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32 Cards in this Set
- Front
- Back
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PERICARDIAL EFFUSION
- SEROUS LAYER (REVIEW) |
- Visceral (epicardium)
- Parietal - Fibrous |
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PERICARDIAL EFFUSION
- DESCRIPTION |
Fluid accumulation between the visceral and parietal layers of myocardium.
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PERICARDIAL EFFUSION
- ETIOLOGIES (INFECTIONS) |
VIRAL
- Staphylococcus, pneumococcus, tuberculosis, bacterial - Parasitic |
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PERICARDIAL EFFUSION
- ETIOLOGIES (MALIGNANT) |
- Metastatic disease (lymphoma, melanoma)
- Direct extension (lung carcinoma, breast carcinoma) |
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PERCARDIAL EFFUSION
- ETIOLOGIES (INFLAMMATORY) |
- Post MI (Dressler's Syndrome)
- Uremia - Systemic inflammatory disease (lupus, scleroderma) - Post-cardiac surgery - Radiation |
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PERICARDIAL EFFUSION
- ETIOLOGIES (INTRACARDIAC-PERICARDIAL COMMUNICATION) |
- Blunt or penetrating chest trauma
- Post-catheter procedures (cardiac cath, pacemaker insertion, surgery) - Post-infarction LV rupture - Aortic dissection |
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PERICARDIAL EFFUSION
- 2D FINDINGS |
Pericardium with fluid terminates above
descending aorta. |
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PERICARDIAL EFFUSION
- UNIQUE PEs |
- Loculated PE: pocket of pericardial fluid
- PE w/ fibrous strands: benign pericardial ahesions - Post open-heart surgery: clot behind RA might be seen due to bypass canulation in RA - Epicardial fat: over anterior RA, may be mistaken for PE - Metastatic PE: tumors in pericardial space, fluid is cloudy |
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PERICARDIAL EFFUSION
- ACUTE PERICARDITIS |
- Inflammation of pericardium
- Cause: infection, post MI (Dressler's Syndrome) - Echo findings: possible small effusion - Friction rub HS - 12 lead: global minor ST-T wave elevation |
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PLEURAL EFFUSION
- DESCRIPTION |
Fluid accumulation in the pleural space.
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PLEURAL EFFUSION
- ETIOLOGIES |
- Idiopathic
- Respiratory infection - Post-op finding - Bed ridden patients |
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PERICARDIAL EFFUSION
- ECHO FINDINGS |
Echo free space is seen posteriorly and terminates below descending aorta.
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PLEURAL EFFUSION
- PERICARDIAL VS. PLEURAL |
Large posterior echo free space with smaller anterior echo free space is most likely pleural effusion.
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CARDIAC TAMPONADE
- DESCRIPTION |
When the pressure from pericardial fluid in the pericardial space exceeds the pressure of the cardiac chambers and it causes the chambers to collapse. Rapidly accumulating PEs can create this.
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CARDIAC TAMPONADE
- DESCRIPTION (MOST LIKELY TO COLLAPSE) |
Most vulnerable to collapse are the lower pressure chambers (RA/RV). LA and LV less commonly collapse.
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CARDIAC TAMPONADE
- DESCRIPTION (CARDIAC OUTPUT) |
- CO can't be maintained
- HR increases - Blood pressure drops - Increased jugular distention - Potential cardiac shock. |
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CARDIAC TAMPONADE
- 2D FINDINGS |
- RA collapse in systole
- RV collapse in diastole - Large and plethoric IVC |
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CARDIAC TAMPONADE
- ETIOLOGIES |
- Idiopathic
- Post cardiac surgery (valve, bypass, transplant) - Bacterial, fungal, HIV - Perforation of myocardium: rupture by acute MI or perforation from catheter - Neoplasm: most common is metastatic |
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CARDIAC TAMPONADE
- LEFT HEART COLLAPSE |
Less common type collapse from tamponade where right heart pressures are higher than left (due to pulmonary HTN) causing left heart collapse.
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CARDIAC TAMPONADE
- CLINICAL SIGNS AND SYMPTOMS |
- SOB
- Increased HR - Decreased BP - Decreased CO - Muffled heart sounds |
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CARDIAC TAMPONADE
- BECK'S TRIANGLE |
Increased HR
/\ / \ /_____\ Decreased BP Jugular vein dilation |
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CARDIAC TAMPONADE
- PULSUS PARADOXUS |
BP decreases ~20mmHg with inspiration
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CARDIAC TAMPONADE
- VENTRICULAR INTERDEPENDENCY |
- RV/LV interaction w/ tamponade: septal shift
- RV expands into LV bowing IVS into LV - Leads to decreased LV SV during inspiration |
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CARDIAC TAMPONADE
- DOPPLER OF TAMPONADE |
- MV: MV E wave velocity decreases by >25%
- TV: opposite of MV, E wave velocity increases by >25% |
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CARDIAC TAMPONADE
- TREATMENT |
Pericardiocentesis: removal of fluid with syringe
- Patient is awake - Performed in cath lab - Difficult to see location of needle due to ultrasound artifact |
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CONSTRICTIVE PERICARDITIS
- DESCRIPTION |
Pericardium becomes fibrotic with adhesions between visceral and parietal layers causing pericardium to lose its elastic properties
(diastolic filling problem). |
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CONSTRICTIVE PERICARDITIS
- ETIOLOGIES |
- Idiopathic
- Infections - TB in less developed countries - Mediastinal irradiation - Autoimmune diseases (e.g. lupus) - Post cardiac surgery or MI |
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CONSTRICTIVE PERICARDITIS
- 2D FINDINGS |
- Thickening of pericardium is difficult to see on 2D, diagnosed by MRI/CT
- Ventricles are small to normal in size - Atria are normal - Dilated and plethoric IVC |
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CONSTRICTIVE PERICARDITIS
- M-MODE |
- May demonstrate diastolic rebound since ventricle is resistant to filling
- IVS has notching in early and mid diastole - Notching on IVS after P wave = "Spanish Notch" - LVPW has rapid descent in early diastole and flattened LV wall in diastole |
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CONSTRICTIVE PERICARDITIS
- DOPPLER |
- Similar to tamponade, MV velocity decreases with inspiration
-Diastolic dysfunction due to pericardial constraint (normal early filling, impaired filling late) |
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CONSTRICTIVE PERICARDITIS
- CLINICAL SIGNS AND SYMPTOMS |
- DOE because LV can't stretch to fill with
increased volume from exercise - HS: pericardial knock during diastolic filling |
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CONSTRICTIVE PERICARDITIS
- TREATMENT |
Pericardial stripping.
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