Cardiac Inflammatory Conditions

Question 1

When does Rheumatic Fever occur?

Answer 1

Follows an immunological reaction to recent (2-6 weeks ago) Streptococcus pyogenes infection

Question 2

What is diagnosis of Rheumatic Fever based on?

Answer 2

Diagnosis is based on

• Evidence of recent streptococcal infection
• Accompanied by 2 major criteria or 1 major with 2 minor criteria

Question 3

What shows evidence of recent streptococcus infection?

Answer 3

• Raised or rising streptococci antibodies
• Positive throat swab
• Positive rapid group A streptococcal antigen test

Question 4

What is the major criteria in Rheumatic Fever?

Answer 4

• Erythema marginatum
• Sydenham’s chorea
• Polyarthritis
• Carditis and valvulitis (eg, pancarditis)*
• Subcutaneous nodules

Question 5

What is the Minor Criteria in Rheumatic Fever?

Answer 5

• Raised ESR or CRP
• Pyrexia
• Arthralgia (not if arthritis a major criteria)
• Prolonged PR interval

Question 6

What are the features of Acute Pericarditis?

Answer 6

• Chest pain: may be pleuritic. Is often relieved by sitting forwards
• Non-productive cough
• Dyspnoea
• Flu-like symptoms

Question 7

What is seen on examination of Acute pericarditis?

Answer 7

• Pericardial rub
• Tachypnoea
• Tachycardia

Question 8

What are the causes of Acute Pericarditis?

Answer 8

• Viral infections (Coxsackie)
• Tuberculosis
• Uraemia (causes ‘fibrinous’ pericarditis)
• Trauma
• Post-myocardial infarction
• Dressler’s syndrome
• Connective tissue disease
• Hypothyroidism
• Malignancy

Question 9

What are ECG changes in Acute Pericarditis?

Answer 9

• Widespread ‘saddle-shaped’ ST elevation
• PR depression: most specific ECG marker for pericarditis

Question 10

What are the causes of Constrictive Pericarditis?

Answer 10

Any cause of pericarditis particularly TB

Question 11

What are symptoms of Constrictive Pericarditis?

Answer 11

• Dyspnoea
• Right heart failure:
  
  • Elevated JVP
  • Ascites
  • Oedema
  • Hepatomegaly

Question 12

What are examination findings in Constrictive Pericarditis?

Answer 12

• JVP shows prominent ‘X’ and ‘Y’ descent
• Pericardial knock
• Loud S3
• Kussmaul’s sign is positive

Question 13

What does constrictive pericarditis show on CXR?

Answer 13

Pericardial Calcification

Question 14

What are differences between Constrictive pericarditis and Cardiac tamponade?

Answer 14

Cardiac Tamponade

• Absent ‘Y descent’ on JVP
• Pulsus Paradoxus Present
• Kussmaul sign rare

Constrictive pericarditis

• X + Y present on JVP
• Pulsus Paradoxus Absent
• Kussmaul sign present
• Pericardial calcification on CXR

Question 15

What is Kussmaul’s sign?

Answer 15

A paradoxical rise in JVP during inspiration

Question 16

What are features of Cardiac Tamponade?

Answer 16

• Dyspnoea
• Raised JVP, with an absent Y descent - this is due to the limited right ventricular filling
• Tachycardia
• Hypotension
• Muffled heart sounds
• Pulsus paradoxus
• ECG: electrical alternans

Question 17

What is the treatment for cardiac tamponade?

Answer 17

Pericardiocentesis