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42 Cards in this Set

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