Surgical Management of AHD

Cards (29)

  • Pericardium Layers:
    • Visceral pericardium (serous): Supposedly non-sensitive.
    • Parietal Pericardium (fibrous): Responsible for pain in pericarditis
  • Pericardial Fluid:
    • Situated between visceral and parietal layers.
    • Normal Volume: 1550 mL.
    • Ultrafiltrate of plasma.
  • Functions of Pericardium:
    • Prevents sudden dilatation of cardiac chambers.
    • Restricts heart's anatomic position.
    • Minimizes friction with surrounding structures.
    • Prevents heart displacement and vessel kinking.
    • Retards infection spread, but exceptions exist.
  • Survival Without Pericardium:
    • Yes, it can be harvested for patches in cardiac traumas.
  • Acute Pericarditis Causes:
    • Bacterial/Viral Infection.
    • Tuberculosis.
  • Acute Pericarditis Symptoms:
    • Chest Pain: Retrosternal, left precordial, referred to back.
    • Pain quality: Pleuritic, sharp, aggravated by coughing, relieved by sitting up.
  • Acute Pericarditis Physical Examination:
    • Pericardial Friction Rub: Audible in 85%, high-pitched scratching.
  • ECG Findings in Pericarditis:
    • ST segment elevation in limb leads and V2 to V6.
    • Reciprocal depression in aVR.
    • Evolution: ST returns to normal, then T wave inversion
  • ACUTE PERICARDITIS
    ST elevation often with upward concavity
    No significant changes in QRS complexes
    ST segments return to normal and only then or even later do the T waves become inverted
  • MI
    ST elevations are convex with reciprocal depression more prominent
    QRS changes particularly Q with noticing
    T wave inversions are usually seen within hours before the ST segments have become isoelectric
  • Different Stages of ECG in Pericarditis:
    • Stage 1: ST elevation in standard leads & V2 to V6.
    • Stage 2: ST segments return to normal.
    • Stage 3: T wave inversion.
    • Stage 4: ECG may normalize weeks or months later.
  • Pericarditis Progression:
    • Without intervention, may progress to pericardial effusion.
  • Pericardial Effusion:
    • Fluid within pericardial sac.
    • Risk of misdiagnosis with cardiomyopathy.
    • Often secondary to TB or malignancy (breast/liver).
  • Pericardial Effusion Physical Exam Findings:
    • Faint heart sounds, disappearing friction rub.
    • Vanishing apex impulse, Ewart’s sign.
  • Pericardial Effusion Diagnostic Imaging:
    • Chest x-ray: "Water bottle" configuration.
    • Echocardiography: Echo-free space, electrical alternans.
  • Pericardiocentesis:
    • Fluid removal via subxiphoid approach.
    • Differentiates exudates and transudates.
    • Identifies causes of bloody pericardial fluid.
  • Cardiac Tamponade:
    • Accumulation obstructs ventricular blood flow.
    • Common causes: neoplastic diseases, trauma.
    • Factors contributing to cardiac tamponade.
  • Clinical Signs of Tamponade:
    • Hypotension, distended neck veins, paradoxical pulse.
    • Diminished pulsation, reduced QRS complex.
  • Beck’s Triad:
    • Hypotension, neck vein engorgement, muffled heart sounds.
  • Diagnosis and Treatment of Tamponade:
    • Diagnosis via echocardiography and Doppler ultrasound.
    • Emergency pericardiocentesis and surgical drainage.
    • Pleuropericardial window contraindications.
  • Pleuropericardial Window:
    • Surgical drainage technique.
    • Contraindications in acute trauma or bacterial pericarditis.
  • Distinguishing Bloody Fluid:
    • Coagulated blood indicates cardiac chamber.
    • Non-coagulated suggests pericardial source.
  • Cardiac Tamponade Causes:
    • Neoplastic diseases, idiopathic pericarditis, uremia.
    • Cardiac operations, trauma tuberculosis.
  • Pericardial Effusion in Malignancy:
    • Commonly from breast or liver metastatic tumors.
  • Echocardiography Details of Pericardial Effusion:
    • Echo-free space, electrical alternans.
    • Estimation of pericardial fluid amount.
  • Chest X-ray Configuration of Pericardial Effusion:
    • "Water bottle" appearance.
    • Pathognomonic results.
  • Indications for Pleuropericardial Window:
    • Hemodynamically stable undiagnosed effusion.
    • Coexistence with pericardial, pleural, or pulmonary pathology.
  • Contrast: Pericardial vs. Cardiac Chamber Blood:
    • Coagulation of cardiac chamber blood.
    • Non-coagulation of pericardial blood.
  • Cardiac Tamponade Mimickers:
    • Constrictive pericarditis, hypovolemic shock.
    • Acute/Chronic Obstructive Airway Disease, pulmonary embolus.