Diseases of pericardium Flashcards
What do pericardial diseases cause?
- Increased pericardial fluid
- Inflammatory disease, effusive disease, or BOTH
The pericardium contains how much plasma ultrafiltrate?
15-50mL
What is the most common disorder of the pericardium?
Acute pericarditis
Acute pericarditis is found in how many hospitalized pts?
.1-.2%
Acute pericarditis is found in how many pts in the ED w/ non-ischemic chest pain?
5%
What causes acute pericarditis?
Idiopathic
- Undx viral infections: Coxsackie virus B, Influenza
How does acute pericarditis present?
As an isolated processes or 1st sign of underlying systemic disease
What is the presenting sx in acute pericarditis?
Chest pain (in > 95%)
- Sudden onset
- Sharp, pleuritic
- Radiation to trapezius ridge
What improves & exacerbates chest pain?
- Improves w/ leaning forward
- Exacerbated by coughing, inspiration, lying flat
What is seen on PE for acute pericarditis?
Pericardial friction rub
- Scratchy, squeaky quality
- Loudest over LSB
What causes pericardial friction rub?
Friction btwn the 2 layers of pericardium
What does acute pericarditis look like on ECG?
- Changes correlate w/ epicardial inflammation
- *Diffuse ST elevation (concave up)
- PR segment depression
Stages of acute pericarditis
- Stage 1: diffuse ST elevation w/ PR depression
- Stage 2: normalization of ST & PR segments
- Stage 3: diffuse, T wave inversion
- Stage 4: normalization
Pericardiocentesis & pericardial biopsy
- Low yield
- Can be dx & therapeutic
When might you perform a pericardiocentesis?
- Refractory to med therapy
- Hemodynamic compromise
- High complication rates
When might you perform a pericardial biopsy?
- Illness lasting > 3 wks w/out a definitive dx
- Recurrent pericarditis
Describe the procedure of pericardiocentesis
- Supine w/ head of bed at 30-60 degree
- Under u/s guidance
- Insert needle at 5-6th ICS at LSB
What are markers of acute pericarditis?
- Cardiac: Elevated troponin
- Inflammatory: CRP, ESR, WBC
Dx criteria for acute pericarditis
Need 2 of the following:
- Typical CP
- Pericardial friction rub
- Characteristic ECG changes
- New/worsening pericardial effusion
What are the 3 overall goals of tx for acute pericarditis?
- Relief of pain
- Resolve inflammation
- Prevent reoccurrence
How long is tx for acute pericarditis?
2 wks or less, unless sx persist
When is pericardial effusion present?
When amt of fluid inside pericardium exceeds normal amt
What causes pericardial effusion?
Secondary to injury or insult to pericardium
- Idiopathic
- Infectious
- Malignancy
- Autoimmune
- Drugs
Pericardial effusion sx
- Asx (often discovered incidentally)
- CP, pressure, discomfort