B4.062 - Big Case Pericarditis Flashcards
Normal pericardial functions
attaches the heart to the thorax
shock absorber
Lubricant to decrease friction with heart beats
Prevents excessive dilation
helps with diastolic relaxation of cardiac muscle
differential Dx for chest pain
GERD Angina MI Pericarditis aortic dissection
what is acute pericarditis
acute inflammation of the pericardium
describe acute pericarditis pain
mid sternal chest pain sharp/knife like pain worse with deep inspiration/coughing better when sitting worse with laying supine unrelenting
symptoms of pericarditis
pain prodromal phase fever malaise several days to weeks dyspnea fatigue
acute pericarditis physical exam findings
tachycardia
increased temperature
pericardial rub (velcro sound)
work up for acute pericarditis
blood work (troponin, CBC, sedimentation rate, viral serology)
CXR
Echo
CT/MRI
stage 1 pericarditis on ECG
Begins with onset of chest pain, lasts several days. Concave upward ST elevations seen in precordial leads. T waves remain upright in those leads with ST elevation
stage 2 pericarditis on ECG
ST sements return to the baseline, T waves becomre flat and PR segment may become depressed
stage 3 pericarditis on ECG
T wave inversion may be seen. May persist for weeks
stage 4 paricarditis on ECG
normalization
what do you look for on an echo if pericarditis is suspected
pericardial effusion
diagnostic criteria of pericarditis
2 of 4: Characteristic chest pain pericardial friction rub classic ECG changes som pericardial effusion
supportive criterion for pericarditis
evidence of systemic inflammation
pericardial inflammation on MRI/CT
most common etiology of acute pericarditis
idiopathic viral infection malignancy connective tissue disease MI radiation uremia aortic dissection drugs
drugs that can cause pericardtitis
hydralazine
methyldopa
procainamide
major predictors of severity of pericarditis
fever >100.4 subacute onset cardiac tamponade large pericardial effusion NSAIDs don't work after 7 days
minor predictors of pericarditis severity
immunosuppressed state
history of oral anticoagulant therapy
acute trauma
elevated cardiac troponin level
treatment of uncomplicated acute periarditis
NSAIDs high dose 4-6 weeks, gradual taper, give gastro prophylaxis
corticosteroids
colchicine
how does colchicine work
may be given with NSAIDs
used to treat gout
concentrates in neutrophils, prevents neutrophil migration and decreases inflammation
what is acute pericarditis
a few weeks (4-6)
what is incessant/intractable pericarditis
> 6 weeks
may accumulate more fluid/tamponade
fluid may become exudative/organized
chronic pericarditis
3-6 months
recurrent pericarditis
resolves but comes back after 4-6 weeks
