Pericardial Disease

1. Visceral pericardium

2. Parietal pericardium

What are the two layers of the pericardium?

Fibrous pericardium

Outermost layer of the pericardium.

Contiguous with the adventitia of the great vessels.

Serous pericardium

Inner portion of the pericardium.

Two-layered sac that breaks up into the visceral and parietal pericardium.

1. Visceral

2. Parietal

What are the two layers of the serous pericardium?

Parietal pericardium

The outer layer of the serous pericardium.

Visceral pericardium

The inner layer of the serous pericardium.

Also known as the epicardium.

Pericardial cavity

Area which normally contains a small amount of serous fluid to prevent friction.

Lies between the visceral and parietal pericardium.

1. Fixes cardial position anatomically

2. Prevents excess movement

3. Reduces friction between the heart and surrounding organs

4. Acts as a barrier to infection or malignancy from surrounding organs

What is the function of the pericardium (4)?

1-2 mm

What is the normal pericardial thickness?

<50 mL

What is the normal amount of pericardial fluid?

Pericarditis

Inflammation of the pericardium.

1. Infectious

2. Autoimmune

3. Reactive

4. Metabolic

5. Traumatic or iatrogenic

6. Neoplastic

7. MI

What are the causes of pericarditis (7)?

1. Pericardial chest pain

2. Pericardial friction rub

3. EKG features

4. New or increasing pericardial effusion

For the diagnosis of pericarditis, at least two of the four criteria must be met.

1. Widespread ST elevation

2. Diffuse PR depression

3. Diffuse T wave inversion

4. Normalization

What are the EKG features of pericarditis (4)?

Pericardial friction rub

“Scratchy” sound on auscultation.

1. Chest pain

2. Dyspnea

3. Tachycardia or palpitations

4. Fever

5. General weakness or malaise

6. Leg swelling

7. Cough

What are the symptoms of pericarditis (7)?

1. Sudden or gradual onset

2. Sharp

3. Aggravated by laying supine

What are the characteristics of chest pain associated with pericarditis (3)?

1. NSAIDs

2. Colchicine

3. Corticosteroids

4. Aspirin

What are the treatment options for pericarditis (4)?

Pericardial effusion

Abnormal accumulation of pericardial fluid.

May be diffuse or loculated.

Fluid accumulation leads to an increased intrapericardial pressure, which can negatively affect heart function.

1. Infectious

2. Autoimmune

3. Neoplastic

4. Endocrine or metabolic

5. Trauma or iatrogenic

6. Radiation therapy

7. Volume overload states (CHF, cirrhosis)

8. MI

9. Idiopathic

What are the causes of pericardial effusion (9)?

Iatrogenic

Relating to illness caused by medical examination or treatment.

1. Dyspnea

2. Orthopnea

3. Chest pain

4. Cough

5. Painful breathing

6. Fainting or dizziness

7. Low-grade fever

8. Rapid heart rate

9. Fatigue or weakness

What are the symptoms of pericardial effusion (9)?

Asymptomatic pericardial effusion

A patient can have significant pericardial effusion and experience no signs or symptoms, particularly if the fluid has increased slowly.

More common if the effusion is caused by cancer or inflammatory disorders.

Echocardiography

The main diagnostic too used in the evaluation of pericardial effusion.

Swinging heart

Large effusions can produce a ___ .

50-100 mL

Volume of a small pericardial effusion.

100-500 mL

Volume of a moderate pericardial effusion.

>500 mL

Volume of a large pericardial effusion.

Trivial pericardial effusion

Echolucent space <10mm.

Seen only in systole.

Small pericardial effusion

Echolucent space <10mm.

Seen only in systole and disatole.

Moderate pericardial effusion

Echolucent space 10-20 mm.

Large pericardial effusion

Echolucent space >20 mm.

1. Cardiac tamponade

2. Constrictive pericarditis

Any time the indication for an echo is pericarditis or if a pericardial effusion is visualized, then extra images should be taken to evaluate for ___.

1. Ventricular interdependence

2. MV and TV inflow respiratory variation

3. Annulus versus

4. Expiratory hepatic venous diastolic flow reversal

What should be evaluate on echo when assessing for cardiac tamponade or constrictive pericarditis (4)?

Ventricular interdependence

Dysfunction of one ventricle secondary to a disorder of the other.

Annulus versus

Septal E’ velocity is greater than (>) the lateral E’ mitral annulus on TDI.