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RCE Guidelines Studying > ESC Pericarditis 2015 > Flashcards

ESC Pericarditis 2015 Flashcards

1
Q

5 baceteria that cause pericarditis?

A

Staph

Strep

Lyme (Borrelia Burgdoferi)

TB

Coxiella

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2
Q

5 non infectious causes of Pericarditis?

A

Autoimmune

Trauma

Neoplastic

Uremic

Drug related

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3
Q

5 drugs associated with Pericarditis?

A
  • Procainamide
  • Hydralazine
  • Anti TB
  • 5-FU
  • Cyclophosphamide
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4
Q

What are two additional supportive findings of Pericarditis (apart from diagnostic criteria)

A
  • CRP / ESR

- Pericardial inflammation on CMR

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5
Q

What is incessant Pericarditis?

A

-Lasting for > 4-6 weeks but < 3 months without remission

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6
Q

What is recurrent Pericarditis?

A

4-6 weeks symptom free period and a symptom-free interval of 4-6 weeks or longer

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7
Q

What is chronic pericarditis?

A

Lasting more than 3 months

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8
Q

What are 5 Major predictors of poor prognosis?

A
  • Fever > 38
  • Subacute onset
  • Large Pericardial Effusion
  • Cardiac Tamponade
  • Lack of response to ASA or NSAIDs after 1 week of therapy
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9
Q

What are 4 minor criteria for prognosis for pericarditis?

A
  • Myocardial involvement
  • Immunosuppression
  • Anticoagulation
  • Trauma
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10
Q

What is starting dose for Prednisone for Pericarditis?

A

0.25-0.5 mg/kg/day

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11
Q

What class of recommendation is CMR for Peri with Myo involvement? Hospialization?

A
  • Class 1

- Yes

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12
Q

How long exercise restriction for myocarditis?

A

6 months

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13
Q

What is indication for CMR/CT in CP? Cath?

A
  • Class 1

- Indicated when non-invasive diagnostic methods do not provide a definite diagnosis of constriction

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14
Q

What are 2 differences in physical exam in CP vs RCM?

A
  • Kussmaul sign

- Pericardial knock

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14
Q

What are 2 differences in physical exam in CP vs RCM?

A
  • Kussmaul sign

- Pericardial knock

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15
Q

What are 5 differences in Echo exam in CP vs RCM?

A
  • Septal bounce
  • Pericardial thickening
  • Respiratory variation of the mitral peak E velocity of >25% and TV > 40%
  • Tissue Dopple septal E prime > 8 cm/s
  • Decreased expiratory diastolic hepatic vein velocities with large reversals
16
Q

What are 4 differences in Invasive Hemodynamics in CP vs RCM?

A
  • Dip and plateau sign/Square root sign
  • LVEDP - RVEDP < 5mmhg
  • Ventricular interdependence (assessed by systolic area index > 1.1)
  • Kussmaul sign
  • Prominent X and Y descent in JVP
17
Q

What are the three CP syndromes?

A
  • Transient constriction: Reversible pattern of constriction following spontaneous recovery or medical therapy
  • Effusive-constrictive pericarditis: Failure of right atrial pressure to fall by 50% of to a level below 10mmhg after pericardiocentesis
  • Chronic Constriction: Persistent constriction after 3-6 months
18
Q

What are treatments of three CP syndromes?

A
  • Transient constriction: 2-3 month course of empiric anti-inflammatory medical therapy
  • Effusive-constrictive pericarditis: Pericardiocentesis followed by medical therapy. Surgery for persistent cases.
  • Chronic Constriction: Pericardectomy, medical therapy for advanced cases or high risk of surgery or mixed forms with myocardial involvement.
18
Q

What are treatments of three CP syndromes?

A
  • Transient constriction: 2-3 month course of empiric anti-inflammatory medical therapy
  • Effusive-constrictive pericarditis: Pericardiocentesis followed by medical therapy. Surgery for persistent cases.
  • Chronic Constriction: Pericardectomy, medical therapy for advanced cases or high risk of surgery or mixed forms with myocardial involvement.
19
Q

What general chem tests to send Pericardial fluid for?

A
  • Protein level > 3 g/dl
  • Protein fluid/Serum > 0.5
  • LDH > 200
  • Fluid/serum ratio > 0.6
  • CBC
20
Q

how long to treat TB pericardial effusion? how long to wait before pericardectomy?

A

Anti TB therapy for 6 months

Pericardectomy if 4-8 weeks without improving symptoms

21
Q

How to make diagnosis of Chylopericardium?

A
  • Milky opalescent pericardial effusion
  • TG > 500 mg/dl
  • TC : TG < 1
22
Q

Review therapy for recurrent pericarditis

A
23
Q

4 third line immunosuppressants?

A

anakinra

rilonacept

ivig

azathiprine

24
Q

What is exercise restriction in pericarditis for non athletes? athletes?

A

Non athletes: CP free and CRP normalization

Athletes: 3 months

25
Q

In what situation can you start Anti TB therapy for pericardial effusion without confirming serology?

A

In endemic areas with exudative pericardial effusion with no other cause (Should not be empirically started without documentation of systemic TB in non endemic areas)

26
Q

What three therapies can you use for treatment of pericarditis in pregnancy (safe throughout pregnancy and breast feeding)

A
  • Prednisone
  • Acetominophen
  • Colchicine (not mentioned in guidelines)

Note: Prior to 20 weeks all meds OK, ASA preferred. In breast feeding all OK but ASA preferably avoided

27
Q

What are 4 things needed to return to exercise after Pericarditis?

A

Resolution of symptoms, CRP, ECG and Echocardiogram

above and 3 months in athletes

28
Q

At what CrCl level to avoid Colchicine?

A

CrCl < 10

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