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S2: Ch1 CV 2-2

S2: Ch1 Cv 2-2

by scorpio2417, Dec. 2011

Subjects: jeef

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145 Cards in this Set

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	320. Tx of Restrictive Cardiomyopathy?	a. Treat underlying disorder? i. Hemochromatosis: Phlebotomy and deferoxamine ii. Sarcoidosis: Glucocorticoids iii. Amyloidosis: No tx available. b. Give digoxin if systolic dysfunction is present (Save for pts w/cardiac amyloidosis, who have increased incidence of digoxin toxicity. c. Use diuretics and vasodilators (for pulmonary and peripheral edema) cautiously bc a decrease in preload may compromise cardiac output.
	321. W/respect to murmurs, what effect do Standing, the Valsalva, and Leg raise maneuvers have?	a. They diminish the intensity of all murmurs save for MVP and HCM
	322. W/respect to murmurs, what effect does squatting have on murmurs?	a. It increases the intensity of all murmurs except MPV and HCM.
	323. W/respect to murmurs, what effect does sustained hand-grip have on murmurs of MVP and HCM?	a. Sustained handgrip increases the intensity of MVP murmur, but diminishes the intensity of HCM murmur. b. Sustained handgrip increases systemic resistance.
	324. Myocarditis?	a. Inflammation of the myocardium, w/many possible causes. b. May be asymptomatic, or may present w/fatigue, fever, chest pain, pericarditis, CHF, or even death. c. Look for elevations in cardiac enzyme levels and Erythrocyte sed rate.
	325. Causes of Myocarditis?	a. Viral: Coxsackie B. b. Bacterial: 1. Group A strep in rheumatic fever 2. Lyme disease 3. Mycoplasma 4. etc c. SLE d. Meds (e.g. sulfonamides) e. Idiopathic
	326. Tx of Myocarditis?	a. Supportive. Tx underlying causes if possible, and tx any complications.
	327. Acute pericarditis characteristics? 1	a. May be an isolated or part of an underlying disorder or generalized disease. b. Causes: 1. Idiopathic (probably postviral): Most cases of idiopathic pericarditis are postviral, usually preceded by a recent flu-like illness or by upper respiratory or GI symptoms. 2. Infectious 3. Acute MI (first 24 hrs after MI) 4. Uraemia 5. Collagen vascular diseases (e.g., SLE, scleroderma, RA, sarcoidosis)
	327. Acute pericarditis characteristics? 2	6. Neoplasm 7. Drug-induced lupus (procainamide, hydralazine) 8. After MI: (Dressler’s syndrome)-usually wks-months after MI 9. After surgery- postpericardiotomy syndrome 10. Amyloidosis 11. Radiation
	328. Infectious causes of pericarditis?	a. Viral: Echovirus, coxsackievirus, HIV, Hep A or B b. Bacterial: TB c. Fungal d. Toxoplasmosis.
	329. Prognosis for pericarditis?	a. Majority of pts recover w/in 1-3 wks. b. A minority of pts have a prolonged course or recurrent sx.
	330. Complications of pericarditis?	a. Pericardial effusion b. Cardiac tamponade- can occur in up to 15% of pts; close observation is important.
	331. Clinical features Acute Pericarditis?	a. Chest pain (not always present) b. Fever and non-productive cough may be present c. Pericardial friction rub!!!!!
	332. Describe chest pain associated w/acute pericarditis (if present)?	a. Often severe and PLEURITIC (can differentiate from pain of MI bc of association w/breathing)!!!!! b. Often localized to the retrosternal and left precordial regions and radiates to the trapezius ridge and neck. c. Pain is positional: It is aggravated by lying supine, coughing, swallowing, and deep inspiration. d. Pain is not always present, depending on the cause (e.g., usually absent in rheumatoid pericarditis.
	333. What relieves the pain associated w/pericarditis?!?!?!?	a. Relieved by sitting up and leaning forward!
	334. Pericardial friction rub (associated w/pericarditis)?	a. Caused by friction between visceral and parietal pericardial surfaces. b. Scratching, high-pitched sound w/3 components: 1. Atrial systole (presystolic) 2. Ventricular systole (loudest and most frequently heard) 3. Early Diastole c. Heard best during expiration w/pt sitting up and w/stethoscope placed firmly against the chest.
	335. Diagnosis of Pericarditis?	a. ECG shows 4 changes in sequence: 1. Diffuse S-T elevation and PR DEPRESSION!!!! 2. S-T segment returns to normal 3. T wave inverts 4. T wave returns to normal. b. Echo if pericarditis w/effusion is suspected, but echo is often normal.
