Kpii_Postmid_Intmed_Myo&pericarditis

Front 1

What are the 2 sorts of Pericardial Dz?
WHat is normal cc of fluid in pericardium

Back 1

-Acute Pericarditis--most common
-Chronic Constrictive Pericarditis (PCD)

Visceral Peri usually leaks 10-30 ccs

Front 2

What is intrapericardial pressure

Back 2

Neg During Ejection
--facilitates atrial filling/passive flow into atria during Ventricular Systole

Front 3

Acute PCD, lasts how long
Clinical features

Back 3

<6wks
"Fibrinous"--infiltrate is fibrinous and effusive (bloody)

Front 4

SubAcute PCD, lasts how long
Clinical features

Back 4

6wks - 6mos
"Constrictive"
effusive

Front 5

Chronic Constrictive PCD, lasts how long
Clinical features

Back 5

>6mos
Effusive
Adhesive (nonconstrictive

Front 6

Most common infectious etiologies of PCD

Back 6

Viral-- +coxackie
Bacterial -- + TB
Mycotic

Front 7

Name some non infectious causes of PCD

Back 7

Myxedema (due to thyroidisms), MI, Uremic, Neoplasm, Aneurysm,
--Autoimmune/Hypersensitivity--SLE, RA or R. Fever

Front 8

What are common drugs to cause PCD

Back 8

INH, Procainamide, Hydralazine, Chromylin, Minoxidil

Front 9

Name the 2 non-obvious Sx of PCD in add to effusions/tamponade/pain/friction

Back 9

EKG changes
Paradoxical Puls

Front 10

When is the pericardial friction rub heard best

Back 10

During expiration--this is most impt Sx/Sign for PCD

Front 11

Name some of the EKG features for PCD

Back 11

ST segment elevations, also depression in aVR

-ST changes will return to baseline followed by persistent T-wave inversion

QRS voltage decreases
PACs, A-Fib

Front 12

ST character in PCD EKG

Back 12

Concave ST that is elevated

dont forget the persistence of inverted T-waves after STs return
and the reciprocal ST depr in aVR

Front 13

What is CXR feature on Pericardial Effusion (PCEf)

Back 13

Water bottle silhouette
but echo is best test--shows echo free space

Front 14

Large PCEf, Area of Dullness, and Tubular Breath Sounds at L. Scapula = what

Back 14

Ewarts Sign

l

Front 15

With large effustions (ie Ewarts), heart may swing freely, what is EKG effect

Back 15

Electrical Alternans
--flip flopping of QRS or Low voltage

--LOOKs like a barbed wire fence

Front 16

Hemopericardium indcates what

Back 16

PCEf that's bloody--think TB, Tumor, post MI injury (esp if anticoags used) or R. Fever

Front 17

What is def of Cardiac Tamponade (CTamp)

Back 17

Fluid accumulation (ttl amount NOT determinant, rather rate of filling) in sac sufficient to cause obstructiion to filling/inflow of blood into Vents
=Can cause equalization of cardiac chambers = dec CO and End Diastolic P.

Front 18

Parameters for CTamp if rapid?
If slow

Back 18

250ccs if rapid = CTamp
1000 if slowIy

Front 19

What are clinicals for CTamp:
JVD?
BP?
CO?
JVP?
JVP Trace Changes?

Back 19

In add to anxious:
JVD? Inc
BP? Dec
CO? Dec (heart tone too)
JVP? Inc
JVP Trace Changes? PROMinent X decent, no y-wave

Front 20

What is Paradoxical Pulse

Back 20

Greater than normal inspiratory fall in systolic arterial pressure (10mmHg)

Front 21

Tx for Viral OR Idiopathic Acute PCD

Back 21

ASA, NSAID, Steroids
Rest 7-14 days

Front 22

Dresslers Syndrome?

