Pathophysiology Ii

Front 1

The pericardium consists of __________ layers.

Back 1

two

Front 2

Name the two layers of the pericardium.

Back 2

Fibrous layer

Visceral layer (serous pericardium)

Front 3

True/False:

The Fibrous layer of the Pericardium consists of two layers.

Back 3

False

*Visceral layer

Front 4

Name the two sub-layers of the Visceral layer of the Pericardium.

Back 4

Parietal serous pericardium

Epicardium (visceral serous pericardium)

Front 5

The outer parietal pericardium is fused to the _______________, and the inner epicardium (visceral pericardium) is fused to the _____________.

Back 5

Fibrous Pericardium -fused to the parietal serous pericardium

Heart -fused to the epicardium (visceral serous pericardium)

Front 6

What lies between the Visceral (epicardium) and Parietal serous layers of the pericardium?

Back 6

pericardial cavity

Front 7

The Pericardial Cavity is filled with ___-___ ml of lubricating ____________ fluid.

Back 7

5-10 ml

serous fluid

Front 8

True/False:

Pericardial Effusions happen between the Parietal and Visceral layers of the serous pericardium.

Back 8

True

Front 9

What encases all four chambers of the heart and extends about 1-2 cm up the great vessel and pulmonary veins?

Back 9

Pericardium

Front 10

What isolates the heart from the rest of the mediastinum, lungs, and pleural space?

Back 10

Pericardium

Front 11

What serves as a barrier for the heart from infection and reduces friction with surrounding structures in the body during contraction and rotation?

Back 11

Pericardium

Front 12

The __________________ limits the total volume of the heart chambers, affects the pressure distribution, and mediates the interaction between the RV and LV diastolic filling?

Back 12

Pericardium

Front 13

A small "pocket" of pericardium surrounding the great arteries posteriorly, is called?

Back 13

Transverse Sinus

Front 14

A blind "pocket" of the pericardium that extends posteriorly to the LA, between the four pulmonary veins, is called?

Back 14

Oblique Sinus

Front 15

Inflammation of the pericardium, is called?

Back 15

Pericarditis

*usually relates with pericardial effusion

Front 16

Clinically, the diagnosis of pericarditis is based on at least two of the four characteristic features, which are?

Back 16

1. chest pain
2. widespread ST elevation on ECG
3. pericardial rub on auscultation (rubbing sound)
4. new or increased pericardial effusion
   

Front 17

What is the most common pathology of the pericardium?

Back 17

Acute Pericarditis

Front 18

What symptom is most common in Acute Infectious types of Pericarditis?

Back 18

chest pain

*usually severe, retrosternal, left precordial (above heart) and may refer to neck, arms, left shoulder

Front 19

True/False:

Symptoms of Pericarditis are exacerbated by coughing, inspiration, and recumbency (lying flat).

Back 19

True

Front 20

True/False:

Pericardial disease can be caused by viral, bacterial, or parasitic infections.

Back 20

True

Front 21

True/False:

Pericardial disease can be caused by Dressler's Syndrome (post-MI), Uremia (blood in urine/kidney failure), Lupus, radiation, drug induced, or post-cardiac surgery.

Back 21

True

Front 22

True/False:

Pericardial disease can be caused by aortic dissection, cath procedures, lymphoma, lung carcinoma, melanoma, breast carcinoma.

Back 22

True

Front 23

True/False:

Pericarditis is a clinical diagnosis that cannot be made independently by an echocardiogram. The echo is used to evaluate for Pericardial Effusion, thickening, or Tamponade physiology.

Back 23

True

Front 24

True/False:

If a Pericardial Effusion is present, the possibility of Tamponade physiology should be considered.

Back 24

True

Front 25

If pericardial thickening is present, examination for evidence of ________________ physiology should be considered.

Back 25

Constrictive

Front 26

True/False:

Pericardial Effusion could be acute or chronic.

Back 26

True

Front 27

True/False:

Intrapericardial pressure is 0-5 mmHg.

Back 27

True

Front 28

The presence of an abnormal amount of fluid or abnormal type of fluid within the pericardial space, is called?

Back 28

Pericardial Effusion

Front 29

Physiologic consequences of fluid in the pericardial space depends on what? (2)

Back 29

Volume of fluid

Rate of fluid accumulation

Front 30

True/False:

Chest pain, dyspnea, and palpitations are all symptoms of a Pericardial Effusion.

Back 30

True

Front 31

True/False:

Chronic pericarditis may lead to Constrictive Pericarditis.

Back 31

True

Front 32

Term meaning: enlarged heart

Back 32

cardiomegaly

Front 33

In the absence of prior pericardial disease or surgery, pericardial effusions are usually __________ and ___________ with clear separation between parietal and visceral pericardium.

Back 33

diffuse
symmetric

Front 34

Which two views provide excellent visualization of the pericardial effusion both anterior and posterior to the heart?

Back 34

subcostal SAX

PLAX

Front 35

True/False:

Physiologically, a normal separation between the heart and the parietal pericardium is seen during diastole.

Back 35

False

*seen during systole only

Front 36

Up to ____ ml of pericardial effusion is considered normal.

Back 36

25 ml

Front 37

True/False:

If you see fluid during systole and diastole, that is Pericardial Effusion.

Back 37

True

Front 38

A clear space in systole and diastole of < ___ cm, is considered a small pericardial effusion.

Back 38

< 1 cm

Front 39

A posterior clear space maintained in systole and diastole that is greater than or equal to ___ cm, is considered moderate pericardial effusion.

Back 39

> 1 cm or = 1cm

Front 40

A clear space greater than or equal to ____ cm OR an anterior and posterior clear space seen in systole and diastole, is considered a large pericardial effusion.

