Cards: Pericardial Disease Flashcards
If someone is suspected of having pericarditis, why should an echo be performed?
Echocardiography should be performed in patients with suspected acute pericarditis to evaluate for the presence of a hemodynamically significant pericardial effusion; however, the absence of an effusion does not rule out the diagnosis.
What is the risk of recurrent pericarditis and how should it be managed?
After an episode of acute pericarditis, as many as 30% of patients develop recurrent pericarditis. There is a low (<1%) risk of developing constrictive pericarditis. Recurrent pericarditis can be treated with anti-inflammatory agents with a slower, longer taper (for example, 4 months), the addition of colchicine, or the use of glucocorticoids. Etiologies of acute pericarditis other than viral or idiopathic causes should be suspected.
When are glucocorticoids used for the management of acute pericarditis?
Glucocorticoids in the treatment of acute pericarditis are reserved for patients with contraindications to NSAIDs and those with refractory pericarditis.Glucocorticoids in the treatment of acute pericarditis are reserved for patients with contraindications to NSAIDs and those with refractory pericarditis.
What is first line therapy for acute pericarditis?
First-line therapy for acute pericarditis is high-dose NSAIDs; colchicine can be used in conjunction with standard NSAID therapy.
What is constrictive pericarditis and what causes it?
Constrictive pericarditis is a chronic disorder that results from pericardial inflammation, fibrosis, and possibly calcification, leading to a loss of elasticity. Although many cases are idiopathic, causes of constrictive pericarditis include chest radiation therapy, cardiac surgery, trauma, post–myocardial infarction syndromes, and systemic diseases that affect the pericardium, such as connective tissue disease, malignancy, tuberculosis, and other infections.
In constrictive pericarditis, who may be considered for medical therapy?
Some patients with constrictive pericarditis can have reversible or transient inflammation, such as post-pericardiotomy syndrome after cardiac surgery, that responds to anti-inflammatory agents. Thus, it may be reasonable to perform a trial of medical therapy (such as NSAIDs) before pericardiectomy surgery in some patients presenting with constrictive pericarditis, particularly those with mild symptoms, a potentially reversible cause of acute inflammation, and no evidence of chronic constriction. Diuretic therapy may reduce volume overload and improve symptoms transiently.
What is the surgical treatment for pericarditis?
Cardiac surgery with pericardiectomy is the definitive treatment for relief of heart failure in patients with constrictive pericarditis.
What is the best treatment for cardiac tamponade?
Pericardiocentesis with echocardiographic guidance is the most expeditious treatment for cardiac tamponade.