	336. Tx of Acute pericarditis?	a. Most cases are self-limited and resolve in 2-6 wks. b. Tx the underlying cause if unknown c. NSAIDs are the mainstay of therapy (for pain and other systemic sx) d. Glucocorticoids may be tried if pain does not respond to NSAIDs, but should be avoided if at all possible.
	337. **Cardinal manifestations of acute pericarditis?	1. Chest pain 2. Pericardial friction rub 3. ECG changes 4. Pericardial effusion (w/or w/out tamponade).
	329. Prognosis for pericarditis?	a. Majority of pts recover w/in 1-3 wks. b. A minority of pts have a prolonged course or recurrent sx.
	330. Complications of pericarditis?	a. Pericardial effusion b. Cardiac tamponade- can occur in up to 15% of pts; close observation is important.
	338. What is a specific ECG finding for acute pericarditis?!?	a. PR depression!
	331. Clinical features Acute Pericarditis?	a. Chest pain (not always present) b. Fever and non-productive cough may be present c. Pericardial friction rub!!!!!
	332. Describe chest pain associated w/acute pericarditis (if present)?	a. Often severe and PLEURITIC (can differentiate from pain of MI bc of association w/breathing)!!!!! b. Often localized to the retrosternal and left precordial regions and radiates to the trapezius ridge and neck. c. Pain is positional: It is aggravated by lying supine, coughing, swallowing, and deep inspiration. d. Pain is not always present, depending on the cause (e.g., usually absent in rheumatoid pericarditis.
	329. Prognosis for pericarditis?	a. Majority of pts recover w/in 1-3 wks. b. A minority of pts have a prolonged course or recurrent sx.
	333. What relieves the pain associated w/pericarditis?!?!?!?	a. Relieved by sitting up and leaning forward!
	330. Complications of pericarditis?	a. Pericardial effusion b. Cardiac tamponade- can occur in up to 15% of pts; close observation is important.
	331. Clinical features Acute Pericarditis?	a. Chest pain (not always present) b. Fever and non-productive cough may be present c. Pericardial friction rub!!!!!
	334. Pericardial friction rub (associated w/pericarditis)?	a. Caused by friction between visceral and parietal pericardial surfaces. b. Scratching, high-pitched sound w/3 components: 1. Atrial systole (presystolic) 2. Ventricular systole (loudest and most frequently heard) 3. Early Diastole c. Heard best during expiration w/pt sitting up and w/stethoscope placed firmly against the chest.
	329. Prognosis for pericarditis?	a. Majority of pts recover w/in 1-3 wks. b. A minority of pts have a prolonged course or recurrent sx.
	335. Diagnosis of Pericarditis?	a. ECG shows 4 changes in sequence: 1. Diffuse S-T elevation and PR DEPRESSION!!!! 2. S-T segment returns to normal 3. T wave inverts 4. T wave returns to normal. b. Echo if pericarditis w/effusion is suspected, but echo is often normal.
	332. Describe chest pain associated w/acute pericarditis (if present)?	a. Often severe and PLEURITIC (can differentiate from pain of MI bc of association w/breathing)!!!!! b. Often localized to the retrosternal and left precordial regions and radiates to the trapezius ridge and neck. c. Pain is positional: It is aggravated by lying supine, coughing, swallowing, and deep inspiration. d. Pain is not always present, depending on the cause (e.g., usually absent in rheumatoid pericarditis.
	336. Tx of Acute pericarditis?	a. Most cases are self-limited and resolve in 2-6 wks. b. Tx the underlying cause if unknown c. NSAIDs are the mainstay of therapy (for pain and other systemic sx) d. Glucocorticoids may be tried if pain does not respond to NSAIDs, but should be avoided if at all possible.
	333. What relieves the pain associated w/pericarditis?!?!?!?	a. Relieved by sitting up and leaning forward!
	337. **Cardinal manifestations of acute pericarditis?	1. Chest pain 2. Pericardial friction rub 3. ECG changes 4. Pericardial effusion (w/or w/out tamponade).
	330. Complications of pericarditis?	a. Pericardial effusion b. Cardiac tamponade- can occur in up to 15% of pts; close observation is important.
	334. Pericardial friction rub (associated w/pericarditis)?	a. Caused by friction between visceral and parietal pericardial surfaces. b. Scratching, high-pitched sound w/3 components: 1. Atrial systole (presystolic) 2. Ventricular systole (loudest and most frequently heard) 3. Early Diastole c. Heard best during expiration w/pt sitting up and w/stethoscope placed firmly against the chest.
	331. Clinical features Acute Pericarditis?	a. Chest pain (not always present) b. Fever and non-productive cough may be present c. Pericardial friction rub!!!!!
