Cardio E2: Pericardial/Myocardial Disease

Pericarditis can occur s/p viral URI caused by what virus?

Coxsackie

Where does pericarditis pain radiate?

Back, shoulder, neck, epigastrium

What position relieves pain in patients with pericarditis?

Leaning forward/sitting up

What is heard upon auscultation of patients with pericarditis?

Pericardial friction rub that is "scratchy" over LSB

Pericardial friction rub is heard best when the patient is in what position?

Leaning forward during expiration

What is the most important physical finding of pericarditis?

Scratchy friction rub

What CXR findings may be seen in patients with pericarditis?

Increased cardiac silhouette w/ "H2O bottle" configuration

What would pericarditis or pericardial effusion show on a CXR?

Increased cardiac silhouette w/ "H2O bottle" configuration

What are diffuse concave ST-elevation in all leads, or T-wave inversion and possible PR depression indicative of?

Pericarditis

In pericarditis, what test may be normal w/ minimal fluid noted?

Echo

What test can aid in diagnosis of pericarditis, as fluid is not likely to yield helpful info?

Pericardial biopsy

What medication is used to treat recurrent pericarditis?

Colchicine

What medications are used to treat pericarditis?

NSAIDs (+Abx if bacterial)

What does the fluid accumulates in pericardial effusion create which in turn causes sx?

Pressure

In pericardial effusion, symptoms depend on the size of the effusion and what else?

how fast it develops

Pericardial effusion may have symptoms due to pressure of adjacent structures, such as the __________ & __________

Esophagus & Trachea

What EKG findings may be seen with tamponade?

Electrical alternans

What can be heard upon auscultation of patient with pericardial effusion?

Muffled heart sounds

What is the most useful test for pericardial effusion?

Echo

What can be determined regarding pericardial effusion on echo?

Size of effusion, Location of effusion, Hemodynamic significance

What can collapse on inspiration in pericardial effusion?

RV

How is pericardial effusion treated?

Pericardiocentesis or Pericardial window (drainage)

What is Beck's triad?

JVD, Hypotension, Muffled heart sounds

Which pulse can be associated with cardiac tamponade?

Pulsus paradoxus

What is Beck’s triad associated with?

Cardiac tamponade

Patient presents with JVD, hypotension, and muffled heart sounds. What is this indicative of?

Cardiac tamponade

What is Kussmaul sign?

Paradoxical increase in venous distention and pressure during inspiration

Kussmaul sign may be seen in what condition?

Cardiac tamponade

How is cardiac tamponade treated?

Pericardiocentesis or Pericardial window (drainage)

What is it when fibrotic thickening of the pericardium that adheres to the heart?

Constrictive pericarditis

What do sx of mild-moderate constrictive pericarditis mimic?

Right HF

What are some symptoms seen in mild-moderate constrictive pericarditis?

Leg edema, Abdominal fullness, Pain from hepatic congestion (similar to R HF)

What are some symptoms seen in severe constrictive pericarditis?

Pulmonary congestion (cough, DOE, orthopnea), Fatigue, Decreased CO

What finding can be seen on CXR in patients with constrictive pericarditis?

Calcification ring

What does constrictive pericarditis show on a CXR?

Calcification ring

T/F: Pulsus paradoxus is usually seen in constrictive pericarditis

False- usually absent

In constrictive pericarditis, an echo may show what?

Thickened pericardium w/ no effusion

What is the treatment for constrictive pericarditis?

Salt restriction, Diuretics, Pericardectomy

What tx can be performed to treat constrictive pericarditis, but has high operative mortality?

Pericardectomy

What can the latent period of Chaga's disease cause?

Myocarditis

What are some drugs that can cause drug-induced myocarditis?

Chemo drugs- Doxorubicin, 5-FU
HIV drugs- Zidovudine
Phenytoin

2/3 of myocarditis patients have what kind of symptoms?

Flu-like

How do most cases of myocarditis present?

Clinically silent

What is the treatment for peripartum myocarditis?

IVIG, Hydralazine & NTG (if CHF symptoms), Anticoagulation (if thrombus involved)

What are some lab findings associated with myocarditis?

Increased WBC & ESR, Elevated cardiac enzymes, Elevated immunoglobulins, Abnormal T & B cell counts, Cardiac-specific antibodies

What can present with 4-fold increase in immunoglobulins & cardiac-specific antibodies in blood?

Myocarditis

In myocarditis, CO is ______________

Decreased

In myocarditis, LVEDP is ____________

Elevated

What may end up being the best confirmatory test for myocarditis if EBM cannot be performed?

MRI

What is the definitive test for myocarditis?

Biopsy

What should pts avoid while inflammation is present in myocarditis?

Exercise

What is the most common cause of cardiac tamponade?

Malignant pericarditis