Term
| what is a common finding in the pericardium? |
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Definition
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Term
| what is a pleural effusion? |
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Definition
| normally, 30-50 mL of straw-colored fluid (typically a transudate, which has a low protein level/specific gravity, as opposed to an exudate) is present in the pericardium, but under certain conditions, the parietal pericardium can distend from fluid -> pericardial effusion |
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Term
| can pleural effusion constrict the heart? |
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Definition
| yes, which can lead to impaired outflow/CO -> CHF |
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Term
| what is hemopericardium? what causes it? |
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Definition
| blood accumulating in the heart, which can be caused by aortic dissection proceeding proximally, a penetrating-type of trauma, or the rupture of a ventricle secondary to an MI (5-7 days post MI) |
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Term
| what is purulent pericarditis? what causes it? |
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Definition
| pus forming in the pericardium, which would be more of an exudate (high protein, fibrinous changes) than transudate |
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Term
| how does the effect of pericarditis on the heart differ depending on the rate of onset? |
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Definition
| the more rapid the accumulation, the more symptomatic and life-threatening it becomes (such as w/cardiac rupture). generally, a more gradual accumulation of symptoms secondary to CHF occur and more time for compensation and medical treatment is allowed |
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Term
| what is cardiac tamponade? what is it often secondary to? |
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Definition
| the compression of the atria and ventricles - restricts cardiac filling. cardiac tamponade is often secondary to significant blood loss |
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Term
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Definition
| pericardial inflammation due to cardiac disorders, thoracic or systemic disorders, metastases, radiation, epicardial tumors, systemic disorders (lupus)or cardiac sx |
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Term
| is primary pericarditis common? |
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Definition
| no, primary pericarditis is unusual and almost always of viral origin |
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Term
| is most pericarditis acute or chronic? |
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Definition
| most pericarditis is acute, but chronic forms can be seen in TB and fungal infections |
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Term
| what are some common kinds of acute pericarditis? |
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Definition
| serous - *most common kind seen on autopsy (straw colored/clear fluid), fibrinous/serofibrinous (thicker, cloudier exudate than serous), purulent (pus attaching itself to the heart), hemorrhagic, and casesous (seen in TB) |
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Term
| is serous pericarditis caused by infections? |
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Definition
| no, usually by noninfectious inflammation due to: rheumatic fever, lupus, scleroedema, tumors, and uremia |
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Term
| can viral infections elsewhere predate pericarditis? |
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Definition
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Term
| can viral myocarditis cause serous pericarditis? |
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Definition
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Term
| even though serous pericarditis is an inflammatory rxn, are many neutrophils, lymphocytes or macrophages seen? |
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Definition
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Term
| how quickly does serous pericarditis accumulate? how much volume does it usually accumulate |
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Definition
| slow accumulation, volume of fluid is not large (50-200 mL) |
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Term
| what is the dilation and increase in permeability of vessels due to inflammation cause over time? |
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Definition
| a fluid of high specific gravity and rich protein content - even though the fluid starts out as transudate |
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Term
| does serous pericarditis organize? |
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Definition
| no, serous pericarditis usually will not become fibrotic or form scar tissue - it will generally resolve on its own (unless you have a large amount) |
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Term
| what is the *most frequent type of pericarditis? |
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Definition
| fibrinous/serofibrinous pericarditis which is serous fluid w/mixed exudate |
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Term
| what is fibrinous/serofibrinous pericarditis usually seen as a complication with? |
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Definition
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Term
| what is dressler syndrome? |
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Definition
| fibrinous/serofibrinous pericarditis that can develop 2 wks - several months post-MI, w/autoimmune etiology |
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Term
| what are some other things beyond MIs that can cause fibrinous/serofibrinous pericarditis? |
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Definition
| uremia, radiation of the chest, rheumatic fever, SLE, and trauma |
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Term
| what characterizes the more fibrinous type of fibrinous/serofibrinous pericarditis? |
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Definition
| the surface is more dry with fine granular roughening |
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Term
| what characterizes the more serofibrinous type of fibrinous/serofibrinous pericarditis? |
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Definition
| the increased inflammatory component causes greater, thicker, and more cloudy fluid from an increase in WBC and often, fibrin |
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Term
| what happens to the fibrin present in serofibrinous pericarditis? |
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Definition
| the fibrin may be digested with resolution of the exudate or it may become organized (if there is more) |
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Term
| what causes purulent or suppurative pericarditis? |
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Definition
| invasion of the pericardial space by infective organisms |
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Term
| how do organisms reach the pericardial space in order to cause purulent or suppurative pericarditis? |
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Definition
| organisms reach the pericardial space by 1) direct extension from neighboring inflammation such as empyema (localized accumulation of pus) of the pleural cavity, lobar pneumonia, mediastinal factors, or extension of ring abscesses from IE 2) seeding from the blood 3) lymphatic extension 4) direct induction during sx |
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Term
| what characterizes the exudate associated with purulent or suppurative pericarditis? |
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Definition
| the exudate ranges from a thin to creamy pus of up to 400-500 mL -> which may cause a constrictive pericarditis (impair contractility/outflow of the heart) |
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Term
| how common is resolution of purulent pericarditis? |
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Definition
| infrequent - but this depends on how long the infection is allowed to continue |
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Term
| what kind of inflammatory reaction is purulent pericarditis? |
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Definition
| it is an acute inflammatory reaction, and organization is the usual outcome. the more proteins, pus, and acute inflammatory response, the more likely to have organization over time |
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Term
| what is hemorrhagic pericarditis? what is it usually caused by? |
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Definition
| pericarditis due to exudate consisting of blood w/a fibrinous or suppurative effusion. it is usually caused by malignant tumor involvement of the pericardial sac, but may be seen with bacterial infections, bleeding disorders and TB |
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Term
| can hemorrhagic pericarditis follow cardiac sx? |
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Definition
| yes, and may cause serious blood loss with tamponade |
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Term
| what is most caseous pericarditis due to? |
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Definition
| TB (caused by direct spread from TB foci within the tracheobronchial nodes), though sometimes fungal |
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Term
| what is causeous pericarditis the most frequent cause of? |
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Definition
| disabling, fibrocalcific, and chronic constrictive pericarditis |
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Term
| what composes the spectrum of chronic pericarditis? |
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Definition
| there may be a whitish plaque-like thickening of serosal membranes (solider's plaque), or delicate adhesions found at autopsy w/no significant impairment of cardiac function (usually associated w/infection). in severe cases, organization can cause complete obliteration of the pericardial sac - causing a stringy type of adhesion between the visceral and parietal pericardium called *adhesive pericarditis |
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Term
| what is adhesive mediastinopericarditis? |
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Definition
| the pericardium adhering to other components of the mediastinum over time, usually following suppurative or caseous pericarditis (not serous). the pericardial sac may be obliterated - leading to great strain on cardiac function |
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Term
| how can adhesive mediastinopericarditis mimic CMP? |
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Definition
| the increased workload due to constriction may lead to RVH or dilation. (so before calling it hypertrophic CMP, make sure the pericardium is w/o disease) |
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Term
| what is constrictive pericarditis? |
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Definition
| when the heart is encased in a dense, fibrous, or fibrocalcified scar and the pericardial space is obliterated - limits diastolic expansion and CO. cadiac hypertrophy and dilation cannot occur b/c of the dense fibrotic scar |
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