Dressler Syndrome Flashcards
What is pericarditis?
Inflammation of the pericardial sac, resulting in pericardial effusion which can be serous, haemorrhagic or purulent.
This can reduce cardiac output and reduce chamber filling, resulting in diastolic dysfunction
How is pericardial rub differentiated from pleurisy?
When a patient holds their breath, rub will disappear in pleurisy.
Pericardial rub is triphasic while pleurisy is biphasic.
What are the causes of acute pericarditis?
*Infection
*Autoimmune from systemic lupus, rheumatoid arthritis
*Malignancy
*Uraemia or anorexia
*Post MI
*Post-cardiac trauma from catheter ablation, pacemaker placement or CPR
Which infections can cause acute pericarditis?
Epstein-Barr virus infection
Tuberculosis
Adenovirus
Herpes
What are the causes of chronic pericarditis?
Adhesion and constrictive pericarditis
In post-MI, what is the cause of acute pericarditis a few days post MI?
Peri-infarction pericarditis, with death of tissue in the pericardial sac.
In post-MI, what is the cause of acute pericarditis weeks post MI?
Dressler syndrome
What is Dressler syndrome?
Occurs a few weeks after trauma to the heart, from surgery, trauma or PCI. It is an autoimmune inflammatory response against the myocardium.
What are the clinical features of Dressler syndrome?
Pleuritic chest pain relieved by leaning forwards, with fever and leukocytosis, dyspnoea and reduced appetite.
CXR and ECHOw I’ll show pericardial effusion. CXR will show cardiac silhouette.
How is Dressler syndrome managed?
It is self-limiting but for symptomatic patinets, high dose aspirin 300mg/NSAIDs or coritcosteroids
How is the ECG affected in acute pericarditis?
ST elevation in all leads with a saddle shape
PR depression in all leads EXCEPT AVR
How does pericarditis present?
Pleuritic chest pain worsened in on leaning backward and improves on lean aging or ward. There may be fever and high WBC count.
Compression of the phrenic nerve can abuse radiation of pain to trapezius ridges.
Beck’s triad may be present for those at risk of cardiac tamponade
How is acute pericarditis diagnosed?
Diffuse ST elevation on all leads and PR depression on ECG
Echocardiogram showing pericardial effusion with a
How is pericarditis treated?
Aspirin/NSAIDs
Pericardiocentesis
What are the ausculatatin findings for pericardial rub?
Triphasic sound corresponding to atrial systole, ventiruclar systole and early ventircular diastole
When is pericaridocentesis indicated?
Infectious cause of acute pericarditis is suspected
Cardiac tamponade is present
What is constrictive pericarditis?
Reduction in diastolic filling on both sides of the heart results in reduced preload reduced ejection fraction heart failure.
This reduces filling of the IVC and cases hepatic congestion and portal vein hypertension, leading to ascites.
There will be pulmonary hypertension and dystrophic calcification over time.
What are the clinical features of constrictive pericarditis?
Ascites
Abdominal pain
Syncope
Kussmaul sign
Pulsus paradoxus
Tachypnoea
Apical
What is Kussmaul sign?
JVP is raised during inspiration due to reduced chamber filling of the right ventircle from the increased venous return
What is pulsus paradoxus?
Blood pressure drops by more than 10mmHg during inspiration due to interventiruclar septum shifting to compress the left ventircle filling
What are the causes of constrictive pericarditis?
*Tuberculosis
*Post-cardiothoracic surgery
*Auto immune conditions like rheumatoid arthritis and systemic lupus
How is constrictive pericarditis treated?
Surgery with pericardiectomy
What are the complications of constrictive pericarditis
Liver cirrhosis due to portal hypertension
Square-root sign and friedrich’s sign on JVP
Heart failure
What is Freidrich’s sign?
Steep y descent due to reduced passive ventiruclar filling.
What is the first line treatment for acute pericarditis?
Combination of NSAID and colchicine
What is the second line treatment of acute pericarditis?
Colchicine for those with NSAID contraindications, like peptic ulcer disease
How long is the course of NSAIDs for pericarditis?
5-10 days of NSAIDs
