Pericardial Diseases

Front 1

Function of the Pericardium

Back 1

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

Front 2

Hemodynamic Effects of the Pericardium

Back 2

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

Front 3

Syndromes of Pericardial Disease

Back 3

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

Front 4

Acute Pericarditis - etiologies and synotoms

Back 4

Acute Pericarditis:
Etiologies:
-Secondary to pericardial inflammation, but there are many, many causes

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

Front 5

Pericardial Effusion

-Definition
-Etiology
-Symptoms
-Diagnosis

Back 5

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

Front 6

Pericardial Tamponade

-Definition and mechanical consequence
-Diagnosis

Back 6

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

Front 7

Pericardial Tamponade

-Mechanical consequence
-PE Signs

Back 7

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

Front 8

Pericardial Tamponade

-Consequence on JVP and systole

Back 8

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)

Front 9

ECG signs of Pericardial Tamponade

Back 9

Pericardial Tamponade:

ECG may show electrical alternans

Front 10

Pericardial Constriction(Constrictive Pericarditis)

-Defined
-Etiology

Back 10

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)
-trauma/hemorrhage
-post-radiation

Front 11

Pericardial Constriction(Constrictive Pericarditis)

-PE signs
-Treatment

Back 11

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

Treatment:
-surgical and difficult