36 Pericardial Disease
![](https://photos.thisispiggy.com/file/wikiFiles/3mEmBya.jpg)
Pericarditis
![](https://photos.thisispiggy.com/file/wikiFiles/XkbeAtE.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/fuNYWIu.jpg)
- fibrinous: not immune, extension of necrosis
![](https://photos.thisispiggy.com/file/wikiFiles/8MUKQqG.jpg)
- ischemic chest pain not positional
![](https://photos.thisispiggy.com/file/wikiFiles/z5o9K9H.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/br0aTxe.jpg)
- T wave association with pericarditis
![](https://photos.thisispiggy.com/file/wikiFiles/EVrck7f.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/NUTqb3X.jpg)
- P begins at higher point than where R point ends
![](https://photos.thisispiggy.com/file/wikiFiles/DnkFwGe.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/8JF6VH5.jpg)
- inflammation of myocardium not from ischemia
Tamponade
![](https://photos.thisispiggy.com/file/wikiFiles/kwJPndS.jpg)
- cancer pts developing dyspnea: tamponade
![](https://photos.thisispiggy.com/file/wikiFiles/qOYDXRs.jpg)
- wall of fluid muffle heart sounds
![](https://photos.thisispiggy.com/file/wikiFiles/ia4pV5U.jpg)
- usually hypotension only in acute
![](https://photos.thisispiggy.com/file/wikiFiles/9NQ5H4d.jpg)
- black band around infralateral wall (lower left) and in front (top)
![](https://photos.thisispiggy.com/file/wikiFiles/pSsQaOD.jpg)
- inspire, push diaphragm down, compress abdomen vessels (IVC), thorax vessels dilate, increased venous return
- tamponade: RV cannot increase in size, all its increase in size bulges into LV
- asthma/COPD: exaggerated changes in thoracic pressure may leads to hemodynamic changes
![](https://photos.thisispiggy.com/file/wikiFiles/afTU5gd.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/oxEzkIe.jpg)
- tachycardia: increased sympathetic
- EKG: rare, tall and short QRS, heart swinging inside fluid
![](https://photos.thisispiggy.com/file/wikiFiles/TtBdD6B.jpg)
- x descent: RV contraction
- tamponade: RV contraction, makes room in pericardium for fluid to move away from RA to RV, allow RA to relax more, steep x descent
- y descent: filling of RV impaired
- late diastolic collapse of RA
![](https://photos.thisispiggy.com/file/wikiFiles/e1YkJdE.jpg)
Constrictive
![](https://photos.thisispiggy.com/file/wikiFiles/gkoFIb1.jpg)
- viral carditis
- RV stuck to pericardium
- also caused by miliary TB (immigrant)
![](https://photos.thisispiggy.com/file/wikiFiles/xhBR2fy.jpg)
- bright white material surrounding heart, Ca
- long standing inflammation: calcified
![](https://photos.thisispiggy.com/file/wikiFiles/QGo7kvh.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/AamV2Wu.jpg)
- any disease where can't accept venous return leads to kussmaul's sign
![](https://photos.thisispiggy.com/file/wikiFiles/povXDUH.jpg)
- constrictive: RV adhered to pericardium, contracts in systole, and snaps back in diastole, pulled towards pericardium, then it hits the calcified shell, and pressure shoots back up
![](https://photos.thisispiggy.com/file/wikiFiles/9gxO4xc.jpg)
- square root sign: RV falls much more rapidly and deeper than normal, same physiology as RA tracing
- pericardial knock: abrupt stop and shoot up pressure, similar to S3
![](https://photos.thisispiggy.com/file/wikiFiles/851E8qe.jpg)
- Tamponade: RV is able to distend and fill, thus no kussmaul. However, RV fills by pushing septum to LV, thus pulsus
- restrictive: restricting substance, RV cannot accept venous return, and septum frozen
- constriction: RAP goes up in inspiration (Kussmaul); however, increased pressure is not passed along to septum
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