIVE PERICARDITIS IS DIAGNOSED AS ________________ INSTEAD: |
RESTRICTIVE CM |
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HOW ARE RESTRICTIVE CM AND CONSTRICTIVE PERICARDITIS SIMILAR? |
*SIGNS AND SYMPTOMS * BOTH IMPAIRED DIASTOLIC DYSFUNCTION (BIG E, SMALL a) * BOTH HAVE NORMAL SYSTOLIC FUNCTION |
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RESTRICTIVE CM CAN BE DISTINGUISHED FROM CONSTRICTIVE PERICARDITIS IN THESE THREE WAYS: |
RESTRICTIVE: - typically surrounds ventricles NOT entire heart - results in bi-atrial enlargement - thick ventricular walls |
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THE PERICARDIUM CAN BE ABSENT, DUE TO CONGENITAL DEFECT OR SURGICAL REMOVAL, WHAT MAY OCCUR DUE TO IT'S ABSENCE?
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- ENLARGED HEART - EXCESSIVE LV MOTION (HEART WILL ROCK) - HEART MAY SHIFT LEFT |
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A RARE DEVELOPMENTAL ANOMALY THAT PRODUCES NO SYMPTOMS AND ARE USUALLY LOCATED PERTINENT TO THE RIBS AND DIAPHRAGM (dx by 2D or CT of chest) |
PERICARDIAL CYST |
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PERICARDIAL TUMOR: PRIMARY CANCEROUS TUMORS ARE RARE BUT _____________ CAN INVOLVE PERICARDIUM |
MESOTHELIOMAS |
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NAME 4 BENIGN TUMORS AND MASSES: |
- PERICARDIAL CLOT - CYST - LIPOMAS - TERATOMAS |
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DESCRIBE THE 2D APPEARANCE OF METASTASES: |
ECHOGENIC STRUCTURE W/O DISTINCT BORDERS LOCATED ON PERICARDIAL SURFACE (JAGGED EDGES) |
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3 FLUID ACCUMULATION OUTCOMES OF PERICARDIAL EFFUSION: |
- MAY RESOLVE WITH NO RESIDUAL ABNORMALITY - MAY LEAD TO CARDIAC TAMPONADE - MAY LEAD TO FIBROSIS & THICKENING OF PARIETAL LAYER LEADING TO CONSTRICTIVE PERICARDITIS |
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ANATOMY REVIEW OUTER FIBROUS LAYER- __________ INNER SEROUS LAYER- ____________ NORMAL FLUID AMOUNT IN PERICARDIAL SPACE- _______________ |
PARIETAL VISCERAL 20 ml/cc |
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THERE ARE TWO POINTS OF ATTACHMENT FOR PERICARDIAL EFFUSION CALLED: |
OBLIQUE SINUS AND TRANSVERSE SINUS |
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THIS SINUS CONTINUES SUPERIORLY ATTACHING AT THE LEVEL OF THE GREAT VESSELS: |
TRANSVERSE SINUS |
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THIS SINUS: PERICARDIUM EXTENDS AROUND THE HEART, ENCOMPASSING THE VENTRICLES AND TERMINATES BEHIND THE LA BY THE PULMONARY VEINS |
OBLIQUE SINUS |
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ETIOLOGY OF PERICARDIAL EFFUSION (LISTED 12) |
- VIRAL BACTERIAL INFECTION (EX. AIDS) - DRESSLER'S SYNDROME - POST CARDIAC SURGERY - RENAL FAILURE -AORTIC DISSECTION - NEOPLASTIC - AUTOIMMUNE - TRAUMA - DRUG INDUCED - RADIATION - IDIOPATHIC - OBSTRUCTION OF FLUID DRAINAGE |
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SIGNS & SYMPTOMS OF PERICARDIAL EFFUSION |
- CP -TACHYCARDIA -DYSPNEA -HYPOTENSION -FRICTION RUB -PALPITATIONS -CARDIOMEGALY -SYNCOPE -JUGULAR VEIN DISTENSION - PULSUS PARADOXUS - DISTANT HEART SOUNDS |
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DISTANT HEART SOUNDS IS CALLED: |
"EWART'S SIGN" |
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DROP IN SYSTOLIC BP MORE THAN 10MMHG WITH INSPIRATION INDICATES: |
TAMPONADE |
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ENLARGED HEART BY X-RAY DEFINES: |
CARDIOMEGALY |
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A FALSE POSITIVE FOR PERICARDIAL EFFUSION DESCRIBED AS A LOCALIZED FLUID IN ANTERIOR SPACE |
EPICARDIAL FAT PADS |
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OTHER FALSE POSITIVES FOR PERICARDIAL EFFUSION INCLUDE |
- DESCENDING AORTIC ANEURYSM - MASSIVE LAE - HIATAL HERNIA - LV PSEUDOANEURYSMS - IMPROPER GAIN SETTINGS |
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HOW CAN YOU TELL PERICARDIAL EFFUSION FROM PLEURAL EFFUSION? |
PERICARDIAL EFFUSION IS; - ANTERIOR TO DESCENDING AORTA - EVENLY DISTRIBUTED - ANTERIOR TO DIAPHRAGM |
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IF THERE IS A LOCALATED EFFUSION THIS COULD BE CAUSED BY: |
POST SURGERY OR TRAUMA |
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FIBRIN STRANDS INDICATE: |
LONG STANDING EFFUSION OR METASTATIC DISEASE |
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DEFINE THE SEVERITY AND SZ OF THE PERICARDIAL EFFUSION: - MINIMAL FLUID IN SYSTOLE - POSTERIOR ONLY |
PHYSIOLOGIC |
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SEVERITY/SZ OF PERICARDIAL EFFUSION: -FLUID DETECTED IN BOTH SYSTOLE & DIASTOLE - ANTERIOR & POSTERIOR - MEASURES ______ IN WIDTH |