	335. Diagnosis of Pericarditis?	a. ECG shows 4 changes in sequence: 1. Diffuse S-T elevation and PR DEPRESSION!!!! 2. S-T segment returns to normal 3. T wave inverts 4. T wave returns to normal. b. Echo if pericarditis w/effusion is suspected, but echo is often normal.
	338. What is a specific ECG finding for acute pericarditis?!?	a. PR depression!
	336. Tx of Acute pericarditis?	a. Most cases are self-limited and resolve in 2-6 wks. b. Tx the underlying cause if unknown c. NSAIDs are the mainstay of therapy (for pain and other systemic sx) d. Glucocorticoids may be tried if pain does not respond to NSAIDs, but should be avoided if at all possible.
	332. Describe chest pain associated w/acute pericarditis (if present)?	a. Often severe and PLEURITIC (can differentiate from pain of MI bc of association w/breathing)!!!!! b. Often localized to the retrosternal and left precordial regions and radiates to the trapezius ridge and neck. c. Pain is positional: It is aggravated by lying supine, coughing, swallowing, and deep inspiration. d. Pain is not always present, depending on the cause (e.g., usually absent in rheumatoid pericarditis.
	337. **Cardinal manifestations of acute pericarditis?	1. Chest pain 2. Pericardial friction rub 3. ECG changes 4. Pericardial effusion (w/or w/out tamponade).
	333. What relieves the pain associated w/pericarditis?!?!?!?	a. Relieved by sitting up and leaning forward!
	338. What is a specific ECG finding for acute pericarditis?!?	a. PR depression!
	334. Pericardial friction rub (associated w/pericarditis)?	a. Caused by friction between visceral and parietal pericardial surfaces. b. Scratching, high-pitched sound w/3 components: 1. Atrial systole (presystolic) 2. Ventricular systole (loudest and most frequently heard) 3. Early Diastole c. Heard best during expiration w/pt sitting up and w/stethoscope placed firmly against the chest.
	335. Diagnosis of Pericarditis?	a. ECG shows 4 changes in sequence: 1. Diffuse S-T elevation and PR DEPRESSION!!!! 2. S-T segment returns to normal 3. T wave inverts 4. T wave returns to normal. b. Echo if pericarditis w/effusion is suspected, but echo is often normal.
	336. Tx of Acute pericarditis?	a. Most cases are self-limited and resolve in 2-6 wks. b. Tx the underlying cause if unknown c. NSAIDs are the mainstay of therapy (for pain and other systemic sx) d. Glucocorticoids may be tried if pain does not respond to NSAIDs, but should be avoided if at all possible.
	337. **Cardinal manifestations of acute pericarditis?	1. Chest pain 2. Pericardial friction rub 3. ECG changes 4. Pericardial effusion (w/or w/out tamponade).
	338. What is a specific ECG finding for acute pericarditis?!?	a. PR depression!
	339. Constrictive Pericarditis?	a. Fibrous scarring of the pericardium leads to rigidity and thickening of the pericardium, w/obliteration of the pericardial cavity.
	340. Pathophys of Pericarditis?	a. A fibrotic, rigid pericardium restricts the diastolic filling of the heart. b. Ventricular filling is unimpeded during early diastole bc intracardiac volume has not yet reached the limit defined by the stiff pericardium. c. When intracardiac volume reaches the limit set by the noncompliant pericardium, ventricular filling is halted abruptly. (In contrast, ventricular filling is impeded THROUGHOUT diastole in cardiac tamponade).
	339. Constrictive Pericarditis?	a. Fibrous scarring of the pericardium leads to rigidity and thickening of the pericardium, w/obliteration of the pericardial cavity.
	341. Causes of Constrictive pericarditis?	i. In most pts, the cause is never identified and is idiopathic (probably previous pericarditis). ii. Other causes: a. Uraemia, radiation therapy, TB, chronic pericardial effusion, tumour invasion, connective tissue disorder, and prior surgery involving the pericardium.
	340. Pathophys of Pericarditis?	a. A fibrotic, rigid pericardium restricts the diastolic filling of the heart. b. Ventricular filling is unimpeded during early diastole bc intracardiac volume has not yet reached the limit defined by the stiff pericardium. c. When intracardiac volume reaches the limit set by the noncompliant pericardium, ventricular filling is halted abruptly. (In contrast, ventricular filling is impeded THROUGHOUT diastole in cardiac tamponade).
	342. Clinical features of Constrictive pericarditis?	a. Patients appear very ill. b. Initial manifestations are secondary to systemic venous pressure elevation: 1. Edema 2. Ascites 3. Hepatic congestion c. Later manifestations are due to elevation of left-sided intracardiac pressures: pulmonary congestion- Cough, exertional dyspnea, and orthopnea.
