Anatomy & Physiology
These 2 layers comprise the pericardium, which envelops and anchors the heart in the thorax
FIBROUS & SEROUS pericardium
A 25 year old male with no previous medical history presents with a 3/7 hx of sharp left sided chest pain that radiates to the left trapezius muscle. The pain is worse when he lies down and swallows and is relieved with sitting forward. He also complains of occassional fevers and chills and muscle aches. This is the most likely cause of the patient's CHEST PAIN.
VIRAL or IDIOPATHIC pericarditis
These physical exam findings in triad make the diagnosis of cardiac tamponade most likely.
hypotension, elevated JVP & muffled heart sounds
Acute pericarditis often presents with these characteristic EKG findings.
diffuse ST elevation & PR depression
This is first line therapy in most patients with acute pericarditis.
ibuprofen
This layer of the serous pericardium is also called the "epicardium"
the visceral pericardium?
A 52 yo female presents to the ER with left sided parasternal chest pain that is worse with inspiration. She also c/o fever, chills and malaise for the past 2/52. On physical exam, she is confused and excoriations are present on her extremities. A scratchy sound is heard with your stethoscope over the left sternal border that masks the normal S1 & S2. Basic lytes drawn by the triage nurse show an elevated K+ (6.8) & low CO2 (10). The EKG done @ triage is NOT remarkable. You are stumped by this presentation and read the patient's old chart that Gerta has found for you. You find a recent report indicating that the patient's GFR is about 14ml/min. This is the most likely cause for this patient's presentation.
uremic pericarditis
This "paradox" occurs less often in constrictive pericarditis compared to cardiac tamponade and is an indicator of the severity of tamponade.
PULSUS PARADOXUS
This pericardial disease can present as new cardiomegaly on CXR with clear lung fields.
pericardial effusion.
This therapy is first line in patients presenting with uremic or dialysis pericarditis.
dialysis or RRT
This nerve innervates the pericardium & is responsible for the referred pain of pericarditis
the PHRENIC nerve
A 62 yo male presents to the ED with left sided CP and fever for 4/7. 8 weeks ago, he was admitted to hospital with a STEMI. He was not thrombolysed, because he had an actively bleeding scalp laceration. Physical exam is positive for a pericardial rub and his WBC is 16. This syndrome is less common in the post-ACS reperfusion era.
Dressler's Syndrome
In Constrictive Pericarditis, this sound is often best heard during inspiration in early diastole with your stethoscope.
PERICARDIAL KNOCK
EKG changes consisting of beat-to-beat shifts of P-waves AND QRS complexes are pathognomonic for this pericardial disease.
cardiac tamponade
Glucocorticoid therapy is indicated in this subset of diseases involving the pericardium.
Autoimmune Pericarditis
The minimal amount of pericardial fluid required to visualize an enlarged cardiac silhouette on CXR
200 cc's?
A 45 yo F with a hx breast cancer diagnosed 10/12 ago presents with with a 1/12 hx of peripheral edema, increasing abdominal distention and worsening exertional dyspnea. Her JVP is elevated and test for shifting dullness is (+)ve. A third heart sounds is identified on cardiac exam. Additional history of what treatment, would help you make this diagnosis.
a history of radiation treatment
This lack of decline in jugular venous pressure during inspiration may help you diagnose CONSTRICTIVE PERICARDITIS in the appropriate clinical setting.
KUSSMAUL'S SIGN
In patients with symptoms of right heart failure, ring calcification on CXR suggests this pericardial disease.
constrictive pericarditis
This is both therapeutic and diagnostic in patients presenting with cardiac tamponade.
pericardiocentesis
This layer of serous pericardium is electrically inert
the parietal pericardium.
A 30 yo HIV+, homeless M presents w/ 1/12 hx productive cough, night sweats, weight loss and 1/52 hx pleuritic chest pain and fever. CXR reveals a cavitary lesion in the left upper lobe and an enlarged cardiac silhouette. This is the most common cause of pericarditis in some regions of Africa.
Tuberculosis Pericarditis
This "scratching" or "squeaking" sound heard best @ the LLSB w/ the diaphragm of the stethoscope is 1 of 4 diagnostic criteria for acute pericarditis.
PERICARDIAL FRICTION RUB
This non-invasive diagnostic test is key in evaluating whether pericardial effusion has led to cardiac tamponade.
heart u/s.
This option should be reserved for patients who have failed previous treatments and have recurrent pericardial disease.
pericardiectomy