A potential space is a is a double lining Inner layer=visceral pericardium Outer layer=parietal pericardium Serous fluid in between acts as lubricant to prevent friction Pericarditis: Inflammation, Neoplastic Disease, or Congenital Disorders Constrictive or Acute Leads to: o Pain o Exudate Serous pericardial effusion
9 Cardiac tamponade: rapid accumulation of exudate compresses the heart Fibrous friction rub; adhesions o ECG changes Remember those things that cause cell injury and inflammation are the same culprits in pericarditis: o Infection (viral infections are most common cause of acute pericarditis) o Hypersensitivity o Autoimmune (rheumatoid arthritis and lupus) o Ischemia o Physical & Chemical agents (common after radiation to chest tumors) o Constrictive: scar tissue contracts and interferes with diastolic filling of heart—so at rest can’t relax ventricle to allow filling—from inflammation, radiation, or trauma—treat with surgery Disorders of Pericardium: Disorders of Pericardium Pericarditis: o Acute o Chronic o Constrictive Major threat is compression of heart chambers May have no s/s if small or growing Limits preload because of increased intracardiac pressures—so low CO Treat with anti-inflammatory or depends on cause Acute Pericarditis: Inflammation of the pericardium of less than 2 weeks duration May restrict the heart’s movement due to: o Serous exudate filling the pericardial cavity pericardial effusion o Fibrous scar tissue making the pericardium stick to the heart constrictive pericarditis Manifestations Triad: o Chest Pain o Pericardial Friction Rub o ECG changes Pericardial Effusion : Accumulation of fluid or blood in pericardial sac Impairs venous return & ventricular filling decreased CO Etiologies: trauma, cardiac surgery, neoplasms Can be complication of CABG Major threat is compression of heart chambers May have no s/s if small or slow growing—as long as pericardium can stretch and not constrict heart Limits preload because of increased intracardiac pressures
10 Dx. With ECHO Treat with aspiration or surgery (if you do your DB on this concept you must expand it beyond this…) Cardiac Tamponade : Increased intrapericardial pressure caused by pericardial effusion impairs venous return to the heart (decreases preload) Clinical manifestations result from impaired ventricular filling resulting in decreased SV and ultimately decreased CO Drop in BP with inspiration Severe pericardial effusion Dx with echocardiogram—quick, accurate, and noninvasive! Pulsus paradoxus o Clinical indicator of cardiac tamponade o >10mmHg decrease in systolic BP during inspiration o On inhaling, the right ventricle fills with extra blood o Because the heart cannot expand fully when the right ventricle is overfilled, the left ventricle is compressed and cannot accept much blood o
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- Spring '14