36 Pericardial Disease

Pericarditis

  • fibrinous: not immune, extension of necrosis

  • ischemic chest pain not positional

  • like sand paper

  • T wave association with pericarditis

  • diffused ST elevation

  • P begins at higher point than where R point ends

  • inflammation of myocardium not from ischemia

Tamponade

  • cancer pts developing dyspnea: tamponade

  • wall of fluid muffle heart sounds

  • usually hypotension only in acute

  • black band around infralateral wall (lower left) and in front (top)

  • inspire, push diaphragm down, compress abdomen vessels (IVC), thorax vessels dilate, increased venous return
  • tamponade: RV cannot increase in size, all its increase in size bulges into LV
  • asthma/COPD: exaggerated changes in thoracic pressure may leads to hemodynamic changes

  • tachycardia: increased sympathetic
  • EKG: rare, tall and short QRS, heart swinging inside fluid

  • x descent: RV contraction
  • tamponade: RV contraction, makes room in pericardium for fluid to move away from RA to RV, allow RA to relax more, steep x descent
  • y descent: filling of RV impaired
  • late diastolic collapse of RA

Constrictive

  • viral carditis
  • RV stuck to pericardium
  • also caused by miliary TB (immigrant)

  • bright white material surrounding heart, Ca
  • long standing inflammation: calcified

  • any disease where can't accept venous return leads to kussmaul's sign

  • constrictive: RV adhered to pericardium, contracts in systole, and snaps back in diastole, pulled towards pericardium, then it hits the calcified shell, and pressure shoots back up

  • square root sign: RV falls much more rapidly and deeper than normal, same physiology as RA tracing
  • pericardial knock: abrupt stop and shoot up pressure, similar to S3

  • Tamponade: RV is able to distend and fill, thus no kussmaul. However, RV fills by pushing septum to LV, thus pulsus
  • restrictive: restricting substance, RV cannot accept venous return, and septum frozen
  • constriction: RAP goes up in inspiration (Kussmaul); however, increased pressure is not passed along to septum