Heart - Dr. Nowacki Pericardium/mediastinum

Front 1

what cell type lines the pericardium?

Back 1

mesothelial cells

Front 2

What are the two types of pericarditis, which is more common?

Back 2

Most common pericarditis is a secondary phenomenon.

Primary Pericarditis is almost always viral

Front 3

What are the 5 types of acute pericarditis

Back 3

1. serous
2. fibrinous/serofibrinous
3. purulent/suppurative
4. hemorrhagic
5. caseous

Front 4

how much fluid is normally contained in the pericardium/what type?

Back 4

Normally 15-50mL clear serous fluide (transudate of plasma)

Front 5

Describe acute serous pericarditis

how much fluid & causes

Back 5

50-200mL of fluid of exudates slowly accumulates

often idiopathic, but may be related to non bacterial causes (SLE, turmor, uremia, viruses) or Rheumatic fever

Front 6

what is the most common clinical form of acute pericarditis

Back 6

fibrinous/serofibrinous

Front 7

describe acute fibrinous/serofibrinous pericarditis

Back 7

serous fluid mixed with fibrinous exudate

see with MI and assoc with pericardial FRICTION RUB (Dressler's syndrome)

Can resolve or leave adhesions (adhesive pericarditis) or plaque like thickenings

Front 8

what is dressler's syndrome

Back 8

autoimmune condition several weeks post MI

Front 9

describe purlent/suppurative pericarditis

Back 9

exudate of pus -->400-500mL
due to infectious organisms in pericardial space
red granular appearance

organization leads to constrictive pericarditis -->can lead to heart failure

Front 10

how do infectious organisms get into the pericardial space

Back 10

direct extension
seeding of blood
lymphatic extension
direct introduction during cardiotomy

Front 11

describe the pathology

Back 11

The epicardial surface of the heart shows a shaggy fibrinous exudate. This is another example of fibrinous pericarditis. This appearance has often been called a "bread and butter" pericarditis, but you would have to drop your buttered bread on the carpet to really get this effect. The fibrin often results in the the finding on physical examination of a "friction rub" as the strands of fibrin on epicardium and pericardium rub against each other.

Front 12

what are the causes listed in our notes of hemorrhagic pericarditis (4)

Back 12

malignancy
TB
clotting disorders
surgery ( ie Coronary artery bypass)

Front 13

what infection causes caseous pericarditis

Back 13

TB

Front 14

describe chronic pericarditis

Back 14

When pericarditis heals or gets organized it might simply produce fibrous thickenings of the serosal membranes (soldier's plaque), or thin, delicate adhesions of obscure origin. In other cases, organization results in complete obliteration of pericardial sac.

(notes say; thick pearly nonadherent epicardial plaque often found with resolved pericarditis-->the above description helped me more)

Front 15

what are the two types of chronic pericarditis

Back 15

a) Adhesive Mediastinopericarditis - this may follow a suppurative or caseous pericarditis, previous cardiac surgery or irradiation to mediastinum.

b) Constrictive Pericarditis - heart is enclosed in a dense, fibrous or fibrocalcific scar that limits diastolic expansion and seriously restricts cardiac output, resembling restrictive cardiomyopathy.

Front 16

Describe Adhesive Mediastinopericarditis

Back 16

Pericardial sac is obliterated, and adherence to the external surfaces of the parietal layer (tethered to mediastinum)produces great strain on cardiac function. The increased workload causes cardiac hypertrophy and dilation, mimicking DCM (Dilated Cardiomyopathy).

Front 17

Describe Constrictive pericarditis

Back 17

Pericardial space is obliterated and heart surrounded by dense, adherent layer of scar that can resemble a plaster mold in extreme cases (concretio cordis = dec CO).

Front 18

list the 6 causes in our notes of Immune mediated pericarditis

Back 18

dressler's syndrome
post cardiotomy
acute rheumatic fever
SLE/RA/Scleroderma
drug hypersensativity
inflammatory bowel dz

Front 19

describe the natural history of pericarditis

Back 19

usually self limiting, may be relapsing

small % pts dev signs/sx of RHF

can lead to fibrosis/constriction several cases

tx with pericardiectomy (if needed)

Front 20

see if you can describe the 4 things that differentiate MI from pericarditis

Back 20

see chart

Front 21

How much fluid is in a pericardial effusion? what are the consequences

Back 21

>50 mL -->causes intrapleural pressure in the pericardial space, as it rises diastolic filling impaired

Front 22

describe slow developing effusion

Back 22

can be large (>1000cc) and not cause symptoms

he has myxedema in the slide in parentheses-->if you know what it is let me know

Front 23

describe a rapidly developing effusion

Back 23

trauma - can be small and fatal (<200cc)

Front 24

When pericardial pressure is rising and diastolic filling is imparied which is affected more, left or right

Back 24

R >>:L

Front 25

Define pericardial tamponade

Back 25

hemodynamic compromise resulting from a rapid increase in pericardial pressure

Front 26

what are the causes of pericardial tamponade

Back 26

rapidly developing effusion with significant volume = trauma, aortic dissection, AMI with rupture, iatrogenic

Front 27

What are the exam findings

Back 27

Echo: diastolic filling impaired with RA and RV collapse

falling CO

Front 28

SIGNS AND SYMPTOMS of Pericardial Tamponade

Back 28

Pulses Paradoxus - greater than 10mmHg drop in systolic BP between inspiration and expiration (dec during inspiration)

Front 29

what are the 3 causes of special forms of pericardial effusion

Back 29

Chylous effusion
Cholesterol effusion
Hemorrhagic effusion

Front 30

what causes a chylous effusion

Back 30

obstruction of the thoracic duct

Front 31

what causes a cholestrerol effusion

Back 31

Myxedema, RA, TB

Front 32

what causes a hemorhagic effusion

Back 32

TB, tumor, infection, bleeding disorder, surgery

Front 33

what does this demonstrate

Back 33

pulsus paradoxus

Front 34

describe the patholgoy

Back 34

Hemorrhagic pericarditis: (he noted the red nodules in lecture) The surface of the heart with hemorrhagic pericarditis demonstrates a roughened and red appearance. Hemorrhagic pericarditis is most likely to occur with metastatic tumor and with tuberculosis (TB). TB can also lead to a granulomatous pericarditis that may calcify and produce a "constrictive" pericarditis.

Front 35

what is the most common cuase of constrictive pericarditis worldwide

Back 35

tuberculous pericarditis

Front 36

List the pathology associated with the mediastinum

Back 36

Chronic Mediastinitis
Cysts (Anterior compartment)
THymomoa (Anterior compartment)
lymphoma
soft tissue neoplasm (neuroma)
germ cell tumors

Front 37

What usually causes Chronic Mediastinitis?

Back 37

Usually infectious

fungus = histoplasmosis

Front 38

List the pathology associated with the Thymus

Back 38

aplasia (DiGeorge Syndrome: parathy)
cysts
thymoma

Front 39

how does a thymoma typically present

Back 39

it may present as an incidental finding

40% present because of pressure symptoms

40% present as myasthenia gravis

it is a tumor of adults

can also present as many other paraneoplastic syndromes

Front 40

what size are thymomas,

Back 40

may attain large size (15cm to 20 cm)

Front 41

what type of histology are thymomas

Back 41

may be cystic, necrotic, or calcified

Front 42

What percentage are invasive, what is their prognosis

Back 42

20-25% are invasive (locally) and < 50% 5yrs if invasive

Front 43

describe the pathology

Back 43

lymphocytes and thymocytes

grossly lobulated

-Ask surgeon if came otu easily &/or if had clean margins -->IF NOT think invasive thymoma