	341. Causes of Constrictive pericarditis?	i. In most pts, the cause is never identified and is idiopathic (probably previous pericarditis). ii. Other causes: a. Uraemia, radiation therapy, TB, chronic pericardial effusion, tumour invasion, connective tissue disorder, and prior surgery involving the pericardium.
	343. Kussmaul’s sign?!?!	a. JVD fails to decrease during inspiration. b. Sign of constrictive pericarditis!!!!
	342. Clinical features of Constrictive pericarditis?	a. Patients appear very ill. b. Initial manifestations are secondary to systemic venous pressure elevation: 1. Edema 2. Ascites 3. Hepatic congestion c. Later manifestations are due to elevation of left-sided intracardiac pressures: pulmonary congestion- Cough, exertional dyspnea, and orthopnea.
	344. Signs of Constrictive Pericarditis on physical Exam?	a. Jugular venous distension (JVD)-most prominent physical finding: central venous pressure is elevated and displayed prominent X and Y descents. b. Kussmaul’s sign!!! c. Pericardial knock- corresponding to the abrupt cessation of ventricular filling. d. Ascites e. Dependent edema. f. May be difficult to distinguish from restrictive cardiomyopathy.
	345. Diastolic dysfunction in constrictive pericarditis?	a. Early Diastole: Rapid filling b. Late Diastole: Halted filling
	343. Kussmaul’s sign?!?!	a. JVD fails to decrease during inspiration. b. Sign of constrictive pericarditis!!!!
	339. Constrictive Pericarditis?	a. Fibrous scarring of the pericardium leads to rigidity and thickening of the pericardium, w/obliteration of the pericardial cavity.
	340. Pathophys of Pericarditis?	a. A fibrotic, rigid pericardium restricts the diastolic filling of the heart. b. Ventricular filling is unimpeded during early diastole bc intracardiac volume has not yet reached the limit defined by the stiff pericardium. c. When intracardiac volume reaches the limit set by the noncompliant pericardium, ventricular filling is halted abruptly. (In contrast, ventricular filling is impeded THROUGHOUT diastole in cardiac tamponade).
	346. Tx of Constrictive Pericarditis?	a. Surgical: complete resection of the pericardium is definitive therapy and is indicated in many pts. b. It has a significant mortality rate, however.
	344. Signs of Constrictive Pericarditis on physical Exam?	a. Jugular venous distension (JVD)-most prominent physical finding: central venous pressure is elevated and displayed prominent X and Y descents. b. Kussmaul’s sign!!! c. Pericardial knock- corresponding to the abrupt cessation of ventricular filling. d. Ascites e. Dependent edema. f. May be difficult to distinguish from restrictive cardiomyopathy.
	347. Pericardial effusion general characteristics?	a. Defined as any cause of acute pericarditis that can lead to exudation of fluid into the pericardial space. b. Can occur in association w/ascites and pleural effusion in salt and water retention states such as CHF, cirrhosis, and nephrotic syndrome. c. Is often asymptomatic and suspected based on another condition.
	341. Causes of Constrictive pericarditis?	i. In most pts, the cause is never identified and is idiopathic (probably previous pericarditis). ii. Other causes: a. Uraemia, radiation therapy, TB, chronic pericardial effusion, tumour invasion, connective tissue disorder, and prior surgery involving the pericardium.
	345. Diastolic dysfunction in constrictive pericarditis?	a. Early Diastole: Rapid filling b. Late Diastole: Halted filling
	348. Clinical features of pericardial effusion?	a. Muffled heart sounds b. Soft PMI c. Dullness at left lung base (because it may be compressed by pericardial fluid d. Pericardial friction rub may or may not be present.
	342. Clinical features of Constrictive pericarditis?	a. Patients appear very ill. b. Initial manifestations are secondary to systemic venous pressure elevation: 1. Edema 2. Ascites 3. Hepatic congestion c. Later manifestations are due to elevation of left-sided intracardiac pressures: pulmonary congestion- Cough, exertional dyspnea, and orthopnea.
	343. Kussmaul’s sign?!?!	a. JVD fails to decrease during inspiration. b. Sign of constrictive pericarditis!!!!
	339. Constrictive Pericarditis?	a. Fibrous scarring of the pericardium leads to rigidity and thickening of the pericardium, w/obliteration of the pericardial cavity.
	346. Tx of Constrictive Pericarditis?	a. Surgical: complete resection of the pericardium is definitive therapy and is indicated in many pts. b. It has a significant mortality rate, however.