MODERATE < 1 CM |
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SEVERITY/SZ OF PERICARDIAL EFFUSION: - FLUID DETECTED IN BOTH SYST/DIAST - POSTERIOR ONLY - MEASURES <1 CM IN WIDTH |
SMALL |
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SEVERITY/SZ OF PERICARDIAL EFFUSION: - FLUID DETECTED IN BOTH SYST/DIAST - SURROUNDS ENTIRE HEART - >1 CM IN WIDTH |
LARGE |
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THIS IS USED TO DETECT A SMALL EFFUSION: |
M-MODE |
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M-MODE SHOWS A PE BY: |
-ECHO FREE SPACE BETWEEN EPICARDIUM AND PERICARDIUM POSTERIOR TO LV AND/OR RV - PERICARDIAL MOTION ATTENTUATED - PARADOXICAL SEPTAL MOTION |
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PE DOPPLER EVALUATE WHAT? (3) |
VALVES FOR ABNORMALITY DIASTOLIC DYSFUNCTION EARLY SIGNS OF TAMPONADE |
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ACUTE TYPE OF EFFUSION IN WHICH FLUID, PUS, BLOOD, CLOTS OR GAS RAPIDLY ACCUMULATES IN THE PERICARDIUM RESULTING IN COMPRESSION OF THE HEART IS: |
CARDIAC TAMPONADE |
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CARDIAC TAMPONADE IS AKA: |
PERICARDIAL TAMPONADE |
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TRUE/FALSE TAMPONADE IS A CRITICAL DIAGNOSIS AND EMERGENT SITUATION |
TRUE |
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TRUE/FALSE
THE CAUSES OF EFFUSION CAN LEAD TO TAMPONADE? |
TRUE |
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TWO OTHER CAUSES OF TAMPONADE ARE: |
-ACCIDENTAL CARDIAC LACERATION (EX CATH) -TRAUMA |
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ECHO HELPS DETERMINE EFFUSION: |
-SZ -LOCATION -SIGNIFICANCE |
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THE CLINICAL SIGNS OF TAMPONADE KNOWN AS _________________________ INCLUDE: - HYPOTENSION - MUFFLED HEART SOUNDS - ELEVATED VENOUS PRESSURE |
BECK'S TRIAD |
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OTHER CLINICAL SIGNS OF TAMPONADE: |
- INTRA-PERICARDIAL BLEEDING - PULSUS PARADOXUS - PERICARDIAL FRICTION RUB - TACHYCARDIA - HEPATOMEGALY |
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PERICARDIAL EFFUSION LOCATED ONLY IN REGION OF RIGHT OR LEFT HEART IS KNOWN AS: |
REGIONAL TAMPONADE |
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ENLARGED LIVER DUE TO INCREASED VENOUS PRESSURE |
HEPATOMEGALY |
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DUE TO INCREASE PERICARDIAL PRESSURE WHAT WILL EVENTUALLY HAPPEN TO THE RIGHT HEART WITH TAMPONADE |
PRESSURE WILL EVENTUALLY EXCEED RV AND RA DIASTOLIC PRESSURE AND CAUSE COLLAPSE
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TRUE/FALSE: THE VEINS CONTRACT DUE TOBACKUP OF BLOOD UNABLE TO ENTER HEART |
FALSE VEINS BECOME DILATED |
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DUE TO RIGHT HEART COLLAPSE, DECREASED BLOOD FLOW TO THE LV CAUSES: |
-IMPAIRED VENTRICULAR DIASTOLIC FILLING INCREASING DIASTOLIC PRESSURE -DECREASES STROKE VOLUME - INCREASE HR IN ATTEMPT TO MAINTAIN CO |
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2D FINDINGS OF TAMPONADE: |
- LARGE PE - SWINGING HEART MOTION - RESPIRATORY CHANGE IN LV AND RV SZ - POSTERIOR MOTION OF RV IN DIASTOLE - DIASTOLIC COLLAPSE OF RV & RA -LACK OF IVC COLLAPSE ON INSPIRATION |
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TRUE/FALSE
THE RV COLLAPSES BEFORE THE RA |
FALSE RA FIRST |
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TAMPONADE DOPPLER EVALUATE MV OR TV DOPPLER INFLOW FOR: |
RESPIRATORY VARIATIONS |
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HOW CAN YOU ALTER MACHINE TO APPRECIATE VARIATIONS? |
DECREASE SWEEP SPEED TO 25 |
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TRICUSPID INFLOW WILL ______________ AFTER INSPIRATION |
INCREASE |
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MITRAL INFLOW WILL ______________WITH INSPIRATION |
DECREASE (DUE TO INCREASED RV DIASTOLIC FLOW DECREASES MV DIASTOLIC FLOW) |
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COMPLICATIONS OF PE/TAMPONADE |
- HYPOTENSION - SHOCK - DEATH |
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TREATMENT OF PE DESCRIBED AS ASPIRATION OF THE FLUID VIA A CATHETER INSERTED OVER A NEEDLE DIRECTED INSIDE THE PERICARDIUM |
PERICARDIOCENTESIS
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TREATMENT OF PE DESCRIBED AS SURGICAL PROCEDURE WITH OPEN PERICARDIAL DRAINAGE VIA A "WINDOW" MADE BY A SURGEON |
PERICARDIAL WINDOW |
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TREATMENT OF PE DESCRIBED AS REMOVAL OF PERICARDIUM (RARE) |
PERICARDECTOMY |
