takes month or yrs to develop., results in replacement of normal pericardial space by a thick fibrous shell which causes hrt failure by restricting ventricular filling, thus you will have a pos Kussmaul sigh. MCC is TB
Kussmaul's sign-a paradoxical increase in JVP with inspiration, (nrly dec). May be seen with severe rt-sided hrt failure, tricuspid stenosis, rarely cardiac tamponade.
Pulsus paradoxus- a drop in sys BP >10mmHg during inspiration, represents an exaggeration of the normal physiological response to inspiration. Seen in cor pulmonale, constrictive pericarditis, cardiac tamponade. 1/3 seen in retracted Left ventricular filling.
Pericardial Knock-brief, high frequency, precordial sound heard in early diastole, after S2. Seen in pt's with constrictive pericarditis due to dec left vent. filling
vague symptoms namely fever, fatigue, malaise, and echocardiographic evidence of valvular vegetation. Must send for special serologies and cultures for organisms that do not grow in standard blood culture.
HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
Subungual splinter hemorrhages-are a consequence of microemboli.
Janeway lesions-sm, erythematous, macular, nontender lesion on the palms and soles. also a sign of microemboli
Listen for a new-onset regurgitant murmur on cardiac auscultation!
causes fibrous intimal thickening with endocardial plaques limited to the rt hrt. Produces episodes of skin flushing, abdominal cramping, nausea, smiting, and diarrhea, which is thought to be due to the production of Serotonin, Kallikrein, Bradykinin, Histamine, Prostaglandins, and tackykinins by the carcinoid tumors.
The degree of endocardial fibrosis correlates with plasma levels of serotonin and urinary excretion of serotonin metabolite
5-hydroxyindoleacetic acid. Fibrosis is limited to the rt hrt bc both Serotonin and bradykinin are inactivated distally by pulmonary vascular MAO.
End result-Pumonic stenosis and restrictive cardiomyopathy.