Back 22

Post MI Injury
--looks like an infarct, but isn't--rather Autoimmune--1 myocyte versus its neighbor due to hypersensitivey reaction from Ag origninating in myo or pericardium

Front 23

What is most common cause of Chronic Pericardial Effusion

Back 23

TB

Front 24

This results when healing of Acute PCD obliterates cavity due to granulation or scar Dz

Back 24

Chronic COnstrictive PCD
--vent fillin interfered with

Front 25

Kussmauls sign, EKG with LVOC, peripheral edema, dysp/ orthopnea and 1/3 with pardox pulse indicates what

Back 25

Chronic Constrictie PCD
--many etiologies, though TB is most common
--look for calcified pericardium from scars

Front 26

What are some DDXs for Chronic Constrictive PCD

Back 26

-Infiltrative Cardiomyopathies (amyloid, sarcoid, hemochromotosis)
-Endomyocardial FIbrosis
-Tricuspid Stenosis

--if PCD, Rx is Pericardial Resection

Front 27

What amount of effusion needed to see on CXR for PCEf

Back 27

250 cc

Front 28

What is Beck's Triad

Back 28

3 Classic Sx of CTamp
-dec BP
-inc JVP
-Muffled Heart SOunds
-dec Systemic Pre with inspiration (pardox pulse)

Front 29

What are parts of JVP trace

Back 29

a wave, c wave-->x decent, v-wave-->y decent

values btw 5-10 mmHG

Front 30

What is JVP trace for RV Failure?
Morph?
Values

Back 30

Pretty much same as normal
just values in 10-15mmHG range

Front 31

What is JVP trace for Constrictive PCD?

Back 31

Similar to RV Failure, ie, 10-15 mmHG, but v-wave more prominent also = steeper y decent

Front 32

WHat is JVP trace for Pericardial Tamponade?

Back 32

similar values to other Dz, ie 10-15 mmHG, except
NO v-wave. Thus it ends with a x-decent following c-wave
--x decent is very steep

Front 33

Following ecards are for Myocarditis

Back 33

Clues for Myo
1. Tachy out of proportion to fever change
2. CHF during or following acute viral illness
3. new EKG/echo findings following a viral infxn
4. Chronic Myo suspected in Pt with Cardiomyopathies or Idiopathic Arrys

**proportion 1degree F - inc 10HR

Front 34

WHat is the common infectious cause of Myocarditis (MCD) and the 4 bugs within?

Back 34

Viral most common
-Coxsackievirus B
-Echovirus
-CMV
-HIV

Front 35

Lesser common causese of MCD

Back 35

Protazoan--Trypanosoma cruzi (chagas)
Ticks, Hypersensitivity/Autoimmune
Radiation, chemicals, bacterial,

Front 36

10% of these PTs with this certain MCD have LV dysfunction 2ndary to infiltration of myocardium via opportunistic bugs, ie toxoplasmosis

Back 36

HIV Myocarditis
--Also Metastatic from karposis sarcoma

Front 37

Bacterial MCD is usually a complication of what bugs from endocarditits

Back 37

Staph A., or enterococcus
or Diptheria (commonest COD for diptheria)

Front 38

Which MCD is assc. w/ SLE, Thyrotox, Thymoma
-seen in young--middle aged with
Cardiac Enlargement,
ventricular thrombi
MC necrosis

Back 38

Giant Cell MCD
--Rapid often fatal CHF

Front 39

How is Lyme MCD treated
--seen with AV nodal conduction abnorms, 2nd and 3rd degree blocks with syncope and LV dysfx

Back 39

Spirochete--suscept to Ceftriaxone or Pen, Doxy or Amox

Front 40

Note: MCD may nave Asymp State to fulminant CFH/Death

Back 40

ST-T changes, but no specifici
chest pain similar to Angina WITH increased cardiac enzymes
Arrys

Front 41

Though usually normal PE, what might be auscultated in MCD

Back 41

s1, s2/s3 gallop
Mitral Regurge Murmur
Pericardial friction rub

Front 42

Tx for MCD

Back 42

Supportive bed rest
Arrys get amiodarone
CHF get salt, diuretics, dig
---Pts may be very sensitive to dig

--Usual MOA for death is CHF, Tachy or Heart Block