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Pericardial Disease

Terms in this set (21)

Acute benign pericarditis

1. Viral or bacterial
2. Doesn't involve what? (2)
1. Viral

2. Doesn't involve significant effusion or tamponade
Pericarditis following an MI:

1. Acute presentation: how long after transmural MI?

2. Delayed presentation: aka ______ syndrome, appears how long after an MI?
1. 1-3 days

2. Dressler's, weeks to months
Post-cardiac surgery pericarditis

1. etiology (2)
2. Frequency
3. More common in what age group?
4. Treatment?
1. Infective or autoimmune
2. High frequency 10-40%
3. Pediatrics
4. Same as other pericarditis'
1. How would you diagnose acute pericarditis? (2)

2. What are first and second-line tx?
1. Chest pain and/or Friction rub (scratchy, high-pitched sound throughout entire cardiac cycle)

2.
First: NSAIDs or salicylates

Second: Corticosteroids
1. When does a pericardial effusion result in tamponade?

2. Dependent upon (2)

3. Will a rapid or slow effusion cause cardiac tamponade at at a lower volume?
1. When pressure in the pericardial space interferes with cardiac filling

2. size and acuity of effusion

3.Rapid (see pic)
Symptoms of cardiac tamponade are related to one of two things:
1. compression of adjacent structures

-Dyspnea
-Cough ---- hoarseness
-Anorexia ---- dysphagia
-Chest pain

2. pericardial restraint

-Tachycardia
-Jugular venous distention
-Hepatomegaly
-Peripheral edema
Cardiac Tamponade

1. What is the mechanism?

2. Compensatory mechanisms (2)

3. Physical findings (3)
1. Due to pressure imposed by the pericardium causing diastolic collapse, thereby reducing stroke volume and cardiac output

2. tachycardia & peripheral vasoconstriction

3.
-Kussmaul's sign
-Pulsus paradoxus
-Beck's triad
Physical Findings of Cardiac Tamponade

1. What is Kussmaul's sign?

2. What is pulsus paradoxus?
1. JVD with inspiration

2. Greater than 10 mmHg drop in BP during inspiration
Physical Findings of Cardiac Tamponade

1. What is Beck's triad?
2. What is Becks triad considered?
1.
-Quiet heart sounds (muffled)
-Increased jugular venous pressure
-Hypotension

2. The classic or halmark symptoms
1. Tx of cardiac tamponade? How?

2. Temporizing measures until we can get to surgery (3)

3. What rhythm should be maintained and why?
1. Removal of fluid (Pericardiocentesis, pericardial window)

2. a) increase volume

b) increase contractility

c) control acidosis

3. NSR (they really need the atrial kick to fill the LV)
What are the effects of General anesthesia and Positive-pressure ventilation with hemodynamically significant cardiac tamponade?
Life threatening Hypotension
Gold standard for diagnosing cardiac tamponade?
Echocardiography

FYI: others include CT/ MRI, ECG
1. What is the goal of anesthetic management in cardiac tamponade?

2. How is this accomplished? (6)

3. What kind of monitoring will we want to have in this pt?

4. Induction and maintenance: preferred agent?
1. Maintain Cardiac output

2.
-Avoid bradycardia
-Avoid decrease in SVR
-Avoid decrease in Venous return
-Maintain sinus rhythm
-Maintain contractility
-Maintain preload

3. Art line

4.
-inhalational (preferred).
-Ketamine could also get the job done
1. Describe constrictive pericarditis

2. Impaired (systolic/diastolic) filling just like ______ ______
1. Pericardium becomes a rigid shell d/t adhesions and/or scarring. Over time may become calcified.

2. diastolic, cardiac tamponade
Treatment of constrictive pericarditis involves:

1. stripping of ______ which may be closely adherent to the ______

2. May involve (significant/minor) blood loss

3. May require ______ ______
1. pericardium, myocardium

2. significant

3. Cardiopulmonary bypass
Constrictive pericarditis: Management

1. Goal is to maintain (4)

2. Anesthetic drug selection will depend on severity of ______ compromise

3. with severe hemodynamic compromise, this should be treated similar to what?

4. If pt is not (hyper/hypo)tensive, a broader selection of techniques is reasonable within the stated goals
1.
-HR
-contractility
-SVR
-Venous return

2. hemodynamic

3. cardiac tamponade

4. hypotensive
1. Most common cause of pericardial laceration

2. If adjacent structures are also lacerated what may result?

3. How should #2 be treated?
1. -Common in rapid deceleration injuries to the chest wall (ex: MVA)

2. Cardiac herniation

3. Just like cardiac tamponade
If a pt suffered a rapid deceleration injury what should you maintain a high index of suspicion for?
Cardiac contusion
Cardiac contusion

1. What limits the value of chest pain as a symptom?

2. Be alert to ______ changes

3. ______ levels ARE indicated
1. LOC or narcotics may interfere with pain

2. ECG (ST-T abnormalities)

3. Troponin
Bottom line: if I have a trauma pt that isn't behaving like I think they should be cardiac wise, what should be on my differential diagnosis?
Cardiac contusion
1. What is commotio cordis?

2. What can cause it?

3. Treatment?
1. A high impact chest injury during ventricular repolarization producing an unsynchronized impulse resulting in V Fib

2. Football helmet, baseball, steering wheel, etc to the chest

3. Treatment is defibrillation
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