Cardiac Conditions: Aortic & Pericardial Diseases

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Questions and Answers

What is a primary factor that excludes a diagnosis of acute pericarditis?

Presence of friction rub

Enlarged heart seen on chest X-ray

Development of Q waves (correct)

Elevated troponin levels

Which physical examination finding is primarily associated with pericarditis?

Friction rub (correct)

Muffled heart sounds

Gallop rhythm

Loud S1 sound

Which condition is NOT a high-risk indicator for pericarditis?

Hemodialysis (correct)

Oral anticoagulant therapy

Large pericardial effusion

Trauma

Which of the following ECG characteristics differentiates acute pericarditis from acute ischemia?

Diffuse ST segment elevation Signup and view all the answers

What is a common treatment option for managing myopericarditis?

Oral NSAIDs Signup and view all the answers

How is T-wave inversion in pericarditis typically characterized?

Occurs after ST segments return to baseline Signup and view all the answers

Which symptom is least likely to be associated with myopericarditis?

Constant palpitations Signup and view all the answers

What distinguishes the cardiac tamponade from other pericarditis presentations?

Decreased cardiac output due to fluid accumulation Signup and view all the answers

What is the primary treatment option for patients diagnosed with constrictive pericarditis?

Pericardiectomy Signup and view all the answers

What is one of the common causes of constrictive pericarditis?

Post-radiation therapy Signup and view all the answers

Which clinical finding is more indicative of myopericarditis compared to acute pericarditis?

Elevated troponin levels Signup and view all the answers

What electrocardiogram (ECG) change is typically seen in acute pericarditis?

PR depression and concave ST elevation Signup and view all the answers

Which symptom is more common in acute pericarditis than in a myocardial infarction?

Sharp, pleuritic chest pain Signup and view all the answers

Which condition is characterized by the presence of pericardial fluid causing pressure on the heart?

Cardiac tamponade Signup and view all the answers

What distinguishing feature separates the chest pain of pericarditis from myocardial infarction?

Pain worsened by deep inspiration Signup and view all the answers

What should be done for high-risk patients presenting with acute pericarditis?

Hospitalization for monitoring and observing complications Signup and view all the answers

Which of the following treatments is recommended for recurrent pericarditis when initial therapies have failed?

Corticosteroids for incomplete response Signup and view all the answers

What is a common cause of constrictive pericarditis?

Tuberculosis Signup and view all the answers

How is myopericarditis differentiated from pericarditis?

By clinical suspicion of myocardial involvement Signup and view all the answers

What physiological change occurs in the pericardium during constrictive pericarditis?

Decreased compliance causing rapid early diastolic filling Signup and view all the answers

Which of the following is not a typical treatment for acute pericarditis?

Colchicine as first line therapy Signup and view all the answers

At what weight is the dosage of colchicine adjusted in the treatment for recurrent pericarditis?

Above 70 kg Signup and view all the answers

Which imaging method can provide confirmatory findings for recurrent pericarditis in atypical cases?

Magnetic Resonance Imaging (MRI) Signup and view all the answers

What percentage of patients with idiopathic acute pericarditis who are untreated develop recurrent pericarditis?

15-30% Signup and view all the answers

Study Notes

Aortic and Mitral Regurgitation

The structure that prevents excess dilation of the heart in cases of aortic and mitral regurgitation is not mentioned in the text provided.

Diseases of the Pericardium

Pericarditis is the inflammation of the pericardium.
Pericardial effusion is the accumulation of fluid in the pericardial sac.
Cardiac tamponade occurs when the pericardial effusion puts pressure on the heart, restricting its ability to pump blood effectively.
Constrictive pericarditis is a condition where the pericardium becomes thickened and fibrotic, restricting the heart's ability to fill with blood.
Masses within the pericardium can cause various symptoms and complications.
Congenital absence of the pericardium is a rare condition where individuals are born without part or all of the pericardium.