	344. Signs of Constrictive Pericarditis on physical Exam?	a. Jugular venous distension (JVD)-most prominent physical finding: central venous pressure is elevated and displayed prominent X and Y descents. b. Kussmaul’s sign!!! c. Pericardial knock- corresponding to the abrupt cessation of ventricular filling. d. Ascites e. Dependent edema. f. May be difficult to distinguish from restrictive cardiomyopathy.
	340. Pathophys of Pericarditis?	a. A fibrotic, rigid pericardium restricts the diastolic filling of the heart. b. Ventricular filling is unimpeded during early diastole bc intracardiac volume has not yet reached the limit defined by the stiff pericardium. c. When intracardiac volume reaches the limit set by the noncompliant pericardium, ventricular filling is halted abruptly. (In contrast, ventricular filling is impeded THROUGHOUT diastole in cardiac tamponade).
	345. Diastolic dysfunction in constrictive pericarditis?	a. Early Diastole: Rapid filling b. Late Diastole: Halted filling
	347. Pericardial effusion general characteristics?	a. Defined as any cause of acute pericarditis that can lead to exudation of fluid into the pericardial space. b. Can occur in association w/ascites and pleural effusion in salt and water retention states such as CHF, cirrhosis, and nephrotic syndrome. c. Is often asymptomatic and suspected based on another condition.
	348. Clinical features of pericardial effusion?	a. Muffled heart sounds b. Soft PMI c. Dullness at left lung base (because it may be compressed by pericardial fluid d. Pericardial friction rub may or may not be present.
	341. Causes of Constrictive pericarditis?	i. In most pts, the cause is never identified and is idiopathic (probably previous pericarditis). ii. Other causes: a. Uraemia, radiation therapy, TB, chronic pericardial effusion, tumour invasion, connective tissue disorder, and prior surgery involving the pericardium.
	346. Tx of Constrictive Pericarditis?	a. Surgical: complete resection of the pericardium is definitive therapy and is indicated in many pts. b. It has a significant mortality rate, however.
	347. Pericardial effusion general characteristics?	a. Defined as any cause of acute pericarditis that can lead to exudation of fluid into the pericardial space. b. Can occur in association w/ascites and pleural effusion in salt and water retention states such as CHF, cirrhosis, and nephrotic syndrome. c. Is often asymptomatic and suspected based on another condition.
	342. Clinical features of Constrictive pericarditis?	a. Patients appear very ill. b. Initial manifestations are secondary to systemic venous pressure elevation: 1. Edema 2. Ascites 3. Hepatic congestion c. Later manifestations are due to elevation of left-sided intracardiac pressures: pulmonary congestion- Cough, exertional dyspnea, and orthopnea.
	343. Kussmaul’s sign?!?!	a. JVD fails to decrease during inspiration. b. Sign of constrictive pericarditis!!!!
	348. Clinical features of pericardial effusion?	a. Muffled heart sounds b. Soft PMI c. Dullness at left lung base (because it may be compressed by pericardial fluid d. Pericardial friction rub may or may not be present.
	344. Signs of Constrictive Pericarditis on physical Exam?	a. Jugular venous distension (JVD)-most prominent physical finding: central venous pressure is elevated and displayed prominent X and Y descents. b. Kussmaul’s sign!!! c. Pericardial knock- corresponding to the abrupt cessation of ventricular filling. d. Ascites e. Dependent edema. f. May be difficult to distinguish from restrictive cardiomyopathy.
	339. Constrictive Pericarditis?	a. Fibrous scarring of the pericardium leads to rigidity and thickening of the pericardium, w/obliteration of the pericardial cavity.
	339. Constrictive Pericarditis?	a. Fibrous scarring of the pericardium leads to rigidity and thickening of the pericardium, w/obliteration of the pericardial cavity.
	339. Constrictive Pericarditis?	a. Fibrous scarring of the pericardium leads to rigidity and thickening of the pericardium, w/obliteration of the pericardial cavity.
	340. Pathophys of Pericarditis?	a. A fibrotic, rigid pericardium restricts the diastolic filling of the heart. b. Ventricular filling is unimpeded during early diastole bc intracardiac volume has not yet reached the limit defined by the stiff pericardium. c. When intracardiac volume reaches the limit set by the noncompliant pericardium, ventricular filling is halted abruptly. (In contrast, ventricular filling is impeded THROUGHOUT diastole in cardiac tamponade).
	345. Diastolic dysfunction in constrictive pericarditis?	a. Early Diastole: Rapid filling b. Late Diastole: Halted filling
	340. Pathophys of Pericarditis?	a. A fibrotic, rigid pericardium restricts the diastolic filling of the heart. b. Ventricular filling is unimpeded during early diastole bc intracardiac volume has not yet reached the limit defined by the stiff pericardium. c. When intracardiac volume reaches the limit set by the noncompliant pericardium, ventricular filling is halted abruptly. (In contrast, ventricular filling is impeded THROUGHOUT diastole in cardiac tamponade).
