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Pericarditis/Tamponade: Difference between revisions
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Pericarditis is an inflammation of the pericardium (heart sac) usually caused by a virus. Echocardiographic is often seen in the pericardium (pericardial effusion). A fatal complication of pericarditis is that an inflammation in the heart causes the pericardial fluid or blood to fill up when relaxed, this is called tamponade. | Pericarditis is an inflammation of the pericardium (heart sac) usually caused by a virus. Echocardiographic is often seen in the pericardium (pericardial effusion). A fatal complication of pericarditis is that an inflammation in the heart causes the pericardial fluid or blood to fill up when relaxed, this is called tamponade. | ||
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Doppler measurements | ==Doppler measurements== | ||
Evidence of an inflow impediment to the LV and RV expressing itself in elevated filling pressures. The mitral and tricuspid inflow pattern will play an E / A ratio >1 exhibit generally. Also, the deceleration time will be of the mitral E- top shortened (<180 msec.) In the pulmonary vein flow, the S- wave will be smaller than the D- wave. | |||
Evidence of an inflow impediment to the LV and RV expressing itself in elevated filling pressures. The mitral and tricuspid inflow pattern will play an E/A ratio >1 exhibit generally. Also, the deceleration time will be of the mitral E- top shortened (<180 msec.) In the pulmonary vein flow, the S- wave will be smaller than the D- wave. | |||
In a constrictive the right and left ventricular filling influence each other. The following indications point to this: | In a constrictive the right and left ventricular filling influence each other. The following indications point to this: | ||
Respiratory variation in MV inflow (at start of inspiration decline MV inflow E -top >25%) and TV inflow (at start of inspiration increase of E -top >40%). | |||
Respiratory variation in pulmonary vein flow wherein at the beginning of expiration the diastolic forward flow >10% increase. | *Respiratory variation in MV inflow (at start of inspiration decline MV inflow E -top >25%) and TV inflow (at start of inspiration increase of E -top >40%). | ||
*Respiratory variation in pulmonary vein flow wherein at the beginning of expiration the diastolic forward flow >10% increase. | |||
Also, atrial fibrillation, this respiratory variation can be observed. In severe obstructive pulmonary same pattern can be seen. Reinforced by the change in intrathoracic pressure However, this will also increase sharply to the right ventricle during inspiration caval flow. In a constrictive flow will hardly increase. | Also, atrial fibrillation, this respiratory variation can be observed. In severe obstructive pulmonary same pattern can be seen. Reinforced by the change in intrathoracic pressure However, this will also increase sharply to the right ventricle during inspiration caval flow. In a constrictive flow will hardly increase. | ||
After a pericardectomie | After a pericardectomie often still an abnormal filling pattern is observed. On the one hand it is thought that this is due to incomplete pericardectomie. On the other hand this is possible because the myocardium is sometimes involved in the disease process. The measured with TDI early diastolic velocity of the mitral valve annulus septal (E ') often takes postoperatively decreases, which would fit in a relaxation disorder of the myocardium. When may explain in autopsies the increased myocardial fibrosis that is found. The disease process which gave constriction, can also cause myocardial fibrosis. (radiotherapy, auto- immune processes). The emergence of a more restrictive image after pericardectomie is associated with a worse prognosis. | ||
==Constrictive pericarditis== | |||
Constrictive pericarditis is a form of pericarditis in which the pericardverdikt and if it were a hard shell forms around the heart. This is also called " armored heart " called. Thus, the heart can not fill normally (diastolic dysfunction). Inhalation reduces the pressure in the chest. Due to the lower pressure more blood can flow to the right ventricle. This bends the ventricular septum to the LV far. The LV can therefore be less filled. | Constrictive pericarditis is a form of pericarditis in which the pericardverdikt and if it were a hard shell forms around the heart. This is also called " armored heart " called. Thus, the heart can not fill normally (diastolic dysfunction). Inhalation reduces the pressure in the chest. Due to the lower pressure more blood can flow to the right ventricle. This bends the ventricular septum to the LV far. The LV can therefore be less filled. | ||
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|colspan="2"|'''Evidence of constrictive pericarditis''' | |||
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|'''M -mode''' | |||
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*Rapid early diastolic and flat mid-diastolic LV motion back and aortic root | |||
*Early diastolic notch in motion pattern interventricular septum | |||
*At the end of diastolic notch, followed by forward movement of septum | |||
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| | |'''2 - D images''' | ||
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*Pericardium thickened (often difficult to take MRI where much more reliable) | |||
*Movement septum to LV during inspiration and expiration to RV at (AP4CH) | |||
*Early opening of pulmonary valve | |||
2 - D images | *Dilated inferior vena cava with little respiratory variation | ||
Pericardium thickened (often difficult to take MRI where much more reliable) | |||
Movement septum to LV during inspiration and expiration to RV at (AP4CH) | |||
Early opening of pulmonary valve | |||
Dilated inferior vena cava with little respiratory variation | |||
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