Pericardial Diseases and Cardiac Trauma

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  1. Common responses to pericardial Injury
    • Acute Pericarditis
    • Pericardial Effusion
    • Constrictive Pericarditis
  2. Acute Pericarditis
    • Cause: Viral infection
    • Acute benign pericarditis: transient and uncomplicated clinical course. 
    • Can occur after an MI (Dressler's syndrome is a delayed acute pericarditis)
  3. Acute Pericarditis Diagnosis
    • Chest pain worsening with inspiration and is relieved by leaning forward
    • Friction Rub: occurs throughout the cardiac cycle
    • Stage 1: Diffuse ST elevation and PR depression
    • Stage 2: Normalization of the ST and PR segments 
    • Stage 3: Widespread T wave inversion
    • Stage 4: Normalization of the T waves
  4. Acute Pericarditis Treatment
    • Salicylates or NSAIDs
    • Steroids for further tx
  5. Pericardial Effusion and Cardiac Tamponade
    • Pericardial fluid accumulates in the pericardial cavity
    • Tamponade: occurs when pressure of the fluid in the pericardial space impairs cardiac filling. 
    • Fluid: transudative or exudative  (seroanguineous)
    • S/S: depends on size and duration. Normal pericardial space holds 15ml of plasma ultra filtrate.
  6. Cardiac Tamponade
    • Spectrum of hemodynamic abnormalities of varying severity
    • S/S: Increased CVP, pulses paradoxus, equalization of cardiac filling pressures, hypotension, decreased voltage on the ECG, activation of the SNS
    • Large effusions: compression of esophagus, trachea, and lungs w/ anorexia, dyspnea, couch, and chest pain. 
    • Kussmaul's sign: distention of the jugular veins during inspiration
    • Pulsus paradoxus: slight and irregular pulse disappearing during inspiration and returning during expiration (decrease of systolic >10mm Hg during inspiration). 
    • Ventricular discordance: dyysynchrony or opposing response of the R/LV to filling during the respiratory cycle. 
    • Beck's triad (33% of pts): quiet heart sounds, increased jugular venous pressure, and hypotension. 
    • Tx: fluid removal, temporizing measures (expand intravascular volume, catecholamines, and correcting metabolic acidosis).
  7. Cardiac Tamponade Anesthesia
    • GA and PPV can result in life-threatening hypotension (vasodilation, myocardial depression, or decreased venous return). 
    • Pericardiocentesis under local anesthesia is preferred
    • Induction: Ketamine or Benzo w/ N2O, relaxation (pancuronium)
    • Anticipate the change from hypotension to hypertension following release of severe tamponade.
  8. Constrictive Pericarditis
    • Chronic: fibrous scarring and adhesions that create a rigid shell around the heart
    • Acute: fibroelastic constriction. 
    • S/S: Increased CVP and low CO due to lack of diastolic filling of the heart. Signs often mimic RV failure w/o pulmonary congestion. AFib is a common manifestation. Kussmaul's sign is common however pulses paradoxus is not. 
    • ECG: nonspecific, minor changes.
  9. Constrictive Pericarditis Anesthesia
    • Minimze changes in HR, SVR, venous return, and contractility
    • Maintenance: Combo of opioids bentos, and N2O with or w/o volatiles.
  10. Pericardial and Cardiac Trauma
    Blood from aortic or cardiac injury can fill the pericardial space and cause cardiac tamponade
Card Set:
Pericardial Diseases and Cardiac Trauma
2015-09-15 01:31:02
Pericardial Diseases Cardiac Trauma
Pericardial Diseases and Cardiac Trauma
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