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PericardialDz

lecture 25 brickner

QuestionAnswer
disorder of heart muscle characterized by diastolic dysfunction but nl systolic ventricular function restrictive cardiomyopathy, least common type of cardiomyopathy
most common causes of restrictive cardiomyopathy amyloidosis, sarcoidosis and hemochromatosis
presentation of restrictive cardiomyopathy predominantly R-sided failure due to elevated right atrial and ventricular pressures. sx: fatigue, DOE, peripheral edema, maybe heart block or a-fib too
what causes DOE in restrictive cardiomyopathy? low cardiac output NOT pulmonary sequela. right heart is overfilled and typically doesn't push lots of vol out into the lungs = no pulmonary vascular congestion
PEx of pt with R heart failure JVD, hepatomegaly, abd girth increase, RUQ pain, nausea, peripheral edema, inspiratory increase in jugular venous distension (Kussmaul sign)
clinical course of pt with restrictive cardiomyopathy very poor prog usually 1-2 yrs after dx, death from low output heart failure, heart block, a-fib and its complications or refractory ventricular arrhythmias
CXR and EKG of pt with restrictive cardiomyopathy CXR: possible CM, but usually nl sized heart, possible pleural effusions // EKG: low voltage, AV and rhythm disturbances are common
Echo results of pt with restrictive cardiomyopathy all chamber diastolic pressures are elevated and equal with prominent y descent from rapid atrial emptying, square root sign or dip and plateau on ventricular pressure tracing
constrictive pericarditis pericardium is thickened and fibrotic resulting in restriction of heart during diastole. think heart is in a concrete shell that won't let it expand
common etiologies for constrictive pericarditis most commonly idiopathic, TB, viral, remote bacterial/fungal/parasitic infection, SLE or RA, irradiation, malignangy of pericardium or prev surg
presentation of pt with constrictive pericarditis insidious onset of abd swelling from ascites, peripheral edema, fatigue, dyspnea from diminished CO. possible vague abd discomfort or nonspecific retrosternal CP
PEx of pt with restrictive pericarditis almost same as with restrictive cardiomyopathy EXCEPT at the apex there should be a pericardial knock as well as Kussmaul's sign
tx of restrictive pericarditis milder cases may be treated with diuretics. those who failed medical tx may need total pericardectomy
radiographic finding diagnostic for restrictive pericarditis presence of pericardial calcification on CXR or pericardial thickening on MRI/CT
etiologies of acute pericarditis typically idiopathic, following AMI, infectious process, blunt or sharp trauma to the chest, uremia, invasion of adj tumor, irradiation, surg or med-related
presentation of pt with acute pericarditis sharp retrosternal CP that is classically worsened with deep inspiration or when lying supine but improved by sitting hunched over, dyspnea, cough, hoarseness or dysphagia
diagnostic tests for acute pericardiits diffuse ST elevation pattern on ECG, CXR showing pericardial effusion, pericardial friction rub on exam, serum Cr to r/o uremic pericarditis
tx of acute pericarditis go after the underlying cause if there is enough evidence to support one. o/w give ASA/NSAIDs to relieve pain/inflammation and effusion will resolve within days-wks
pericardial tamponade life-threatening complication of pericardial inflammation where effusion pressure inside pericardial sac begins to compromise heart function
pulsus paradoxus seen with pericardial tamponade. with inspiration the right heart fills and left side is underfilled with drop in SBP felt as softer pulse pressure distally
clinical signs of pericardial tamponade decreased BP or narrow pulse presure, inc HR and RR, inc JVP, pulsus paradoxus
Echo findings of pt with pericardial tamponade collapsed RV during diastole or equalization of diastolic pressures in R sided chambers of heart
EKG findings of pt with pericardial tamponade diffuse ST segment elevation, low voltage, electrical alternans (each QRS height is alternating in size) due to heart swinging back in forth within pericardial fluid
Created by: sirprakes
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