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Pericardial disease flashcards

8 high-yield MRCP Part 1 cards from the Intellect Medicos Cardiology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. Kussmaul's sign (the JVP rising, or failing to fall, on inspiration) is classic for which pericardial condition?

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   Constrictive pericarditis.

   Why? The rigid pericardial shell stops the right heart accepting the extra venous return of inspiration, so the JVP rises instead of falling.

2. Apart from widespread saddle-shaped ST elevation, which ECG finding supports acute pericarditis?

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   PR-segment depression.

   Why? Inflammation of the atrial surface alters atrial repolarisation, seen as PR depression (with PR elevation in aVR).

3. What is Beck's triad?

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   Hypotension, raised JVP and muffled heart sounds — cardiac tamponade.

   Why? Fluid under pressure stops the ventricles filling: output falls (hypotension), venous return backs up (raised JVP), and the fluid dampens the heart sounds.

4. In a first episode of acute pericarditis, colchicine is added to an NSAID or aspirin for ______.

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   3 months

   Why? Colchicine reduces recurrence. A recurrent episode is treated for 6 months.

5. In constrictive pericarditis, the classic chest X-ray finding is ______ and the definitive treatment is pericardiectomy.

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   pericardial calcification

   Why? The rigid shell limits diastolic filling, so patients present with right heart failure (raised JVP, ascites, oedema). Echo is the first-line investigation.

6. In constrictive pericarditis, the classic chest X-ray finding is pericardial calcification and the definitive treatment is ______.

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   pericardiectomy

   Why? The rigid shell limits diastolic filling, so patients present with right heart failure (raised JVP, ascites, oedema). Echo is the first-line investigation.

7. Which JVP descent is absent in cardiac tamponade but prominent in constrictive pericarditis?

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   The y descent.

   Why? In tamponade, fluid compresses the heart throughout diastole, so early ventricular filling is blocked. In constriction, early filling is rapid until the rigid pericardium suddenly stops it.

8. Which antibiotic interaction makes colchicine toxicity (potentially fatal) more likely?

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   Clarithromycin (or erythromycin), which inhibits CYP3A4 and P-glycoprotein and raises colchicine levels.

   Why? Colchicine is used for 3 months in first-episode pericarditis. The notes also list severe renal or hepatic failure as contraindications.