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11 Cards in this Set

  • Front
  • Back
Function of the Pericardium
1) The Pericardium is a Passive-Elastic Structure

2) It exerts no effect on systolic function of the heart

3) It only plays a role during diastole, when the heart is at it’s upper normal limit of volume
Hemodynamic Effects of the Pericardium
Hemodynamic Effects of the Pericardium:

1) To limit acute dilation of the heart

2) To modulate interdependence of the left and right heart chambers
(Like sharing a sleeping bag)

3) Concept of total intrapericardial volume should be kept in mind
Syndromes of Pericardial Disease
Syndromes of Pericardial Disease:
1) Pericarditis: inflammation

2) Effusion: modest fluid accumulation

3) Pericardial tamponade: fluid accumulation with hemodynamic consequences

4) Pericardial constriction: presence of thickened pericardium that limits cardiac filling
Acute Pericarditis - etiologies and synotoms
Acute Pericarditis:
-Secondary to pericardial inflammation, but there are many, many causes

-pleuritic chest pain
-friction rub
-Characteristic ECG changes: diffuse ST elevation, PR depression
-May cause an effusion to occur
Pericardial Effusion

Pericardial Effusion:

1) Accumulation of fluid in the intrapericardial space
-If fluid accumulates gradually the pericardium adapts

2) Many causes

3) May be asymptomatic

4) Best diagnosed through use of echocardiography
Pericardial Tamponade

-Definition and mechanical consequence
Pericardial Tamponade
1) Increase of total intrapericardial volume with resultant increase in pressure

2) Cardiac filling is thus limited by the high intrapericardial pressure

3) Very specific hemodynamic pattern

4) Best diagnosed clinically
Pericardial Tamponade

-Mechanical consequence
-PE Signs
Mechanical consequence of Pericardial Tamponade:

1) LV and RV share common space that is reduced in volume

2) For RV volume to increase LV volume must go down: enhanced ventricular interdependence

3) During inspiration aortic BP drops >10 mmHg: pulsus paradoxus

4) Very important physical sign in tamponade
Pericardial Tamponade

-Consequence on JVP and systole
Consequence of Pericardial Tamponade on JVP and systole:

1) Early in diastole intrapericardial volume reaches maximal achievable level

2) Characteristic X but no Y descent in jugular venous tracing

3) At end-diastole the pressure is equal in all cardiac chambers

4) Systolic function is normal or better (catecholamines)
ECG signs of Pericardial Tamponade
Pericardial Tamponade:

ECG may show electrical alternans
Pericardial Constriction(Constrictive Pericarditis)

Constrictive Pericarditis:

1) Pericardium is thickened, fibrotic, calcified

2) May be visualized on CXR or CT of chest

3) Numerous causes:
-chronic pericarditis
-infection (TB, histoplasmosis)
Pericardial Constriction(Constrictive Pericarditis)

-PE signs
PE signs of Constrictive Pericarditis:

1) Abnormal jugular pulse: Kussmaul’s sign

2) Dip and plateau sign on ventricular filling curves (atrial curves as well, since AV valves are open)

3) Peripheral edema

4) Ascites

-surgical and difficult