layers of the heart… pericardial & myocardial disease
DESCRIPTION
Layers of the Heart… Pericardial & Myocardial Disease. Ashlea Wilmott PGY-1 FRCPC Emergency Medicine. Pericarditis Pericardial Effusion Tamponade. WBC Trop ESR/CRP CK, CK-MB . Lytes BUN Creat Urine and Serum tox. EKG Findings. EKG Findings. Benign Early Repolarization. - PowerPoint PPT PresentationTRANSCRIPT
Layers of the Heart…
Pericardial & Myocardial Disease
Ashlea WilmottPGY-1 FRCPC Emergency Medicine
Pericarditis Pericardial Effusion
Tamponade
WBC Trop ESR/CRPCK, CK-MB
LytesBUNCreatUrine and Serum tox
Stage
Time Frame EKG Findings
1 First hours-days
- Diffuse ST elevation (concave up)- Reciprocal ST depression in aVR and V1- Elevated PR segment in aVR and depression of PR elsewhere
(highly specific)
2 Variable - Normalization of ST and PR segments- T wave flattening
3 Variable - Diffuse T wave inversions - May not be seen in some patients
4 Weeks -months - Normalization- May have persistent T wave inversions
EKG FindingsPericarditis MI
ST segment elevation
- Begins at the J point- Rarely >5mm- Retains concavity
- Typical pattern is convex- Can exceed 5mm in height
Distribution - Generalized - Vessel distribution
Sequence - ST and T wave findings are NOT simultaneous
- Simultaneous
Normalization - Generally a longer process
Morphology - Each lead has its own characterization
- Vessel distribution of ST evolution
PR depression - Common - Rare
Pathologic Q wave
- Rare - Common
Arrhythmia - Rare - Common
EKG FindingsPericarditis Benign Early Repolarization
ST segment elevation
- Begins at the J point- Rarely >5mm- Retains concavity
- Begins at the J point- Maintains normal configuration
Distribution - Generalized - Most common V3-V6
PR depression - Common - Uncommon
Evolution of change
- Very Common - Uncommon
ST elevation to T wave amplitude ratio in V6
- >0.24 - <0.24
Benign Early Repolarization
+ LR 5.4
Causes of pericaditis
IdiopathicEverything Else
Causes of Pericarditis
P Post MI (Dressler’s Syndrome)
E Exocrine (Myexdema)
R Radiation induced
I Infectious
C Collagen Vascular Disease
A Amyloidosis, Anticoagulation, Aneurysm (dissection)
R Renal failure
D Drugs – The 5 P’s Penicillin, phenytoin, procainamide, pressure (hydralazine), pulmonary (INH)
I Idiopathic, Idiopathic Thrombocytopenic Purpura
T Trauma, Tumors (malignancy)
I Infective endocarditis with ring abscess
S Sarcoidosis
Infectious
PERICARDIAL
EFFUSION
TAMPONADE……
Signs and Symptoms of Cardiac Tamponade
Symptoms of Cardiac Tamponade
Symptom Sensitivity (%)
Dyspnea 87-89
Fever 25
Chest pain 20
Cough 7-10
Sign Frequency (%)
Elevated Neck Veins 100
Tachycardia 81-100
Systolic BP > 100 58-100
Pulsus Parodoxus >10mmHg 98
Pulsus Parodoxus > 20mm Hg 78
Pulsus Parodoxus >30mm Hg 49
Diminshed heart sounds 36-84
Hepatomegaly 58
Signs of Cardiac Tamponade
Signs of Cardiac Tamponade
Sign Sensitivity (%)
Pulsus paradoxus >10 mm HG 82 + LR 3.3
Tachycardia 77
Elevated JVP 76
Diminished heart sounds 28
Hypotension 26
Hypertension 33
Peripheral edema 21-28
Kussmaul 26
Sensitivity 89%- JAMA
EKG Findings of Cardiac Tamponade
Finding Sensitivity (%)
Low voltage EKG 42
Atrial arrhythmia 6
Electrical alternans 16-21
ST elevation 18-30
PR depression 18
Pericardiocentesis
Constrictive Pericarditis
Myocardial Disease
The Cardiomyopathies
Coxsackie BAdenovirus
Cardiac Enzymes