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42 Cards in this Set
- Front
- Back
Functions of the pericardium?
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maintains position of heart
pervents cardiac distention by sudden vol overload |
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How is the pericardium perfused?
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pericardiophrenic arteries traveling with phrenic nerves and mamary a
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How is the pericardium inervated?
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vagal from esphogeal plexus
phrenic nerves |
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What are the 2 layers of the pericardium?
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visceral
pariteal |
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What is the visceral layer made of?
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transparent mono-layer of mesothelial cells
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What is the parietal layer made of?
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elastin fibers interspersed among dense parallel bundles of collagen - less compliant
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what does the parietal layer contribute to?
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LV & RV resting diastolic pressures
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What are some congenital abnormalities of the pericardium?
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pericardial angenesis
cysts |
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pericardial agenesis
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males
bilateral - no clinical sig unilateral -> accentuate cardiac mobility & alows displacement into pleural space causing tricuspid insufficiency |
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pericardial cysts
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most commonly r. costophrenic angle
no tx if assymptomatic |
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undernormal conditions what does the pericadium contain?
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30-50mL thin, clear, strawcolored fluid which is an ultrafiltrate of plasma
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The volume of the pericardium exceeds that of the heart by?
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10-20%
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Pericardial Tamponade
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fluid enters the pericardial space faster than rt the pericardium can stretch
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What is the most common cause of pericardial tamonade?
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hemorrgage
can be: effusions, blood, clots, pus, gas |
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Beck's Triad of pericardial tamponade
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Neck vein distention
muffled heart sounds systemic hypotension |
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pulsus parodoxus in pericardial tamponade
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normal inspiration decline in systemic systolic BP is accentuated
>10mmHg |
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What happens when you inspire
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inc in neg intrathoracic pressure to inc R side filling and LV septum is flattened so systolic BP goes down
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Acute Serous pericarditis
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scant PMNs, leukocytes & MP invade the epicardial & pericardial surfaces
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Acute fibrinous paricarditis
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serous fluid mixed w fibrous exudate
surface is dry w granules pericardial fluid contains leukocytes/blood |
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Other acute pericarditis
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purulent/suppurative
hemorrhagic caseous - TB |
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Clinical signs of aucte pericarditis?
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postural pain
pericardial friction rub diffuse ST abnormalities on EKG |
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Viral acute pericarditis
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immune depostion or direct viral attack
coxsackie, influenza, HIV, Hep Tx expectant |
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Bacterial (suppurative) acute pericarditis
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strep, pneumococcal, staph
emergent surgical drainage & antibiotics |
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fungal acute pericarditis
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immunocompromised pts
candida, aspergillus - indolent histoplasma - resloves 2 wks coccidiodes - dissemintated |
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Tuberuclous acute pericarditis
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fibrinous exudate w PMNs
serous effusions w lymphocytes absorption of effusion w organization of caseating granulomas & pericardial thickening due to fibrin collagen & fibrosis constrictive scarring w extensive calcification |
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Metabolic acute pericarditis
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Uremia - on dialysis
CRI w pain, fever & rub transudativ or exudative but is usually hemorrhagic surgical drainage or dialysis |
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Drug acute pericarditis
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procinamide
hydralazine methysergide emetine minoxidil - rogain |
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rheumatiod arthritis acute pericarditis
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10% of RA pts
immune complex deposition |
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Hyothyroid acute pericarditis
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large, clear, high protien, high cholesterol, high specific gravity effusion
rarely progresses to tamponade |
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Radiation acute pericarditis
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dose dependent response
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neoplasma acute pericarditis
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primary pericardial tumors are rare
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other causes of acute pericarditis
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postinfaction (dresslers)
postpericardiotomy syndrome |
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Chronic pericarditis
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fibrous thickening of serosal membranes or thing delicate adhesions
complete obliteration of the pericardial space may occuer |
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adhesive mediastinopericarditis
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associated iwth suppurative or caseous processes
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constrictive pericarditis
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dense, fibrous or fibrocalcific scar forms
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etiology of pericardial constriction
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infectious etiologies declining
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pahtophysiology of pericardial constriction
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10-80% of pericardial filling during the 1st fourth of diastole
square rt sidng associated w ventricular diastolic pressure Kussmauls sign |
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Kussmauls sign
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pericardial constriction
paradoxical distention of neck veins during inspiration |
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6 Signs of Pericardial constriction
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1. equalization of pressures
2. elevation of MAP 3. square root sign 4. prominent y descent in RAP 5. elevated RV end diastolic pressure 6. preserved LV EF |
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Mycardial restriction signs
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inc jugular venous pressure
prominent X & Y descents small or normal heart pulmonary congestion hepatic congestion no LVH depressed ventricular systolic fxn |
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cardiac allograft survival is limited by
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graft arteriopathy
-progressive intimal proliferation of coronary aa -mech uncertain |
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progressive arateriopathy is often..
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asymptomatic
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