02.14a Surgical Diseases of the Pericardium Flashcards
Normal pericardial fluid
< 15 mL
Acute inflammation of the parietal and visceral pericardium
Mostly idiopathic
Acute pericarditis
Most common bacterial cause of pericarditis in the Philippines
TB
Most common cause of idiopathic pericarditis
Viral infection
Pericardial effusion two weeks after surgery
Postpericardiotomy syndrome
Substernal chest pain during inspiration, worsened by supine position and relieved by leaning forward
Orthopnea, dyspnea
Pericardial friction rub
Beck’s triad (hypotension, distended neck veins, muffled heart sounds)
Four stages of ECG
Acute pericarditis
ST segment elevation with concave upward ST segments
Noted in all leads except aVR
With reciprocal depressions in a aVR and sometimes in V1
First stage
ST segments return to baseline with T-wave flattening
Second stage
T-wave inversion without Q wave formation
Third stage
Characterized by ECG normalization
Fourth stage
Imaging to detect effusion
CXR
Imaging to detect and determine the degree of effusion, thickness of pericardium
2D echo
What do we look for on imaging?
Right ventricular collapse
Left ventricular collapse
Dilated inferior vena cava
Work up to establish the etiology of pericarditis
Fluid examination
Pericardial biopsy
Treatment for bacterial or purulent pericarditis
Antibiotics
Treatment for postpericadiotomy syndrome, viral, post-MI, idiopathic pericarditis
Short course NSAIDS (5-7 days)
Indication of surgery in patients with acute pericarditis
Tamponade (emergency), suppurative pericarditis
Need to perform biopsy
Not responding to treatment
Two methods to drain
Pericardiocentesis
Tube pericardiostomy
Smaller bore tube is preferred instead of a needle Local anesthesia is given Percutaneous insertion Permits repeated drainage Cannot obtain pericardium for biopsy Prone to myocardial injury
Pericardiocentesis
Bigger bore tube, less prone to clog
Subxiphoid incision down to pericadium
Less prone to myocardial injury
More painful
Tube pericardiostomy
Sequelae of untreated acute pericarditis or TB pericarditis
Thickened fibrotic pericardium impedes normal diastolic filling
Male>female
Constrictive pericarditis
Most common cause(s) of constrictive pericarditis
Idiopathic
Post-cardiothoracic surgery
Constriction prevents dilatation, hence there will be a decrease in strove volume and consequent decrease in CO
The clinical manifestation is easy fatigability
Chronic constrictive pericarditis
Most common presenting symptoms and occurs in virtually all patients
Dyspnea