	340. Pathophys of Pericarditis?	a. A fibrotic, rigid pericardium restricts the diastolic filling of the heart. b. Ventricular filling is unimpeded during early diastole bc intracardiac volume has not yet reached the limit defined by the stiff pericardium. c. When intracardiac volume reaches the limit set by the noncompliant pericardium, ventricular filling is halted abruptly. (In contrast, ventricular filling is impeded THROUGHOUT diastole in cardiac tamponade).
	339. Constrictive Pericarditis?	a. Fibrous scarring of the pericardium leads to rigidity and thickening of the pericardium, w/obliteration of the pericardial cavity.
	341. Causes of Constrictive pericarditis?	i. In most pts, the cause is never identified and is idiopathic (probably previous pericarditis). ii. Other causes: a. Uraemia, radiation therapy, TB, chronic pericardial effusion, tumour invasion, connective tissue disorder, and prior surgery involving the pericardium.
	346. Tx of Constrictive Pericarditis?	a. Surgical: complete resection of the pericardium is definitive therapy and is indicated in many pts. b. It has a significant mortality rate, however.
	347. Pericardial effusion general characteristics?	a. Defined as any cause of acute pericarditis that can lead to exudation of fluid into the pericardial space. b. Can occur in association w/ascites and pleural effusion in salt and water retention states such as CHF, cirrhosis, and nephrotic syndrome. c. Is often asymptomatic and suspected based on another condition.
	342. Clinical features of Constrictive pericarditis?	a. Patients appear very ill. b. Initial manifestations are secondary to systemic venous pressure elevation: 1. Edema 2. Ascites 3. Hepatic congestion c. Later manifestations are due to elevation of left-sided intracardiac pressures: pulmonary congestion- Cough, exertional dyspnea, and orthopnea.
	341. Causes of Constrictive pericarditis?	i. In most pts, the cause is never identified and is idiopathic (probably previous pericarditis). ii. Other causes: a. Uraemia, radiation therapy, TB, chronic pericardial effusion, tumour invasion, connective tissue disorder, and prior surgery involving the pericardium.
	341. Causes of Constrictive pericarditis?	i. In most pts, the cause is never identified and is idiopathic (probably previous pericarditis). ii. Other causes: a. Uraemia, radiation therapy, TB, chronic pericardial effusion, tumour invasion, connective tissue disorder, and prior surgery involving the pericardium.
	340. Pathophys of Pericarditis?	a. A fibrotic, rigid pericardium restricts the diastolic filling of the heart. b. Ventricular filling is unimpeded during early diastole bc intracardiac volume has not yet reached the limit defined by the stiff pericardium. c. When intracardiac volume reaches the limit set by the noncompliant pericardium, ventricular filling is halted abruptly. (In contrast, ventricular filling is impeded THROUGHOUT diastole in cardiac tamponade).
	342. Clinical features of Constrictive pericarditis?	a. Patients appear very ill. b. Initial manifestations are secondary to systemic venous pressure elevation: 1. Edema 2. Ascites 3. Hepatic congestion c. Later manifestations are due to elevation of left-sided intracardiac pressures: pulmonary congestion- Cough, exertional dyspnea, and orthopnea.
	348. Clinical features of pericardial effusion?	a. Muffled heart sounds b. Soft PMI c. Dullness at left lung base (because it may be compressed by pericardial fluid d. Pericardial friction rub may or may not be present.
	343. Kussmaul’s sign?!?!	a. JVD fails to decrease during inspiration. b. Sign of constrictive pericarditis!!!!
	341. Causes of Constrictive pericarditis?	i. In most pts, the cause is never identified and is idiopathic (probably previous pericarditis). ii. Other causes: a. Uraemia, radiation therapy, TB, chronic pericardial effusion, tumour invasion, connective tissue disorder, and prior surgery involving the pericardium.
	342. Clinical features of Constrictive pericarditis?	a. Patients appear very ill. b. Initial manifestations are secondary to systemic venous pressure elevation: 1. Edema 2. Ascites 3. Hepatic congestion c. Later manifestations are due to elevation of left-sided intracardiac pressures: pulmonary congestion- Cough, exertional dyspnea, and orthopnea.
