Patients with Pericardial Effusion and Tamponade

Patients with Pericardial Effusion and Tamponade
Order 5989321
Patients with Pericardial Effusion and Tamponade
1 A 61-year old woman with recent tricuspid valve
repair presents with increasing dyspnea, orthopnea,
and presyncope. The patient was hypotensive, with
distended jugular veins, and distant heart sounds
on physical examination. On the basis of the
hemodynamic tracing from the right ventricle (RV)
shown in the following figure, which of the following
statements is incorrect?
(A) Pulsus paradoxus is likely to be present
(B) Presence of right ventricular collapse lasting
more than one third of diastole is a more
sensitive echo finding in this condition than
right atrial collapse
(C) Blunt or absent Y descent on the right atrial
pressure tracing is typically described in this
condition
(D) Ventricular interdependence may be accentuated
2 Cardiac tamponade in the absence of pulsus paradoxus is described with all of the following, except:
(A) Aortic incompetence
(B) Severe rheumatoid spondylitis
(C) Constrictive pericarditis
(D) Large atrial septal defect
3 Regarding the intervention depicted in the figures,
which of the following statements is incorrect?
(A) Left pleural effusion occurs in 1% to 2% of
cases
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Patients with Pericardial Effusion and Tamponade
Percutaneous Balloon Pericardiotomy for Patients with Pericardial Effusion and Tamponade 263
(B) A pericardiocutaneous fistula is a potential
complication
(C) It is recommended that the balloon be inflated
until the waist disappears
(D) Biplane fluoroscopy is recommended
4 All of the following are relative contraindications to
percutaneous balloon pericardiotomy, except:
(A) Marginal respiratory reserve
(B) Presence of a large pleural effusion
(C) Thrombocytopenia
(D) Malignant pericardial effusion
5 Which of the following catheterization finding most
reliably supports a diagnosis of pericardial constriction over restrictive cardiomyopathy?
(A) Pulmonary artery systolic pressure <50 mm Hg
(B) A prominent Y descent
(C) Equalization of right and left heart late diastolic
pressures
(D) Ventricular interdependence
6 Regarding pericardiocentesis, which of the following
statements is most accurate?
(A) It is advisable to drain <500 mL at a time to
avoid acute right ventricular dilatation
(B) Recurrence ratewith drainage of large idiopathic
pericardial effusions is no better than with
conservative management
(C) Major complications occur during 1.3% to 1.6%
of pericardiocenteses
(D) Effusions measured by echo tend to be larger
than those measured by computed tomography
(CT) or magnetic resonance imaging (MRI)
7 In the setting of aortic dissection, which of the
following statements is incorrect?
(A) Pericardial effusion coincides with 17% to 45%
of cases
Patients with Pericardial Effusion and Tamponade
(B) Pericardial tamponade occurs most frequently
with a De-Bakey type I dissection
(C) Pericardiocentesis may cause extension of the
dissection
(D) Surgery should be performed as soon as possible
8 In patients with large malignancy-related pericardial
effusion treated with percutaneous balloon pericardiotomy, which of the following is incorrect?
(A) Fever occurs in approximately one third of
patients post procedure
(B) Recurrence rate at 4 months is approximately
50%
(C) Results with immediate and deferred procedures
are similar
(D) Lung and breast cancer associated effusions are
most common
9 A 64-year-old man with a history of alcohol dependency presented to the emergency room with
increasing dyspnea, chronic cough, hemoptysis, and
persistent fever. Echocardiography confirms the
presence of a large pericardial effusion. Simultaneous right atrial pressure and pericardial opening
pressure are shown in the following figure. Regarding this hemodynamic tracing, which of the following
statements is incorrect?
(A) The X descent during ventricular systole is the
dominant waveform
(B) The right atrial and pericardial pressures fall
during inspiration
(C) With increased pericardial fluid accumulation,
the X descent will become less prominent and
the Y decent more pronounced
(D) RV mid-diastolic pressure may be elevated and
equal to the right atrial and pericardial pressure
10 The patient discussed in Question 9 had a cardiac
CT (short axis shown in the following figure) on
admission. He had a reasonable symptomatic response to pericardiocentesis and his pericardial pressure returned to zero post-tap; however, his right
atrial pressure remained elevated. On the basis of
his findings on cardiac CT scan and his hemodynamic parameters, a presumptive diagnosis of
effusive-constrictive pericarditis was made. Which
of the following findings does not support this diagnosis?
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