Acute and constrictive pericarditis Flashcards
Define and causes of acute pericarditis
Inflammation of pericardium with or without involvement of myocardium (perimyocarditis)
Causes:
Idiopathic
Viral (coxsackie B)
Bacterial (staph, strep, TB)
1-3 days after MI (clean up damaged tissues)
Postoperative (postpericardiotomy syndrome) due to blunt trauma
Uremia
Radiation
Symptoms of acute pericarditis
Pleuritic chest pain (sharp, retrosternal, worse with coughing swallowing deep inspiration, better with sitting and leaning forward)
Pericardial friction rub on auscultation due to friction of pleural and visceral tissues during expiration
Low grade fever
Diagnosis and treatment of AP
ECG: diffuse ST elevation
Echo will be normal unless effusion is there
X-ray normal
Troponin is MILDLY elevated not like ACS
Treatment: NSAIDs (aspirin, ibuprofen, indomethacin) and treat underlying cause (TB)
If AP is post MI, ONLY USE ASPIRIN
Define chronic constrictive pericarditis? And effusive constrictive pericarditis?
Cause of constrictive?
It’s pericardial inflammation lasting longer than 3 months, resulting in thick, fibrous, and calcified pericardium. It causes forward and backward HF. Any cause of acute can cause constrictive but commonly bacterial (TB)
It can be complicated by effusion, leading to tamponade as well
Clinical features of constrictive pericarditis?
Backward failure:
Raised JVP, peripheral edema, hepatomegaly with tender liver.
Forward failure:
Tachycardia, dyspnea, pericardial knock (extra sound heard on left sternal border due to cessation of ventricular filling in early diastole), pulses paradoxes (reduced blood pressure by 10 mmHg during deep inspiration)
Diagnosis and treatment of constrictive pericarditis?
Echo: thick pericardium with sudden cessation of ventricular filling during early diastole
X-ray: calcifications
Treatment is diuretics and surgical removal of pericardium
