7 Pericarditis Flashcards
most common symptom of acute pericarditis
sharp or stabbing precordial or retrosternal pain
referral of pain in pericarditis
left trapezial ridge, due to inflammation of the joining diaphragmatic pleura
(a particular distinguishing feature)
characteristic of chest pain in acute pericarditis
aggravated by inspiration or movement
most severe when patient is supine, and is relieved when the patient sits up and leans forward
most common and imporant physical finding in pericarditis
pericardial friction rub
-best heard with diaphragm of stethoscope at LLSB or apex when the patient is sitting and leaning forward
causes of acute pericarditis
-idiopathic
-infectious
-malignancy
-drug-induced (procainamide, hydralazine)
-rheumatic (SLE, RA)
-radiation-induced
-Dressler’s syndrome (2-10 weeks post-MI)
-uremia
-myxedema
classic ECG findings in acute pericarditis
diffuse ST-segment elevation (most pronounced in the lateral precordial leads),
PR-sement depression, and
ST-segment depression in lead aVR
diffuse T wave inversion in stage 3
treatment of pericarditis
NSAIDs for 7 days to 3 weeks
Corticosteroids - alternative if with NSAID-intolerance or NSAID failure
Colchicine - adjunct if with persistent symptoms at 72 hours
0.5 mg PO BID
Hospitalization is not necessary in most cases
indicators of poor prognosis
temp >38
subacute onset over weeks
immunosuppression
history of oral anticoagulant use
failure to respond to NSAIDs after 1 week of therapy
assoc’d myocarditis (cardiac biomarkers, HF symmptoms)
large pericardial effusino (an echo-free space >20 mm),
or cardiac tamponade
characteristic intraventricular pressure trace of constrictive pericarditis
dip and plateau “square root sign” of the right ventricular pressure trace
treatment of choice in constrictive pericarditis with signifiant constriction and impaired ventricular fillling
percardiectomy