	343. Kussmaul’s sign?!?!	a. JVD fails to decrease during inspiration. b. Sign of constrictive pericarditis!!!!
	342. Clinical features of Constrictive pericarditis?	a. Patients appear very ill. b. Initial manifestations are secondary to systemic venous pressure elevation: 1. Edema 2. Ascites 3. Hepatic congestion c. Later manifestations are due to elevation of left-sided intracardiac pressures: pulmonary congestion- Cough, exertional dyspnea, and orthopnea.
	344. Signs of Constrictive Pericarditis on physical Exam?	a. Jugular venous distension (JVD)-most prominent physical finding: central venous pressure is elevated and displayed prominent X and Y descents. b. Kussmaul’s sign!!! c. Pericardial knock- corresponding to the abrupt cessation of ventricular filling. d. Ascites e. Dependent edema. f. May be difficult to distinguish from restrictive cardiomyopathy.
	343. Kussmaul’s sign?!?!	a. JVD fails to decrease during inspiration. b. Sign of constrictive pericarditis!!!!
	343. Kussmaul’s sign?!?!	a. JVD fails to decrease during inspiration. b. Sign of constrictive pericarditis!!!!
	344. Signs of Constrictive Pericarditis on physical Exam?	a. Jugular venous distension (JVD)-most prominent physical finding: central venous pressure is elevated and displayed prominent X and Y descents. b. Kussmaul’s sign!!! c. Pericardial knock- corresponding to the abrupt cessation of ventricular filling. d. Ascites e. Dependent edema. f. May be difficult to distinguish from restrictive cardiomyopathy.
	344. Signs of Constrictive Pericarditis on physical Exam?	a. Jugular venous distension (JVD)-most prominent physical finding: central venous pressure is elevated and displayed prominent X and Y descents. b. Kussmaul’s sign!!! c. Pericardial knock- corresponding to the abrupt cessation of ventricular filling. d. Ascites e. Dependent edema. f. May be difficult to distinguish from restrictive cardiomyopathy.
	345. Diastolic dysfunction in constrictive pericarditis?	a. Early Diastole: Rapid filling b. Late Diastole: Halted filling
	346. Tx of Constrictive Pericarditis?	a. Surgical: complete resection of the pericardium is definitive therapy and is indicated in many pts. b. It has a significant mortality rate, however.
	345. Diastolic dysfunction in constrictive pericarditis?	a. Early Diastole: Rapid filling b. Late Diastole: Halted filling
	345. Diastolic dysfunction in constrictive pericarditis?	a. Early Diastole: Rapid filling b. Late Diastole: Halted filling
	344. Signs of Constrictive Pericarditis on physical Exam?	a. Jugular venous distension (JVD)-most prominent physical finding: central venous pressure is elevated and displayed prominent X and Y descents. b. Kussmaul’s sign!!! c. Pericardial knock- corresponding to the abrupt cessation of ventricular filling. d. Ascites e. Dependent edema. f. May be difficult to distinguish from restrictive cardiomyopathy.
	345. Diastolic dysfunction in constrictive pericarditis?	a. Early Diastole: Rapid filling b. Late Diastole: Halted filling
	346. Tx of Constrictive Pericarditis?	a. Surgical: complete resection of the pericardium is definitive therapy and is indicated in many pts. b. It has a significant mortality rate, however.
	346. Tx of Constrictive Pericarditis?	a. Surgical: complete resection of the pericardium is definitive therapy and is indicated in many pts. b. It has a significant mortality rate, however.
	347. Pericardial effusion general characteristics?	a. Defined as any cause of acute pericarditis that can lead to exudation of fluid into the pericardial space. b. Can occur in association w/ascites and pleural effusion in salt and water retention states such as CHF, cirrhosis, and nephrotic syndrome. c. Is often asymptomatic and suspected based on another condition.
	348. Clinical features of pericardial effusion?	a. Muffled heart sounds b. Soft PMI c. Dullness at left lung base (because it may be compressed by pericardial fluid d. Pericardial friction rub may or may not be present.
	347. Pericardial effusion general characteristics?	a. Defined as any cause of acute pericarditis that can lead to exudation of fluid into the pericardial space. b. Can occur in association w/ascites and pleural effusion in salt and water retention states such as CHF, cirrhosis, and nephrotic syndrome. c. Is often asymptomatic and suspected based on another condition.
	346. Tx of Constrictive Pericarditis?	a. Surgical: complete resection of the pericardium is definitive therapy and is indicated in many pts. b. It has a significant mortality rate, however.
	347. Pericardial effusion general characteristics?	a. Defined as any cause of acute pericarditis that can lead to exudation of fluid into the pericardial space. b. Can occur in association w/ascites and pleural effusion in salt and water retention states such as CHF, cirrhosis, and nephrotic syndrome. c. Is often asymptomatic and suspected based on another condition.