Pericarditis

Most common cause of pericarditis is infectious (usually viral).
Other causes include idiopathic, inflammatory (usually autoimmune), metabolic (uremia), recent MI (Dressler's syndrome), and metastatic cancer.

Clinical Presentation of Acute Pericarditis

Pleuritic and positional, retrosternal chest pain, often worsened by lying supine and relieved by sitting and leaning forward.
Pericardial friction rub is a characteristic sound heard with a stethoscope, typically over the left sternal border.
ECG changes include diffuse ST elevation or PR depression.
Pericardial effusion may develop.

Chest Pain in Pericarditis vs. Infarction

Pericarditis pain is more likely to be sharp and pleuritic, worsened by coughing, inspiration and swallowing.
Pericarditis pain is worse by lying supine and relieved by sitting and leaning forward.

ECG Changes in Pericarditis

Typical ECG changes include PR depression and concave ST-elevation.

ECG Differences in Pericarditis vs. Ischemia

In pericarditis, ST segment deflections have convex shaped rising legs of the T waves, compared to concave in ischemia.
ECG changes in acute ischemia are region-specific, while in acute pericarditis, changes are diffuse.
There are no reciprocal changes in pericarditis, unlike ischemia.
Pericarditis does not lead to infarct patterns such as Q waves or loss of R waves.
T-wave inversion might occur in acute ischemia with elevated ST segments, but it is uncommon in acute pericarditis.

Pericardial Friction Rub

High frequency sound best heard with a stethoscope diaphragm, lying supine and at the end of expiration.
Characterized by three sounds: one systolic and two diastolic.

Pericardial Effusion

High-risk patients with an initial episode of acute pericarditis should be hospitalized to determine the cause and monitor for cardiac tamponade.
Close follow-up is critical for patients not hospitalized.

High-Risk Criteria for Pericarditis

Major criteria include:
- Fever greater than 38°C
- Subacute onset
- Large pericardial effusion
- Cardiac tamponade
- Lack of response to NSAIDs/ASA after 1 week
Minor criteria include:
- Myopericarditis
- Immunosuppression
- Trauma
- Oral anticoagulant therapy

Management of Pericarditis

Initial investigations for all suspected patients include physical exam, ECG, chest x-ray , echocardiogram, CRP and troponin.
Special investigations are recommended for patients with high-risk criteria, including exploring the epidemiological background.
Patients with high-risk criteria warrant hospital admission and inpatient treatment.

Treatment of Pericarditis

Treat underlying cause.
Use anti-inflammatory drugs:
- NSAIDs/ASA: CRP-guided (1-2 weeks), protect gastrointestinal system.
- Colchicine: prevents recurrence, dosage of 2x1 for >70kg for 3 months.
- Prednisone: for recurrent or autoimmune causes, not recommended as first-line therapy.
Restrict exercise.

Recurrent Pericarditis

15-30% of patients with idiopathic acute pericarditis not treated with colchicine experience recurrent pericarditis.
50% of patients with recurrent disease will have at least one further recurrence.
Inadequate treatment of the initial episode is a common cause of recurrence.

Therapy for Recurrent Pericarditis

Corticosteroids for patients with insufficient response to initial double therapy.
Myopericarditis: Pericarditis with suspected myocardial involvement.
Perimyocarditis: Predominant myocarditis with pericardial involvement.

Constricted Pericarditis

Scarring of the visceral and parietal layers restricting cardiac chambers.
Causes include tuberculosis, idiopathic or viral pericarditis, mediastinal irradiation, open-heart surgery, chronic renal failure, and connective tissue disorders.

Physiology of Constriction

The pericardium acts as a calcified shell.
Decreased compliance leads to:
- Rapid early diastolic filling
- Impaired late diastolic filling

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Description

This quiz covers critical topics related to aortic and mitral regurgitation, as well as diseases of the pericardium. It includes essential definitions such as pericarditis, pericardial effusion, and cardiac tamponade, providing a comprehensive understanding of these cardiac conditions.