Constrictive Pericarditis
Caused by Viral infections or Radiation or Heart Surgery
Thickening of Pericardium, Pericardial calcification on MRI
Symptoms: SOB, Fatigue
JVP elevated, Ascites, Pedal Edema
Early Diastolic Pericardial Knock
Prominent X and Y descents
Respirophasic Septal Shifting=Bulging of septum to the left on inspiration
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Restrictive Cardiomyopathy
Caused by Amyloidosis or Sarcoidosis or Endomyocardial Fibrosis
Ventricle wall thickening and atrial enlargement=Cardiomegaly
Symptoms: SOB, Fatigue
JVP elevated, Ascites, Pedal Edema
3rd heart sound due to heart failure, 4th heart sound due to reduced compliance, Murmurs, heart blocks
Blunting of X descent
Signs of Amyloidosis like Ecchymoses, Petechiae, Purpura etc can be seen if it caused this condition.
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Cardiac Tamponade
Caused by Aortic dissection, pulmonary hypertension caused by systemic sclerosis etc.
A fast accumulation of fluid in the pericardium leads to a steep rise in pericardial pressure causing cardiogenic shock, whereas a slow accumulation of fluid takes longer to reach critical or symptomatic pericardial pressure.
Symptoms: SOB, Hypotension, Tachycardia, chest pain, tachypnea.
Muffled heart sounds and elevated jugular venous distention. Lower-extremity edema bilaterally.
Lung sounds are clear.
Pulsus paradoxus [ an exaggerated blood pressure variation with the respiratory cycle.]
Electrocardiography reveals low voltages throughout all leads.
CXR->normal cardiac silhouette until the effusions are at least moderate in size (~200 mL).
Bedside therapeutic pericardiocentesis can precipitate hemodynamic collapse in patients with systemic sclerosis who have uncontrolled PAH.
Pericardiocentesis should be avoided in the setting of aortic dissection leading to cardiac tamponade.
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Hypertrophic Obstructive Cardiomyopathy or HOCM
Asymmetric Hypertrophy of Left Ventricle
Diastolic Dysfunction due to reduced compliance
Symptoms: SOB, Fatigue, Sudden death after exercise, Chest pain
Brisk upstroke-Bifid or Trifid pulse [Pulsus Bisferiens]
Murmur increases with less flow/volume with valsalva or standing
Needs Betablocker to slow the heart so that LV fills better reducing the murmur
Defibrillator if patient develops NSVT
Septal Myotomy is treatment.
