Clinical types of pericarditis

Question 1

Acute pericarditis

Answer 1

most common disease of the pericardium

presumed to be viral, but not proven

self-limited (1-3 wks)

Question 2

Most common viruses implicated in Acute pericarditis

Answer 2

Coxsackie virus (especially group B)

echovirus

*these viruses not routinely cultured, so specific diagnosis takes lots of work

Question 3

Acute pericarditis pathology

Answer 3

usually:

• -serous,
• -fibrinous, OR
• -serofibrinous

Rarely:

• -purulent
• -hemorrhagic

Question 4

Most common symptom of acute pericarditis

Answer 4

sudden onset of sharp, pleuritic chest pain

improved by sitting up and leaning forward

Question 5

Most common sign of acute pericarditis

Answer 5

pericardial friction rub

Question 6

Pericardial friction rub

Answer 6

a superficial scratchy or squeaking sound heard best along the left sternal border

often triphasic:

1. atrial systole component
2. ventricular systole component
3. early diastole (rapid filling) component

NOT limited to inspiration (like pleural rub)

Question 7

If elevated troponin also…

Answer 7

myopericarditis

Question 8

Electrocardiogram for acute pericarditis

Answer 8

SENSITIVE:
widespread ST elevation (concave upwards)
–reciprocal ST segment depression in leads aVR and V1

SPECIFIC:

• -PR segment elevation in lead aVR
• -PR segment depression in aVL, aVF, V5 and V6

Question 9

Diagnostic criteria for acute pericarditis

Answer 9

any two of the following:

• -typical chest pain
• -pericardial friction rub
• -“suggestive” changes on EKG
• -pericardial effusion

Question 10

Treatment of acute pericarditis

Answer 10

supportive

hospitalization for pts w/ myopericarditis

Question 11

Prognosis for pts w/ acute viral or idiopathic pericarditis

Answer 11

good long term

Question 12

Acute pericarditis due to pyogenic bacteria

Answer 12

rare
purulent
generally fulminant
high mortality

Staph aureus
Strep pneumoniae

Question 13

Causes of acute pericarditis due to pyogenic bacteria

Answer 13

• -extension of empyema OR
• -rupture of myocardial abscess through visceral pericardium into pericardial space OR
• -seeding of pre-existing effusion OR
• -hematogenous infection

Question 14

empyema

Answer 14

purulent infection in pleural space

Question 15

Results of acute pericarditis due to pyogenic bacteria

Answer 15

fibrinous adhesions
organization
fibrous adhesions

–>constrictive pericarditis if pt lives long enough

Question 16

Autoimmune pericarditis

Answer 16

30% of pts w/ lupus and RA

usually:

• -serous
• -fibrinous
• -serofibrinous

Rarely:

• -purulent
• -hemorrhagic

Question 17

Uremia

Answer 17

fibrinous pericarditis

some substance normally excreted by kidney irritates pericardium

Question 18

metastatic carcinoma

Answer 18

serous, fibrinous, or serofibrinous pericarditis

tends to obstruct lymphatic drainage from the pericardium, resulting in a gradually progressive serous effusion, which may contain some of the malignant cells

Question 19

Hemorrhagic pericarditis

Answer 19

rare

associated w/:

1. metastatic carcinoma
2. leukemia (b/c thrombocytopenia)
3. tuberculosis

Question 20

Important for unexplained pericarditis

Answer 20

skin test for TB

chest x-ray