36 Pericardial Disease
Pericarditis
- fibrinous: not immune, extension of necrosis
- ischemic chest pain not positional
- T wave association with pericarditis
- P begins at higher point than where R point ends
- inflammation of myocardium not from ischemia
Tamponade
- cancer pts developing dyspnea: tamponade
- wall of fluid muffle heart sounds
- usually hypotension only in acute
- black band around infralateral wall (lower left) and in front (top)
- 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
- tachycardia: increased sympathetic
- EKG: rare, tall and short QRS, heart swinging inside fluid
- 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
Constrictive
- viral carditis
- RV stuck to pericardium
- also caused by miliary TB (immigrant)
- bright white material surrounding heart, Ca
- long standing inflammation: calcified
- any disease where can't accept venous return leads to kussmaul's sign
- 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
- 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
- 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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