1What are the two layers of the normal pericardium?
visceral and parietal
2How many mL of fluid is found in the pericardium?
15-40 mL
3What are some of the benefits of fluid in the pericardium?
prevents the sudden dilation of the heart during exercise
protective barrier to infection
4Which form of pericarditis is the most common form?
acute peridcarditis
5How long does acute pericarditis last?
6 weeks
6How long does subacute pericarditis last?
6 weeks to 6 months
7Which type of pericarditis is fibrinous or effusive?
acute
8Which pericarditis is constrictive or adhesive?
chronic
9Which type of pericarditis is effusive and/or constrictive?
subacute
10What are some infectious causes of pericarditis?
viral
pyogenic
TB
fungal
protazoal
parasitic
syphilitic
11What are some noninfectious causes of pericarditis?
acute idiopathic
renal failure
neoplastic
trauma induced
aortic dissection
AMI
post irradiation
12What are some autoimmune causes of pericarditis?
rheumatic fever
collagen vascular diseases (SLE, RA, scleroderma)
drug induced
post cardiac injury
13What are some drugs that can induce pericarditis?
INH
anticoagulants
phenytoin
14What are some clinical findings of acute pericarditis?
chest pain
pericardial friction rub
EKG
15What is the stage 1 finding of an EKG with acute pericarditis?
widespread ST segment elevation with upward concavity
16What is the stage 2 finding on an EKG for a patient with acute pericarditis?
ST segment returns to normal
several days after stage 1
17What are the stage 3 findings on an EKG for a patient with acute pericarditis?
T waves become inverted
18What happens in stage 4 on an EKG for a patient with acute pericarditis?
returns to normal (after several weeks- months)
19What may pericardial effusion lead to?
cardiac tamponade
20What might you see on chest x ray with pleural effusion?
water bottle
21What is CT better at detecting with acute pericarditis?
small effusion
pericardial thickening
pericardial masses
22What is MRI better at detecting with acute pericarditis?
detects pericardial inflammation
23What is the treatment for acute pericarditis (no infection)
bedrest
NSAIDS (ibuprofen or indomethacin)
omeprazole
cochicine
24What do you give if NSAIDs are not tolerant?
glucocorticoids
25When is cochicine is contraindicated?
renal or hepatic dysfuction
26What are some potential causes for pericarditis secondary to postcardiac injury?
blow to the chest
AMI
cardiovascular surgery
27What are some potential causes of pericarditis secondary to collagen vascular disease?
SLE --> elevated ANA levels
hx of RA
28what is cardiac tamponade?
accumulation of pericardial fluid that restricts cardiac function which limits ventricular filling and decreases CO
29How many mL of fluid can cause cardiac tamponade if it occurs rapidly?
200 mL
30How many liters cause cardiac tamponade in a slow progression?
2 liters
31What are the symptoms of cardiac tamponade?
Beck's Triad:
hypotension
soft/absent/muffled heart sounds
JVD
32What is a significant indication of cardiac tamponade?
pulsus paradoxus
33What is pulsus paradoxus?
systolic BP increases by 10 mm Hg on inspiration
34What else is pulsus paradoxus seen in?
constrictive pericarditis
hypovolemic shock
acute vs chronic COPD
PE
35What is the most common treatment and approach are used for pericardial effusion?
pericardiocentis at the subxyphoid
36What does chronic constrictive pericarditis results from?
granular tissue that forms during the healing of acute pericarditis
37How do patients present with constrictive pericarditis?
weakness
fatigue
edema
increased abdominal growth
abdominal discomfort
exertional dyspnea
orthopnea
38What is kassmauls sign? what does it indicate?
venous pressure does not decrease during inspiration
chronic constrictive pericarditis
39What are some s/s or chronic constrictive pericarditis?
jaundice
ascites
early third heart sound
hepatomegaly
40What is the treatment for chronic constrive pericarditis?
pericardial resection
41What is endocarditis?
bacterial or fungal infection involving the valves or endocardial surface tissue
42What does clinical presentation depend on with endocarditis?
the valves involved
virulence of organisms
43What is the most common bacterial etiology for endocarditis?
staph aureus
44What are the risk factors for endocarditis?
over 60
artificial valves
damaged valves
congenital heart defects
people who inject drugs
poor dental health
long term cath placement
45What are some common causes of nonbacterial thrombotic endocarditis?
mitral regurg
aortic stenosis
aortic regurg
VSD
46What is something that all endocarditis patients present with at some point?
fever
47What are osler nodes and what is it usually found with?
painful violaceous raised lesions on the toes, fingers and feet
endocarditis
48What are janeway lesions and what is it usually found with?
painless erythematous lesions on the palms and soles
endocarditis
49What other clinical findings might you find with endocarditis?
petechiae
murmur
hematuria a/o proteinuria
50How is endocarditis diagnosed?
culture: three "two bottle" sets from different sites over 2 hour time frame
echocardiogram
51What criteria is used for diagnosis of endocarditis?
duke
52How many of each criteria from the duke criteria do you need in order to diagnose endocarditis?
2 major criteria
1 major criteria and 3 minor criteria
5 minor criteria
53How is endocarditis treated?
organism specific bactericidal that is prolonged
54What is death from endocarditis usually associated with?
co-morbities
55High risk patients for endocarditis require what?
prophylaxis for dental procedures
56What are some things that put patients at high risk for endocarditis?
prosthetic heart valve
LVAD
prior hx of endocarditis
unrepaired congenital shunts
known valvular defect
57What prophylactic atbx is given?
amoxicillin
58What prophylactic atbx is given if allergic to PCN?
clarithromycin or azithromycin
59What is PWID limited to? What s/s would you see?
tricuspid valve
fever and faint murmur