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Description
Flashcards by ecmarchese, updated more than 1 year ago
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Created by ecmarchese
almost 11 years ago
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| Question | Answer |
| Outer fibrous layer | Parietal layer |
| Inner serous layer | Visceral layer |
| What is another term for visceral? | Epicardial |
| What is edelmans normal amount of fluid around the heart? | 20-40 ml/cc |
| Continues superiority attaching at the level of the great vessels. | Transverse Sinus |
| Pericardium extends around the heart, encompassing the ventricles | Oblique sinus |
| Where does the oblique sinus terminate? | Posterior at the atrial level, inserting behind the LA by the PV |
| What are some effects of pericardial disease? | Pericardial effusion, tamponade, acute or constrictive pericarditis |
| What May fluid accumulation result in? | Resolution with no residual abnormality, tamponade, residual fibrosis and thickening that leads to constrictive pericarditis, affects the parietal layer. |
| Inflammation of the pericardium which may cause the visceral layer to secrete abnormal amount of fluid/ or abnormal type | Pericardial effusion |
| What are two types of pericardial effusion? | Acute and chronic |
| Where are most effusions located? | Local or generalized |
| What kind of disorder can an effusion be? | Local or systemic disorder |
| What are some causes of a pericardial effusion? | Viral/bacterial infections, dressler syndrome, post cardiac surgery, chronic renal failure, cancer, trauma, radiation therapy, idiopathic, obstruction of the lymphatics, aortic dissection, auto immune or connective tissue disorders |
| What is another term for problems that occur after an MI? | Dressler syndrome |
| What auto immune disease and connective tissue disease causes pericardial effusion? | Lupus, rheumatoid arthritis |
| What do symptoms for pericardial effusion depend on? | How fast the fluid accumulates |
| Inflammation of pericardium causes the walls to rub against each other with audible friction | Friction rub sound |
| When is friction rub sound heard? | Heard with inspiration/ expiration |
| Drop in systolic BP more than 10mmhg with inspiration indicating tamponade | Pulses Paradoxus |
| What are some signs and symptoms of pericardial effusion? | Chest pain, dyspnea, friction rub sound, cardiomegaly, syncope, palpitations, jugular venous distinction, Purdue paradox us, distant heart sounds, tachycardia, hypotension |
| Distant heart sounds | Ewart's sign |
| Where are pericardial fat pads located? | Anteriorly |
| Where is pericardial effusion generally located? | Posterior due to gravity, but with cancer and surgery anterior effusion is likely |
| What are some things that cause a false positive for pericardial effusion? | Pericardial fat pads, left pleural effusion, descending aortic aneurysm, LA enlargement, hiatal hernia, LV pseudo aneurysm, improper gain settings. |
| Hernia near the diaphram. | Hiatal diaphram |
| How do you tell the difference between pericardial and pleural effusion? | Pericardial effusion is anterior to the aorta, anterior to the diaphram, and evenly distributed |
| Can pleural and pericardial effusion coexist? | Yes |
| How does effusion look in 2D? | Echo free space between the epicardium and the pericardium |
| What does a swinging heart suggest? | Large effusion |
| What do fibrin strands indicate in a pericardial effusion? | Long standing effusion or metastatic disease |
| With a pericardial effusion, what can you see on m-mode? | Pericardial motion attenuated, may pick up pseudo- MVP, TVP, SAM, and paradoxical septal motion. |
| What is a benefit of m-mode when looking for pericardial effusion? | Better detection for small PE due to higher sampling rate |
| What does paradoxical septal motion look like? | A snake going across the screen |
| Why do you do Doppler for a pericardial effusion? | Look for abnormalities, evaluate diastolic dysfunction, evaluate for early signs of tamponade. |
| What is the result of a rapid accumulating pericardial effusion? | Tamponade |
| Moderate to large in size, and creates a increase in Intra-pericardial pressure | Tamponade |
| Clear space is detected in systole and diastole posteriorly. (Less than 1cm in width) | Small |
| Clear space detectable in both systole and diastole and anterior and posterior positions. | Moderate |
| A pericardial effusion that is less than 1 cm in width at its greatest width is ________? | Moderate |
| A clear space is detectable in systole and diastole, surrounds the entire heart, and is greater than 1 cm in width | Large |
| What is most tamponade classified as? | Moderate/severe |
| If pericardial effusion is located in the region of the right heart, a _________may result. | Regional tamponade |
| What are some causes of tamponade? | Same as an effusion, cardiac perforation during testing, and trauma |
| Is tamponade a clinical diagnosis? | Yes |
| Why do we use echo if tamponade is suspected? | To determine size, location, and to see if it has a hemodynamics effect upon heart chambers and functions. |
| What is becks triad? | Hypotension, muffled heart sounds, elevated venous pressure. |
| What are some clinical signs of tamponade? | Becks triad, pulsus paradox us, pericardial friction, tachycardia, hepatomegaly |
| Enlarged liver due to increased venous pressure | Hepatomegaly |
| What will you find in the right heart during tamponade? | RV is impaired and RV pressures increased, RV/RA unable to expand to fill properly, the veins become dilated due to backup of blood. |
| Due to the right heart collapse, decreased blood flow to the LV causes? | Impaired ventricular diastolic filing, increased ventricular diastolic pressure, decreased stroke volume, increase HR |
| What is the equation for cardiac output? | Heart rated x stroke volume |
| What are the 2D findings of tamponade? | Large pericardial effusion, respiratory change in LV & RV size, posterior motion of RV in diastole, diastolic collapse of RV & RA, E-F slope of MV/TV, no IVC collapse with inspiration, swinging heart motion |
| What is a definite indicator of tamponade? | Right ventricular diastolic collapse |
| What do you evaluate in Doppler when a pt has tamponade? | MV and TV inflow for respiratory variation. |
| Do you need to change any settings in Doppler when seeing tamponade? | Decrease the sweep speed to 25 to appreciate variation. |
| What does slowing the sweep speed do? | Allows the waveforms yo squish together to see any changes with respirations. |
| In tamponade, tricuspid inflow will ______ with inspiration | Increase |
| In tamponade, mitral inflow will _______ with inspiration. | Decrease |
| Normally there are respiratory variation in the early diastolic filling of RV and LV, but with tamponade you will find? | More than 25% differences in early E and A wave changes ( filling velocities during the inspiration/ expiration in right and left ventricle) |
| What are some complications of effusion/ tamponade? | Hypotension, shock, death |
| What are some treatments for pericardial effusion/ tamponade? | Pericardiocentesis, pericardial window, pericardectomy |
| Aspiration of the fluid via a catheter inserted over a needle directed inside the pericardium | Pericardiocentesis |
| Involves open pericardial drainage via a window made by a surgeon. | Pericardial window |
| Involves removal of the pericardium (rare) | Pericardectomy |
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