Diseases of pericardium. Dry effusion and constrictive pericarditis

Question 1

pathogenesis : pericarditis, dry effusion

Answer 1

• pericarditis dev in the presence of rheumatism or tuberculosis
• rheumatic and tuberculous pericard are manifestations of infectious allergic process.
• some, tuberculous pericard depends on the spread of infection from lungs and tracheobronchial lymph nodes to the pericardium.
• pericarditis develop in other infections as well eg scarlet fever, measles, influenza, or sepsis
• sometimes it dev due to transition of inflammation from the adjacent organs in pleurisy, pneumonia, MI, and injuries to heart and uraemia.

Question 2

pathogenesis : Constrictive pericarditis

Answer 2

• without accumulation of effusion .
• promote lesion of the valvular apparatus
• thickening of pericardium and calcification produce a rigid membrane around the heart
• scar affect the orifice of the vena cave and the fibrous membrane of the liver
• ventricles are quickly filled with blood at the beginning of diastole .
• end of diastole the blood flow in to the right ventricles becomes abruptly upset.
• so blood pressure drops in jugular vein during ventricular filling and end diastolic pressure increase .
• bp increase in the vein of the greater circulation causing enlargement of the liver, ascites and edema

Question 3

clinical picture : Dry effusion

Answer 3

Dry effusion
- 1st stage -heart pain - substernal and sharp, increase body temperature, dyspnoea
pain at heart apex, bottom of sternum, radiate to neck, left shoulder, epigastrium intensive during respiration and in sitting position
- 2nd stage - friction rub heard at lower left sternum, leathery triphasic sound has 3 component
1st heard before 1st heart sound 2nd during systole
3rd at the beginning and middle of diastole

Question 4

clinical picture : dry pericarditis

Answer 4

Dry pericarditis:
- Chest pain that is
- Pericardial friction rub (cardinal sign),

Question 5

pericardial effusion

Answer 5

• Pressing sensation in chest and pain in heart
• Dyspnea and dysphagia
• Fever
• edematous, skin cyanotic and pallied
• Neck veins are swollen
• Orthopnea
• soft heart sounds
• Enlargement of cardiac dullness

Question 6

clinical symptoms : Constrictive pericarditis:

Answer 6

Constrictive pericarditis:
- ascites, edema, hepatomegaly, jugular venous distension, breathlessness, pulmonary distension, sinus tachycardia
- Signs of impaired ventricular filling (Kussmaul‘s sign)
- Friedreich‘s sign
- Pulsus paradoxus
- Fatigue and exercise intolerance
- Atrial fibrillation and loud 3rd sound

Question 7

investigation : Dry pericarditis:

Answer 7

Dry pericarditis:
- ECG -During 1st few weeks, ST elevation. AVR, V1 show ST depression. Later ST segment normalize and T wave inversion present. sinus tachycardia.
- Blood analysis: Leucocytosis - lymphocytosis, increase of cardiac enzymes
- Chest x-ray - large globular or pear shaped heart
- Doppler sound-increase flow in tricuspid and pulmonary valves and decrease in mitral flow during inspiration

Question 8

investigation : Pericardial effusion

Answer 8

Pericardial effusion:
- ECG shows low voltages
- Chest x ray - large globular or pear shaped heart
- EchoCG - demonstrating effusion and right ventricular collapse during late diastole
- Doppler - increased flow through tricuspid and pulmo valves
- MRI – detect hemopericardium

Question 9

investigation : Constrictive pericarditis:

Answer 9

Constrictive pericarditis:
- Chest x-ray: small heart with obvious calcification of pericardium on lateral film
- ECG: low QRS voltage and T wave inversion, high R in 2nd lead and P in v1 is similar to p-mitrale
- EchoCG: thickened pericardium with calcification over right heart, ventricular cavities are small and dilated atria
- Cardiac catheterization and MRI: diastolic pressure equal in all 4 chamber.

Question 10

treatment : Dry pericarditis

Answer 10

Dry pericarditis:
- Anti-inflammatory drugs (aspirin)
- Indometacin, ibuprofen for symptom relief.
- corticosteroids eg prednisalone
- Azathioprine, colchicines in cases of corticort-resistance
- pericardiocentesis when malignant, tuberculosis or a purulent pericarditis is suspected.

Question 11

treatment : Pericardial effusion

Answer 11

Pericardial effusion:
- Pericardiocentesis
- In cases of reaccumulation, pericardial fenestration via balloon pericardiotomy under local anesthesia or by conventional surgical approach