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Pericardial Diseases
More Pericardial Disease
Shock
Syncope
Valvular Heart Disease
100
This is the most common pathological processes involving the pericardium.
What is pericarditis
100
Define pulsus paradoxus.
What is a decrease in systolic bp of > 10mmHg during inspiration (decreased thoracic pressure --> increased VR --> increased RV filling --> septal deviation to left --> reduced LV filling area)
100
These are the 3/4 classifications of shock:
What is hypovolemic, cardiogenic/obstructive, distributive.
100
This is the underlying mechanism of true syncope.
What is transient global cerebral hypoperfusion.
100
Based on primary CC, people survive their condition in this order.
What is angina (5 yrs)>syncope (3 yrs)>failure (2 yrs)>sudden death (no years)
200
These are the two main findings on physical exam in acute pericarditis.
What is low grade fever and pericardial rub (transient).
200
Define pressure equalization in the context of cardiac tamponade.
What is all filling pressures = pericardial pressure (equalization of all diastolic pressures: RA=RVEDP=PCWP=pericardial pressure)
200
These are 5 signs/symptoms of shock:
What is systolic BP < 90; low urine output; cold clammy skin (edematous with septic); altered mental status; lactic acidosis.
200
These are three kinds neurally-mediated reflex syncope.
What is vasovagal (most common); carotid sinus syndrome; situational (post-micturation, cough, defecation...)
200
These are some clinical manifestations of aortic stenosis.
What is long latent period, then angina/exertional syncope/LV failure/sudden death/pulsus tardis and parvis/systolic ejection murmur/S4/soft A2/LV hypertrophy
300
Compare the location, quality and effect of posture of chest pain in acute MI and pericarditis.
What is retrosternal/left shoulder v. precordial/left trapezius; pressure/burning v. pleuritic/sharp; no effect v. relieved by learning forward and exacerbated by recumbency
300
This is the pathophysiology of electrical alternans.
What is the heart swinging closer to and farther away from the ECG leads on the outside of the chest in the fluid inside the pericardium.
300
True or False: SIRS can be triggered by infection, trauma and/or pancreatitis.
What is True: SIRS is Systemic Inflammatory Response Syndrome involving fever, tachycardia, tachypnea, leukocytosis.
300
Evaluation of syncope differs based on:
What is patient age, health status, and presence/absence of cardiac disease in particular.
300
These are some clinical manifestations of aortic regurgitation.
What is wide PP/large SV/degree related to TPR/LV dilation (chronic)/Austin-Flint murmur sometimes.
400
Describe the 4 stages of ECG changes in pericarditis.
What is Stage I: diffuse concave ST elevation + PR depression; Stage II: flat T waves + normalization of ST & PR; Stage III: inverted T waves; Stage IV: usually upright T waves (can remain inverted)
400
This is a physical exam finding not present in constrictive pericarditis that one would find in cardiac tamponade, and the pathophysiology of that finding.
What is Kussmaul's sign: JVP that doesn't go down with inspiration--instead get more distended (also could say pericardial knock).
400
Describe the hemodynamics of each kind (hypovolemic v. cardiogenic v. distributive) of shock in terms of RA, PCW, CO, and SVR.
What is hypovolemic: low/low/low/high; cardiogenic: variable/high/low/high; septic: low/low/high/low (if given fluids, RA and PCW can be normal)
400
These are two causes of orthostatically mediated syncope?
What is ANS disfunction and drug-induced (i.e. narcotics or vasodilators).
400
These are some findings on physical exam in mitral stenosis.
What is loud & snapping S1; opening snap after aortic valve closure; low pitched diastolic murmur at apex
500
Draw the jugular venous pressure (a/x/v/y) waves for a normal heart, a heart with cardiac tamponade, and a heart with constrictive pericarditis on the board.
What is CT shows prominent x descent and blunted y descent; CP shows exaggerated x and y descent ("square root").
500
Finding on cardiac imaging in a patient with advanced constrictive pericarditis.
What is pericardial calcification (CXR, echo, CT).
500
Describes the pathophysiology of non-cardigenic pulmonary edema.
What is lung injury leads to increased permeability = increase in amount of fluid and protein leaving the vascular space in the presence of normal hydrostatic pressure (fluid has high protein content); injury impairs ability to drain fluid from the lungs --> edema. (cardiogenic has increased hydrostatic pressure, an intact endothelial barrier, and a protein-poor edema fluid).
500
True or False: neurological tests are frequently helpful in diagnosing etiologies of syncope.
What is FALSE.
500
Comparison of the murmur/ECG findings/pulmonary edema presence in acute v. chronic mitral regurgitation.
What is chronic: murmur is harsh & pansystolic at apex radiating to axilla; ECG shows a fib and LV dilation; pulmonary edema is uncommon acute: murmur is soft and ends before S2 heard at the base and radiating to neck and back; ECG shows tachycardia; pt has pronounced v wave in neck veins; pulmonary edema is common