Pericardial disease: Clinical (To be retired)
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Pericardial disease: Clinical (To be retired)
Subspeciality surgery
Cardiothoracic surgery
Coronary artery disease: Clinical (To be retired)
Valvular heart disease: Clinical (To be retired)
Pericardial disease: Clinical (To be retired)
Aortic aneurysms and dissections: Clinical (To be retired)
Chest trauma: Clinical (To be retired)
Pleural effusion: Clinical (To be retired)
Pneumothorax: Clinical (To be retired)
Lung cancer: Clinical (To be retired)
Anatomy clinical correlates: Thoracic wall
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Pleura and lungs
Anatomy clinical correlates: Mediastinum
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
cGMP mediated smooth muscle vasodilators
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Antiplatelet medications
Plastic surgery
Benign hyperpigmented skin lesions: Clinical (To be retired)
Skin cancer: Clinical (To be retired)
Blistering skin disorders: Clinical (To be retired)
Bites and stings: Clinical (To be retired)
Burns: Clinical (To be retired)
ENT (Otolaryngology)
Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves
Anatomy clinical correlates: Trigeminal nerve (CN V)
Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves
Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves
Anatomy clinical correlates: Skull, face and scalp
Anatomy clinical correlates: Ear
Anatomy clinical correlates: Temporal regions, oral cavity and nose
Anatomy clinical correlates: Bones, fascia and muscles of the neck
Anatomy clinical correlates: Vessels, nerves and lymphatics of the neck
Anatomy clinical correlates: Viscera of the neck
Antihistamines for allergies
Neurosurgery
Stroke: Clinical (To be retired)
Seizures: Clinical (To be retired)
Headaches: Clinical (To be retired)
Traumatic brain injury: Clinical (To be retired)
Neck trauma: Clinical (To be retired)
Brain tumors: Clinical (To be retired)
Lower back pain: Clinical (To be retired)
Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves
Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves
Anatomy clinical correlates: Trigeminal nerve (CN V)
Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves
Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves
Anatomy clinical correlates: Vertebral canal
Anatomy clinical correlates: Spinal cord pathways
Anatomy clinical correlates: Cerebral hemispheres
Anatomy clinical correlates: Anterior blood supply to the brain
Anatomy clinical correlates: Cerebellum and brainstem
Anatomy clinical correlates: Posterior blood supply to the brain
Anticonvulsants and anxiolytics: Barbiturates
Anticonvulsants and anxiolytics: Benzodiazepines
Nonbenzodiazepine anticonvulsants
Migraine medications
Osmotic diuretics
Antiplatelet medications
Thrombolytics
Ophthalmology
Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review
Eye conditions: Retinal disorders: Pathology review
Eye conditions: Inflammation, infections and trauma: Pathology review
Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves
Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves
Anatomy clinical correlates: Eye
Orthopedic surgery
Joint pain: Clinical (To be retired)
Lower back pain: Clinical (To be retired)
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Wrist and hand
Anatomy clinical correlates: Median, ulnar and radial nerves
Anatomy clinical correlates: Bones, joints and muscles of the back
Anatomy clinical correlates: Hip, gluteal region and thigh
Anatomy clinical correlates: Knee
Anatomy clinical correlates: Leg and ankle
Anatomy clinical correlates: Foot
Trauma surgery
Traumatic brain injury: Clinical (To be retired)
Neck trauma: Clinical (To be retired)
Chest trauma: Clinical (To be retired)
Abdominal trauma: Clinical (To be retired)
Urology
Penile conditions: Pathology review
Prostate disorders and cancer: Pathology review
Testicular tumors: Pathology review
Kidney stones: Clinical (To be retired)
Renal cysts and cancer: Clinical (To be retired)
Urinary incontinence: Pathology review
Testicular and scrotal conditions: Pathology review
Anatomy clinical correlates: Male pelvis and perineum
Anatomy clinical correlates: Female pelvis and perineum
Anatomy clinical correlates: Other abdominal organs
Anatomy clinical correlates: Inguinal region
Androgens and antiandrogens
PDE5 inhibitors
Adrenergic antagonists: Alpha blockers
Vascular surgery
Peripheral vascular disease: Clinical (To be retired)
Leg ulcers: Clinical (To be retired)
Aortic aneurysms and dissections: Clinical (To be retired)
Anatomy clinical correlates: Anterior and posterior abdominal wall
Adrenergic antagonists: Beta blockers
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Antiplatelet medications
Thrombolytics
Assessments
Pericardial disease: Clinical (To be retired)
USMLE® Step 2 questions
0 / 12 complete
Questions
USMLE® Step 2 style questions USMLE
of complete
Reproduced from: Wikimedia Commons
Which of the following interventions is the most appropriate for this patient’s condition?
Memory Anchors and Partner Content
Transcript
Content Reviewers
Rishi Desai, MD, MPHThe pericardium is a sac that covers the heart and the roots of the great vessels.
The pericardium has two layers, an inner serous layer and an outer fibrous layer, and the space between the two layers is the pericardial cavity.
The pericardial cavity is normally filled with about 50 mL of serous fluid that cushions the heart from any kind of external jerk or shock - like a shock absorber.
The pericardium also fixes the heart to the mediastinum, to prevent it from twisting, so that the big vessels don’t get pinched shut.
Pericardial disease is inflammation of the pericardium due to a variety of causes - from infections, to autoimmune disorders, cancer, and trauma.
In pericarditis, the pericardium is inflamed and irritated.
If the inflammation leads to the accumulation of excess fluid in the pericardial sac then it’s called a pericardial effusion, and in its worst form, that extra fluid can cause tamponade physiology.
Finally, there’s constrictive pericarditis, which is where the inflammation is chronic and leads to fibrosis.
In pericarditis, the two inflamed layers of the pericardium rub against one another every time the heart beats. This causes severe, sharp retrosternal chest pain, that radiates to the neck, shoulders, and back, and it typically happens with each breath during inspiration.
That’s because in inspiration the lungs expand, filling the thoracic cavity and compressing the pericardium.
The pain typically worsens when a person is supine and improves when a person is sitting upright and leaning forward.
Upon auscultation, there’s a pericardial friction rub, which is a scratchy, grating, high-pitched rub resembling the sound of leather-on-leather rubbing against each other.
On ECG, there’s widespread ST segment elevation in several leads, which distinguishes it from the ST elevation in myocardial infarction which is only present in the leads that correspond to the infarcted tissue.
Summary
Pericardial disease refers to any medical condition that affects the pericardium, the thin sac that surrounds the heart. Common pericardial diseases include pericarditis, which refers to when it's inflamed; pericardial effusion referring to a buildup of fluid in the pericardial sac; and cardiac tamponade, which is a life-threatening condition that results from excessive fluid buildup in the pericardium that prevents the heart from working properly.
Depending on the specific condition, symptoms of the pericardial disease may include chest pain, shortness of breath, rapid or irregular heartbeat, hypotension, and muffled heart sounds. Treatment may involve medications to reduce inflammation or remove excess fluid, pericardiocentesis, or surgery.
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