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29 Cards in this Set
- Front
- Back
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Acute Pericarditis syndrome characterized by
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Chest pain, Pericardial Friction Rub, EKG Changes
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Acute pericarditis is most common in
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Adult Male
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Acute Pericarditis most common cause
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Viral
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other causes of Acute Pericarditis
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- Idiopathic
- Uremic : renal failure - Bacterial : pneumococcus, streptococcus, Gram (-) Sepsis - acute MI |
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History with Acute Pericarditis
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1. Chest Pain - left precordium radiates to Trapezius
2.Begins 10-14 days after viral syndrome if due to virus 3.Can be similar to Ischemic pain |
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Pain aggravated by
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supine
cough deep inspiration |
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Pain alleviated by
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sitting up
leaning forward |
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Acute Pericarditis Dyspnea
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shallow breathing to avoid pleuritic pain
fever effusion compressing lung and bronchi |
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Pericardial Versus Ischemic Pain
- Location |
Ischemia- Retrosternal; left shoulder; arm
Pericarditis- precordium; left trapezius ridge |
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Pericardial Versus Ischemic Pain
- Quality |
Ischemia- pressure, burning, buildup
Pericarditis- sharp, pleuritic, or dull, oppressive |
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Pericardial Versus Ischemic Pain
- Thoracic Motion |
Ischemia- No effect
Pericarditis- increased by breathing, rotating thorax |
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Pericardial Versus Ischemic Pain
-Duration |
Ischemia- Angina; 1 or 2 to 15min ; unstable angina; 1/2 hr to hrs
Pericarditis- Hours to Days |
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Pericardial Versus Ischemic Pain
-Effect |
Ischemia- Stable angina; usually
Unstable angina or infarction: usually not Pericarditis- No relation |
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Pericardial Versus Ischemic Pain
-Posture |
Ischemia- No effect; may sit, belch, use Valsalva or knee-chest position for relief
Pericarditis- Leaning forward for relief; aggravated by recumbency |
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Physical Exam
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Pericardial Friction Rub
- Scratching, grating, high-pitched -“squeak of the leather of a new saddle under the rider” -3 Components - presystolic, systolic, ventricular filling (Cardiac Motion) |
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Auscultation - pericardial friction rub
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-Stethoscope diaphragm
-Lower left sternal border -Inspiration and full expiration -Sitting-up & leaning forward |
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Chest X-Ray
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Little diagnostic value unless large effusion sometimes left pleural effusions
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Blood Tests
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Nonspecific markers of inflammation, increase WBC’s, increase ESR
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Echocardiogram
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demonstrate effusion
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When in pericarditis self-limiting
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viral
idiopathic post MI post-pericardotomy |
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Pericardial Effusion without compression
-management |
- observation
- pericardiocentesis if compression or need for diagnosis |
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pericardial effusion with compression is caused by:
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increase in pericardial fluid --> increase in intrapericardial pressure
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pericardial effusion with compression is characterized by
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1. Elevation of intracardiac pressures
2. Limitation of right ventricular diastolic filling 3. decrease Stroke Volume and decreaseCO |
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Beck's Triad
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1. Decrease BP
2. Increase Systemic Venous Pressure 3. Decrease quiet heart |
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Cardiac Tamponade
clinical manifestations |
- Beck's Triad
- Tachycardia, Tachypnea are common |
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Cardiac Tamponade physical Exam
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Jugular Venous Distension - most common sign
Tachypnea Tachycardia Pulsus Paradoxus Friction Rub Diminished Heart Sounds Hypotension in only 1/3 of patients |
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Cardiac Tamponade
- Finding at Right Heart Cath |
1. increase RA pressure with decrease or absent y descent
2. RV mid diastolic pressure is increased and = to RA pressure 3. PCWP is = RA pressure 4. LV diastolic pressure = RA pressure |
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Cardiac Tamponade Tx
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pericardiocentesis
Volume loading prior to procedure for hemodynamic support |
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Constrictive Pericarditis
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-Fibrotic, thickened, adherent pericardium restricts diastolic filling of the heart
-Secondary to recurrent pericardial effusions -Chronic stage of fibrosis and thickening of pericardium -Calcium deposits |
