Question Answer 3 diseases encompassed in pericardial disease acute pericarditis, constrictive pericarditis, cardiac tamponade The most common form of acute pericarditis is idiopathic (accounts for 90% of cases) The pericardial sac normally contains up to ___ (how much fluid) 50 mL of fluid; it can hold 80 to 200 mL of fluid acutely Acute pericarditis is what? What happens if it doesnt resolve itself? Inflammatory reaction associated with an intrapericardial fibrinous exudative effusion. The heart may become encased by dense fibrous connective tissue (Chronic constrictive pericarditis) or Large volumes of fluid accumulate leading to cardiac tamponade What is the result of pericardial disease impaired diastolic filling = decreased cardiac output Acute pericarditis pain is different than an MI in what ways? Hurts to breath (pulmonary component), leaning forward reduces pain, postural changes affect pain S/S of pericarditis fever, pericardial friction rub, NON-ELEVATED cardiac enzymes, diffuse ST-segment elevation in 2 or 3 leads What test can be done to diagnose acute pericarditis echocardiography T/F – Acute pericarditis in the absence of an effusion has little effect on cardiac function. true Acute Pericarditis: anesthetic considerations focuses on the underlying pathology Constrictive Pericarditis (CP): etiology Varied: idiopathic, post viral, tuberculous, post-surgical, or radiation-induced Constrictive Pericarditis (CP): The core hemodynamic abnormality is _____ irregular diastolic filling. Constrictive Pericarditis (CP): What would you see in BP? increased diastolic pressures (narrowing of the pulse pressure) Constrictive Pericarditis (CP): Clinical presentation HF symptoms + right-sided congestion (jugular venous distention, edema, and ascites) Constrictive Pericarditis (CP): A history of ______should heighten clinical suspicion in the presence of edema, abdominal distention and exertional dyspnea. cardiac surgery, radiation, or tuberculosis Constrictive Pericarditis (CP): present in virtually all patients that are not hypovolemic Elevated jugular venous pressure (JVP) Constrictive Pericarditis (CP): Auscultation would sound like what high pitched pericardial knock along the left sternal border. Constrictive Pericarditis (CP): What is this disease mistaken for? What would be a significant finding that would distinguish between these diseases Liver disease, high JVP pressures Constrictive Pericarditis (CP): This test can confirm the diagnosis of CP echocardiography Constrictive Pericarditis (CP): Diagnostic findings CXR: show calcified/fibrous pericardium; EKG will show inverted T-wave, low voltage QRS complexes, atrial dysrythmias; Echo will identify the pericardial thickening Constrictive Pericarditis (CP): Anesthetic management preservation of CO – by HR Constrictive Pericarditis (CP): T/F – its better to have the patient bradycardic false – poorly tolerated Constrictive Pericarditis (CP): primary focus maintain cardiac output – avoid bradycardia, agressive positive pressure, excessive myocardial depression, hypotension, etc. – anything that would decrease venous return. Use agents to preserve HR, contractility, and afterload. Constrictive Pericarditis (CP): which induction agent is good ketamine Pericardectomy: the big postoperative considerations ***inotropic support, potential for hemorrhage and dysrythmias, ***myocardial atrophy and possible damage Cardiac tamponade is classified by ______ its cause Cardiac tamponade: how does it happen impaired diastolic filling of the heart, caused by increased intrapericardial pressure that leads to compression of the atria and ventricles Cardiac tamponade: how would it NOT lead to HF Reduced filling -> catecholamine release -> tachycardia, vasoconstriction, increased venous pressure -> maintains CO Cardiac tamponade: how would it lead to HF if catecholamine compensation fails Cardiac tamponade: described as Becks triad: muffled heart sounds, JVD due to increased venous pressure, hypotension Cardiac tamponade: common findings Becks triad + pulsus paradoxus, tachypnea, tachycardia Cardiac tamponade: Diagnostic findings CXR: enlarged cardiac silhouette with widening of mediastinum, EKG: Sinus tach, low voltage QRS, nonspecific ST-T wave abnormalities, Echocardiography Cardiac tamponade: most sensitive diagnostic tool echocardiography Cardiac tamponade: Preoperative considerations IV fluid volume expansion, correct acidosis, Aline/CVA Cardiac tamponade: induction agent of choice Ketamine – for both maintenance and induction Cardiac tamponade: Goal preserve myocardial contractility, HR, preload, afterload, keep NSR Cardiac tamponade: Caution with this positive pressure ventillation – decreases CO Cardiac tamponade: treatment pericardiocentesis or pericardial window Acute pericarditis: treatment pericardiocentesis or pericardial window Cardiac tamponade: potential complications of treatment (pericardiocentesis) coronary laceration, cardiac puncture, pneumothorax, refilling of pericardial fluid
Pathophysiology Test 2: Pericardial Disease

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