Pericardial effusion

Pregunta	Respuesta
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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