Diseases of the pericardium Quiz

A 65-year-old male presents to clinic for surgical evaluation for a pericardiectomy. He reports symptoms including dyspnea at rest and leg-swelling. His past medical history is significant for non-small cell lung cancer in the left lower lobe that was successfully treated with radiotherapy in his 50s and chronic kidney disease. Labs are significant for a serum creatinine of 1.3. You opt to perform a pericardiectomy via a median sternotomy rather than a left thoracotomy due to the previous thoracic radiation. All of the following increase the patient’s risk for mortality EXCEPT:

A 32-year-old male with a past medical history of non-Hodgkins lymphoma treated by thoracic radiation therapy 10 years prior presents with a one week history of dyspnea and lower-extremity edema. A transthoracic echocardiogram demonstrates a thickened pericardium along with a moderate pericardial effusion. Which of the following signs, if present, would clarify the diagnosis?

A 50-year-old obese male is 8 hours post CABG and mitral valve replacement. His chest tube output had been consistently 150 mL/hours since the patient left the operating room, but then suddenly decreased to 10 mL/hr since two hours ago. His initial cardiac index was 2.5 L/min/m2, now 1.2 L/min/m2. CVP was 12 mmHg, now 18 mmHg. HR currently is 130’s, BP 90/70. Lactic acid was 2, now 6. He has been requiring increasing doses of inotropes and pressors. A bedside echo was performed which was a poor study without significant effusion or “tamponade physiology”. What is the appropriate next step:

A 63-year-old woman with a past medical history of mediastinal lymphoma treated radiation has now developed constrictive pericarditis. After a thorough work-up, you proceed with a pericardiectomy. Following the sternotomy, you note several suspicious lesions on the pericardium. Which of the following represents the best next step?

Beck’s triad consists of hypotension, muffled heart sounds, and:

A 64-year-old male with a past medical history of COPD is seen for a three-week history of dyspnea, cough, and leg-swelling. On physical exam, you note jugular vein distension (JVD) and 3+ pitting edema of the lower extremities. Cardiac findings include a regular rate and rhythm, no murmurs, and a loud, high-pitched sound in early diastole. Which of the following represents the most likely diagnosis?

A 61-year-old woman with a past medical history of hypertension, myocardial infection, chronic kidney disease, sarcoidosis, and hypothyroidism is seen in the emergency department for a two-day history of chest pain and dyspnea on exertion. Initial cardiac work-up does not reveal a troponinemia or ischemic ECG findings. A CBC shows a Hgb of 12.2, WBC of 11,000, and a platelet count of 337,000 and her chemistry panel shows a potassium of 3.7, BUN of 88, and creatinine of 3.2. Echocardiogram demonstrates a large, circumferential pericardial effusion. Which of the following represents the most likely etiology of her pericardial effusion?

Which of the following can be used discern constrictive pericarditis from cardiac tamponade and restrictive cardiomyopathy?

A 59-year-old male with a history of restrictive cardiomyopathy secondary to endocardial fibrosis is referred to your clinic for further evaluation. The patient is currently undergoing maximal medical therapy including oral corticosteroids. Despite this, the patient endorses worsening dyspnea on exertion consistent with NYHA class III symptoms. Which of the following is the best next treatment option?

The least common location of primary cancers which metastasize to the pericardium is: