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38 Cards in this Set
- Front
- Back
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What is the definition of Pericarditis?
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An inflammatory or infectious process of the parietal and visceral layers of the pericardium
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What is the definition of Pericarditis?
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An inflammatory or infectious process of the parietal and visceral layers of the pericardium
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what is the purpose pericardial fluid (normally)?
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reduce friction
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what is the normal amount of pericardial fluid?
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5-10mL
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hemodynamic compromise (constriction) is related to what?
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intrapericardial pressure
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what relates to intrapericardial pressure?
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*size of PE
*distensibilitty (compliance) of pericardium *rate of effusion development (rapid is more related to compromise) *chronic inflammation may result in fibrosis & poor compliance and constriction w/o effusion |
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Definition of pericarditis?
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inflammatory or infectious process of the parietal and visceral layers of the pericardium
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what is the most common cause of pericarditis?
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idiopathic
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most cases are probably what?
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viral
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How are the different ways that pericarditis may occur?
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*isolated or in combination with another process
*local or general *acute or chronic |
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what is the onset and possible duration of ACUTE pericarditis?
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*occurs within 2 weeks of 'offending' condiiton and can last up to 6 weeks
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what is the dry, fibrinous, painful condition called?
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"friction rub"
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what is happening in the dry, friction rub process?
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obstruction of the heart's venous system and lymphatic drainage resulting in seepage of fibrin into pericardial sac (leads to a PE that may bring some pain relief)
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What are the different categories and amounts of PE?
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Normal: 5-10mL
small PE: <100mL moderate PE: 100-500mL large PE: >500mL |
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what can follow acute pericarditis?
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chronic pericarditis
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how long can chronic last?
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up to 6 months
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what are some possible complications of pericarditis?
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-Pericardial Effusion (PE)
-Tamponade -Constrictive Pericarditis |
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what is Constrictive Pericarditis?
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pericardial thickening and scarring of the parietal and/or visceral pericardium. The layers become dense and adhere to one another, obliteration peri space. Calcification may occur.
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What can eventually happen with constrictive pericarditis?
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The heart becomes a totally noncompliant structure restricting diastolic filling.
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Does cardiac ouput increase or decrease?
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DECREASE
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T/F: it usually affects all four chambers and cannot be local.
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F: it can be local
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if a tense pericardial effusion develops, what process is impeded?
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diastolic filling
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If all 4 chambers are involved, what happens to the EDP?
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The EDP will equalize and elevate.
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How is this equalization detected?
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Catheterization.
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what is the treatment of choice for constrictive pericariditis?
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Pericardectomy (removal of the pericardium)
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what are some 2-D Echo findings?
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-LV typically normal
-LA enlarged (impaired filling) -Flat LVPW in diastole -PE (subx best view) -IVA & IVS bulge to L during insp. (septal bounce) -dilated hepV & IVC...Inspiratory collapse NOT present during sniff test |
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M-mode findings?
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-LAE
-Flat LVPW motion in diastole -thickened pericardium -paradoxical septal motion (possible) -premature opening of PV (possible) |
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Color Flow findings:
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MR & TR are probable, eval appropriately
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Doppler finding:
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-MR & TR probable, eval approp
-eval diastolic fxn -Mitral inflow pattern has a large E wabe and a small "A" wave WITH resp changes (opposite of CMO) |
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what is the diff between restrictive/infilitrative CMO & constrictive pericarditis?
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-rest/constr CMO surrounds the VENTRICLES, has bi-atrial enlargement, and NO resp changes in mitral inflow
-constr pericarditis surrounds entire heart, chamber pressures tend to equalize, WITH resp changes in mitral inflow patterns |
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What is normal respiratory variability?
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increased RH flow in inspiration; increased LH flow in expiration
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why is resp variability exaggerated w/pericardial thickening/scarring and/or effusion?
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Isolation of the heart from intrathoracic pressure changes
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what type of pattern variability is suggestive of constriction?
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>24% variability in LVIT flow
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what is a caveat of previous slide?
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May not be seen with high filling pressure (ASD, RVH); mech vent may display opposite pattern
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what might cause false positives?
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unstable sample voulme, COPD (HV flow not characteristic of Constriction w/ COPD and obesity), Pleural Effusion
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What are some treatments for pericarditis/effusion?
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-steroid therapy
-immunosuppressant therapy -pericardiocentesis -pericardectomy -pericardial window -analgesics -treat underlying cause |
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What is the treatment of choice for effusion/Tamponade?
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Pericardiocentesis (echo is important as a guide)
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what are some signs & sx of pericarditis?
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Dyspnea/distended neck veins/orthopnea are common to effusion, tamponade, and constrictive forms
With effusion/tamponade Pulsus paradoxus (>10mmHg decrease in BP during insp) With tamponade Beck’s triad Elevated venous pressure, hypotension, quiet heart Friction rub most common with constrictive pericarditits Tachycardia more common with tamponade and constrictive (HF response) Ascites/edema most common with constriction Chest pain most common with constrictive form Kussmal’s sign is characteristic of constriction (inspiratory rise in venous pressure) |
