Acute Pericarditis and Aortic Dissection

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Questions and Answers

Which of these is a common cause of acute pericarditis?

  • Hypothyroidism
  • Hypercholesterolemia
  • Viral infection (correct)
  • Iron deficiency

What symptom is most typically associated with an aortic dissection?

  • Abdominal pain
  • Pain in the extremities
  • Interscapular chest pain (correct)
  • Throat pain

A patient with a suspected pulmonary embolism may present with which of the following?

  • Hemoptysis (correct)
  • Bradycardia
  • Peripheral vasodilation
  • Hypertension

What is a key diagnostic finding for pulmonary embolism that makes it unlikely in a low-risk patient?

<p>Negative D-dimer (B)</p> Signup and view all the answers

A patient with an aortic dissection involving the ascending aorta is most likely to undergo which treatment?

<p>Surgical intervention (C)</p> Signup and view all the answers

Which radiological test is now the preferred diagnostic method for pulmonary embolism?

<p>CT pulmonary angiogram (D)</p> Signup and view all the answers

What condition is typically associated with massive left atrial dilation, causing chest discomfort in the back?

<p>Mitral valve disease (D)</p> Signup and view all the answers

Which symptom is defined as an abnormal awareness of breathing at rest or low exertion?

<p>Dyspnea (D)</p> Signup and view all the answers

Which of the following is a typical sign of a large, central pulmonary embolism?

<p>Hypotension (D)</p> Signup and view all the answers

Which of the following is a risk factor for pulmonary embolism?

<p>Recent surgery (A)</p> Signup and view all the answers

Flashcards

What is Pericarditis?

Inflammation of the pericardium, the sac surrounding the heart. It can be caused by infections, autoimmune disorders, or other factors.

Define Aortic Dissection.

A tear in the inner lining of the aorta, the main artery carrying blood from the heart. It can be caused by high blood pressure or genetic disorders.

What is Pulmonary Embolism?

A blockage of the pulmonary arteries by blood clots, usually traveling from the legs or pelvis. It can be caused by surgery, immobility, or other conditions.

Explain Dyspnea.

A clinical syndrome characterized by breathlessness occurring either at rest or during unexpectedly low exertion.

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Describe Pulmonary Edema.

A condition that causes shortness of breath due to fluid buildup in the lungs. It is often a sign of heart failure.

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What is Dressler's Syndrome?

A type of pericarditis that develops after a heart attack or heart surgery.

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Describe Type A Aortic Dissection.

A condition that involves the ascending aorta and is usually treated surgically.

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Describe Type B Aortic Dissection.

A condition that involves the descending aorta and is usually managed medically or with a stent.

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Define Pleural Rub.

A common sign of pulmonary embolism, appearing as a grating or rubbing sound.

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What is D-dimer?

A blood test that measures the level of a protein fragment released from a blood clot. It can be used to help diagnose pulmonary embolism.

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Study Notes

Acute Pericarditis Causes

  • Idiopathic
  • Infectious (viral, bacterial, fungal)
  • Connective tissue diseases (e.g., lupus, rheumatoid arthritis)
  • Malignancy
  • Radiation therapy
  • Acute myocardial infarction
  • Post-myocardial infarction/cardiotomy (Dressler's syndrome)

Aortic Dissecion

  • Typical patient: middle-aged or elderly with hypertension or arteriosclerosis, occasionally younger with aortic root disease (e.g., Marfan's syndrome)
  • Major symptoms: chest pain, typically interscapular
  • Major signs: often none, sometimes regional arterial insufficiency, cardiac tamponade, sudden death.
  • Diagnosis: chest X-ray (widened mediastinum), transoesophageal echocardiogram, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan.
  • Comments: Type A dissections involve ascending aorta, usually treated surgically. Type B dissections involve the arch/descending aorta and usually managed medically or with an endovascular stent.

Pulmonary Embolism

  • Typical patient: recent surgery, lower limb fracture, long-distance air travel, obese, sedentary, heart failure, malignancy
  • Major symptoms: chest pain, dyspnoea, haemoptysis, syncope
  • Major signs: peripheral emboli (pleural rub), large/central emboli (tachycardia, hypotension, cyanosis, raised jugular venous pressure)
  • Diagnosis: D-dimer (negative in low-risk; pulmonary embolism very unlikely), ECG (sinus tachycardia, right bundle branch block, 'S1, Q3, T3' uncommon), chest X-ray (normal, wedge-shaped peripheral opacification, absent pulmonary vascular markings), echocardiogram (dilated right heart possible), CT pulmonary angiography (superseded V/Q scanning).
  • Comments: suspect pulmonary embolism in patients with unexplained hypoxia, thrombolytic therapy for patients with shock and/or a dilated right heart on echo, patients with no risk factors should be investigated for prothrombotic states

Dyspnea

  • Dyspnea is abnormal awareness of breathing, either at rest or unexpectedly low level of exertion.
  • Major symptom of various cardiac disorders (Table 13.1)
  • Mechanisms complex, including acute pulmonary edema with orthopnea, caused by elevated left atrial pressure.
  • Reduced oxygenation in pulmonary arterioles causes hypoxaemia

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