Back 40

> 2 cm or = 2 cm

Front 41

True/False:

In patients with recurrent pericardial disease, fibrinous strands may be seen within the fluid and on the epicardial surface of the heart.

Back 41

True

*stranding is suspicious for malignancy, inflammation, hemorrhagic effusion

Front 42

Effusion that is localized by adhesions to a small area of pericardial space or consists of several separate areas of pericardial effusion separated by adhesions, is called?

Back 42

Loculated Effusion

*cavities/pockets

Front 43

True/False:

Hemodynamic compromise can occur with even a small amount of loculated fluid.

Back 43

True

Front 44

True/False:

Loculated Effusion may result in Regional Cardiac Tamponade, especially within the first two weeks of cardiac surgery or trauma.

Back 44

True

Front 45

Fluid surrounding the lungs, is called?

Back 45

Pleural Effusion

Front 46

________________ _______ is sandwiched in between the epicardium and myocardium, primarily located anteriorly.

Back 46

Epicardial fat

Front 47

True/False:

A fat pad appears on an echo as an anterior clear space and may be confused with pericardial effusion.

Back 47

True

Front 48

True/False:

It is unusual for effusions to be located anteriorly unless loculated.

Back 48

True

Front 49

True/False:

M-mode shows the flat posterior pericardial echo reflection and the moving epicardial echo with separation between the two in both systole and diastole.

Back 49

True

Front 50

What is the ideal view to differentiate a pericardial effusion from a pleural effusion?

Back 50

PLAX

Front 51

A pericardial effusion is _______________ to the descending thoracic aorta.

Back 51

anterior

Front 52

A pleural effusion is ______________ to the descending aorta.

Back 52

posterior

Front 53

True/False:

A pericardial effusion does not change with respiration.

Back 53

True

Front 54

True/False:

A pleural effusion does not change with respiration.

Back 54

False

*it may change with respiration

Front 55

What is an elevation of intrapericardial pressure due to the accumulation of pericardial effusion called?

Back 55

Tamponade

Front 56

__________________ results in an elevation of intracardiac pressures, progressive limitation of ventricular diastolic filling and reduction in stroke volume.

Back 56

Tamponade

Front 57

When the pressure in the pericardium exceeds the pressure in the cardiac chambers resulting in impaired cardiac filling, it is called?

Back 57

Tamponade

Front 58

Which chamber is affected first by pericardial pressure increase due to Tamponade?

Back 58

Right Atrium

Front 59

As pericardial pressure increases, filling of each cardiac chamber is sequentially impaired. The __________ pressure chambers are affected before the _____________ pressure chambers.

Back 59

lower pressure (atria)

higher pressure (ventricles)

Front 60

With Tamponade, the compressive effect of pericardial fluid is seen most clearly when pressure is lowest in the chamber; during _____________ for the atria, and ______________ for the ventricles.

Back 60

pressure is lowest during...

systole (atria)

diastole (ventricles)

Front 61

True/False:

With Tamponade, filling pressures become elevated as a compensatory mechanism to maintain cardiac output.

Back 61

True

*keeps the chambers from collapsing

Front 62

True/False:

In fully developed Tamponade, diastolic pressures in all four cardiac chambers are equal and elevated.

Back 62

True

*due to exposure of entire heart to elevated pericardial pressure

Front 63

True/False:

With Tamponade, the heart decreases the intracardiac pressures to keep the chambers from collapsing.

Back 63

False

*the heart increases the intracardiac pressures

Front 64

True/False:

Beck's Triad includes hypotension, muffled heart sounds, and elevated jugular venous pressure.

Back 64

True

*Tamponade

Front 65

Pulsus Paradoxus is an inspiratory ____________ of >10 mmHg in systemic blood pressure.

Back 65

decline

*Tamponade

Front 66

________________ disease is the most common cause of Tamponade.

Back 66

Malignant disease

*pericarditis is the 2nd most common

Front 67

Cyanosis, Dyspnea that improves when the patient sits up, hepatomegaly, and jugular venous distension are all signs and symptoms of?

Back 67

Tamponade

Front 68

A "swinging heart" motion pattern, inspiratory "bounce" of the IVS toward the LV with inspiration, or a dilated IVC that does not collapse completely with inspiration, are indications of?

Back 68

Tamponade

Front 69

Name the three surgical treatments for Tamponade.

Back 69

Pericardiocentesis

Pericardial window

Pericardiectomy

Front 70

True/False:

When intrapericardial pressure exceeds right atrial systolic pressure, inversion or collapse of the right atrium wall occurs.

Back 70

True

Front 71

True/False:

Right Ventricular diastolic collapse occurs when intrapericardial pressure exceeds right ventricular diastolic pressure.

Back 71

True

Front 72

A shift in IVS motion toward the left ventricle in diastole and toward the right ventricle in systole, is an indication of?

Back 72

Pulsus Paradoxus

*or an increase in RV volume w/ inspiration

Front 73

In patients with Tamponade, __________________ causes the RV early-diastolic filling velocity to increase (enhance).

Back 73

inspiration

Front 74

In patients with Tamponade, inspiration causes the LV diastolic filling to ________________.

Back 74

diminish (decrease)

Front 75

True/False:

In patients with Tamponade, inspiration increases the tricuspid valve Doppler waveform.

Back 75

True

Front 76

True/False:

In patients with Tamponade, inspiration increases the mitral valve Doppler waveform.

Back 76

False

*decreases

Front 77

True/False:

Low pressure Tamponade may occur in patients with pericardial effusion and hypovolemia.

Back 77

True

Front 78

Stopped at:

Back 78

pg 15 ppt