Condition- Pericarditis Flashcards

1
Q

Describe the anatomy of the different layers of the heart

A
  • Endocardium: like the endothelium of blood vessels. It lines the valves and chambers and is trabeculated
  • Myocardium: made of involuntary striated smooth muscle and enable heart contractions
  • Pericardium:
    • Outer Fibrous Layer
    • Inner Serous layer: further subdivided into two layers
      • Parietal layer
      • Visceral layer = epicardium
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2
Q

List some of the causes of pericarditis

A
  • Idiopathic
  • Infective:
    • Coxsackie B
    • Echo 8
    • Mumps
    • EBV
    • Strep
    • rubella
    • HIV
  • Autoimmune:
    • SLE
    • Rheumatoid arthritis
    • Vascilitides
    • IBD
  • Secondary Immune Processes: post-MI (DRESSLER’S SYNDROME), rheumatic fever
  • Metabolic diseases: uraemia, myxoedema
  • Surgery, radiotherapy
  • Trauma
  • Malignancy
  • Drugs
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3
Q

List some of the presenting symptoms of a patient with pericarditis…

A

Chest pain:

  • S: Central pain
  • O:
  • C: sharp, stabbing, pleuritic pain
  • R: to trapezius ridges (phrenic nerve innervates this area)
  • A: High spiking fever= infectious cause, cough, SOB, nausea
  • T: continuous, constant not responsive to nitrates etc
  • E: worse on lying down, improves on sitting/standing
  • S:
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4
Q

What is the criteria for diagnosing pericarditis?

A

Need at least 2 of the 4 following criteria:

  • Chest pain
  • Pericardial rub
  • ECG- widespread ST elevation
  • Percardial effusion
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5
Q

List the signs of pericarditis on physical examination

A
  • Pericardial Rub: heard at left lower sternal border with patient leaning forward on end-expiration and sounds high-pitched/ sqeuaky
  • Pyrexia
  • Tachycardia - bacterial
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6
Q

What would be seen on an ECG of a patient with pericarditis?

A

upwards concave ST-segment elevation globally with PR depressions

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7
Q

Other than ECGs which investigations can you perform on a patient with pericarditis?

A
  • Echocardiogram: asses pericardial effusion and function
  • Pericardial fluid/ blood culture: to see bacterial infection
  • Bloods:
    • FBC
    • U&Es- serum urea to check if uraemic cause
    • ESR/CRP
    • Cardiac Enzymes- troponin (see myocardial involvement)
  • CXR- usually normal may be globular if large pericardial effusion
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8
Q

In an acute situation if a patient has a cardiac tamponade as a result of the pericarditis which medical procedure would have to be carried out?

A

Periardiocentesis (aspiration of pericardial fluid)

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9
Q

How would you acutely treat pericarditis if it was prurulent?

A
  • Antibiotics + pericardiocentesis
  • NSAIDs
  • PPI (to prevent gastric irritation from NSAIDs)
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10
Q

How would you treat non-prurulent pericarditis?

A
  • NSAID + PPI or Corticosteroids
  • Colchicine
  • Anti-viral therapy
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11
Q

List the complications of pericarditis (4)

A
  • Pericardial effusion
  • Cardiac tamponade
  • Constrictive pericarditis
  • Cardiac arrhythmias
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12
Q
A
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