	339. Constrictive Pericarditis?	a. Fibrous scarring of the pericardium leads to rigidity and thickening of the pericardium, w/obliteration of the pericardial cavity.
	348. Clinical features of pericardial effusion?	a. Muffled heart sounds b. Soft PMI c. Dullness at left lung base (because it may be compressed by pericardial fluid d. Pericardial friction rub may or may not be present.
	347. Pericardial effusion general characteristics?	a. Defined as any cause of acute pericarditis that can lead to exudation of fluid into the pericardial space. b. Can occur in association w/ascites and pleural effusion in salt and water retention states such as CHF, cirrhosis, and nephrotic syndrome. c. Is often asymptomatic and suspected based on another condition.
	329. Prognosis for pericarditis?	a. Majority of pts recover w/in 1-3 wks. b. A minority of pts have a prolonged course or recurrent sx.
	340. Pathophys of Pericarditis?	a. A fibrotic, rigid pericardium restricts the diastolic filling of the heart. b. Ventricular filling is unimpeded during early diastole bc intracardiac volume has not yet reached the limit defined by the stiff pericardium. c. When intracardiac volume reaches the limit set by the noncompliant pericardium, ventricular filling is halted abruptly. (In contrast, ventricular filling is impeded THROUGHOUT diastole in cardiac tamponade).
	329. Prognosis for pericarditis?	a. Majority of pts recover w/in 1-3 wks. b. A minority of pts have a prolonged course or recurrent sx.
	348. Clinical features of pericardial effusion?	a. Muffled heart sounds b. Soft PMI c. Dullness at left lung base (because it may be compressed by pericardial fluid d. Pericardial friction rub may or may not be present.
	348. Clinical features of pericardial effusion?	a. Muffled heart sounds b. Soft PMI c. Dullness at left lung base (because it may be compressed by pericardial fluid d. Pericardial friction rub may or may not be present.
	330. Complications of pericarditis?	a. Pericardial effusion b. Cardiac tamponade- can occur in up to 15% of pts; close observation is important.
	331. Clinical features Acute Pericarditis?	a. Chest pain (not always present) b. Fever and non-productive cough may be present c. Pericardial friction rub!!!!!
	341. Causes of Constrictive pericarditis?	i. In most pts, the cause is never identified and is idiopathic (probably previous pericarditis). ii. Other causes: a. Uraemia, radiation therapy, TB, chronic pericardial effusion, tumour invasion, connective tissue disorder, and prior surgery involving the pericardium.
	330. Complications of pericarditis?	a. Pericardial effusion b. Cardiac tamponade- can occur in up to 15% of pts; close observation is important.
	332. Describe chest pain associated w/acute pericarditis (if present)?	a. Often severe and PLEURITIC (can differentiate from pain of MI bc of association w/breathing)!!!!! b. Often localized to the retrosternal and left precordial regions and radiates to the trapezius ridge and neck. c. Pain is positional: It is aggravated by lying supine, coughing, swallowing, and deep inspiration. d. Pain is not always present, depending on the cause (e.g., usually absent in rheumatoid pericarditis.
	342. Clinical features of Constrictive pericarditis?	a. Patients appear very ill. b. Initial manifestations are secondary to systemic venous pressure elevation: 1. Edema 2. Ascites 3. Hepatic congestion c. Later manifestations are due to elevation of left-sided intracardiac pressures: pulmonary congestion- Cough, exertional dyspnea, and orthopnea.
	333. What relieves the pain associated w/pericarditis?!?!?!?	a. Relieved by sitting up and leaning forward!
	331. Clinical features Acute Pericarditis?	a. Chest pain (not always present) b. Fever and non-productive cough may be present c. Pericardial friction rub!!!!!
	343. Kussmaul’s sign?!?!	a. JVD fails to decrease during inspiration. b. Sign of constrictive pericarditis!!!!
	332. Describe chest pain associated w/acute pericarditis (if present)?	a. Often severe and PLEURITIC (can differentiate from pain of MI bc of association w/breathing)!!!!! b. Often localized to the retrosternal and left precordial regions and radiates to the trapezius ridge and neck. c. Pain is positional: It is aggravated by lying supine, coughing, swallowing, and deep inspiration. d. Pain is not always present, depending on the cause (e.g., usually absent in rheumatoid pericarditis.
	334. Pericardial friction rub (associated w/pericarditis)?	a. Caused by friction between visceral and parietal pericardial surfaces. b. Scratching, high-pitched sound w/3 components: 1. Atrial systole (presystolic) 2. Ventricular systole (loudest and most frequently heard) 3. Early Diastole c. Heard best during expiration w/pt sitting up and w/stethoscope placed firmly against the chest.

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