B4.062 - Big Case Pericarditis

Question 1

Normal pericardial functions

Answer 1

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

Question 2

differential Dx for chest pain

Answer 2

GERD
Angina
MI
Pericarditis
aortic dissection

Question 3

what is acute pericarditis

Answer 3

acute inflammation of the pericardium

Question 4

describe acute pericarditis pain

Answer 4

mid sternal chest pain 
sharp/knife like pain
worse with deep inspiration/coughing
better when sitting
worse with laying supine
unrelenting

Question 5

symptoms of pericarditis

Answer 5

pain
prodromal phase
fever
malaise
several days to weeks
dyspnea
fatigue

Question 6

acute pericarditis physical exam findings

Answer 6

tachycardia
increased temperature
pericardial rub (velcro sound)

Question 7

work up for acute pericarditis

Answer 7

blood work (troponin, CBC, sedimentation rate, viral serology)
CXR
Echo
CT/MRI

Question 8

stage 1 pericarditis on ECG

Answer 8

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

Question 9

stage 2 pericarditis on ECG

Answer 9

ST sements return to the baseline, T waves becomre flat and PR segment may become depressed

Question 10

stage 3 pericarditis on ECG

Answer 10

T wave inversion may be seen. May persist for weeks

Question 11

stage 4 paricarditis on ECG

Answer 11

normalization

Question 12

what do you look for on an echo if pericarditis is suspected

Answer 12

pericardial effusion

Question 13

diagnostic criteria of pericarditis

Answer 13

2 of 4:
Characteristic chest pain
pericardial friction rub
classic ECG changes
som pericardial effusion

Question 14

supportive criterion for pericarditis

Answer 14

evidence of systemic inflammation

pericardial inflammation on MRI/CT

Question 15

most common etiology of acute pericarditis

Answer 15

idiopathic
viral
infection
malignancy
connective tissue disease
MI
radiation
uremia
aortic dissection
drugs

Question 16

drugs that can cause pericardtitis

Answer 16

hydralazine
methyldopa
procainamide

Question 17

major predictors of severity of pericarditis

Answer 17

fever >100.4
subacute onset
cardiac tamponade
large pericardial effusion
NSAIDs don't work after 7 days

Question 18

minor predictors of pericarditis severity

Answer 18

immunosuppressed state
history of oral anticoagulant therapy
acute trauma
elevated cardiac troponin level

Question 19

treatment of uncomplicated acute periarditis

Answer 19

NSAIDs high dose 4-6 weeks, gradual taper, give gastro prophylaxis
corticosteroids
colchicine

Question 20

how does colchicine work

Answer 20

may be given with NSAIDs
used to treat gout
concentrates in neutrophils, prevents neutrophil migration and decreases inflammation

Question 21

what is acute pericarditis

Answer 21

a few weeks (4-6)

Question 22

what is incessant/intractable pericarditis

Answer 22

> 6 weeks
may accumulate more fluid/tamponade
fluid may become exudative/organized

Question 23

chronic pericarditis

Answer 23

3-6 months

Question 24

recurrent pericarditis

Answer 24

resolves but comes back after 4-6 weeks

Question 25

recurrent pericarditis management

Answer 25

NSAIDs as prior
exercise restriction
colchicine

Question 26

management for pericarditis for really intractable cases

Answer 26

IV immunoglobulins
azothiaprine
anakinra (IL B receptor antabonist)

Question 27

last resort for recurrent pericarditis

Answer 27

surgical pericardectomy

Question 28

complications of acute pericarditis

Answer 28

cardiac tamponade

constrictive pericarditis