ESC Pericarditis 2015 Flashcards
5 baceteria that cause pericarditis?
Staph
Strep
Lyme (Borrelia Burgdoferi)
TB
Coxiella
5 non infectious causes of Pericarditis?
Autoimmune
Trauma
Neoplastic
Uremic
Drug related
5 drugs associated with Pericarditis?
- Procainamide
- Hydralazine
- Anti TB
- 5-FU
- Cyclophosphamide
What are two additional supportive findings of Pericarditis (apart from diagnostic criteria)
- CRP / ESR
- Pericardial inflammation on CMR
What is incessant Pericarditis?
-Lasting for > 4-6 weeks but < 3 months without remission
What is recurrent Pericarditis?
4-6 weeks symptom free period and a symptom-free interval of 4-6 weeks or longer
What is chronic pericarditis?
Lasting more than 3 months
What are 5 Major predictors of poor prognosis?
- Fever > 38
- Subacute onset
- Large Pericardial Effusion
- Cardiac Tamponade
- Lack of response to ASA or NSAIDs after 1 week of therapy
What are 4 minor criteria for prognosis for pericarditis?
- Myocardial involvement
- Immunosuppression
- Anticoagulation
- Trauma
What is starting dose for Prednisone for Pericarditis?
0.25-0.5 mg/kg/day
What class of recommendation is CMR for Peri with Myo involvement? Hospialization?
- Class 1
- Yes
How long exercise restriction for myocarditis?
6 months
What is indication for CMR/CT in CP? Cath?
- Class 1
- Indicated when non-invasive diagnostic methods do not provide a definite diagnosis of constriction
What are 2 differences in physical exam in CP vs RCM?
- Kussmaul sign
- Pericardial knock
What are 2 differences in physical exam in CP vs RCM?
- Kussmaul sign
- Pericardial knock
What are 5 differences in Echo exam in CP vs RCM?
- 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
What are 4 differences in Invasive Hemodynamics in CP vs RCM?
- 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
What are the three CP syndromes?
- 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
What are treatments of three CP syndromes?
- 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.
What are treatments of three CP syndromes?
- 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.
What general chem tests to send Pericardial fluid for?
- Protein level > 3 g/dl
- Protein fluid/Serum > 0.5
- LDH > 200
- Fluid/serum ratio > 0.6
- CBC
how long to treat TB pericardial effusion? how long to wait before pericardectomy?
Anti TB therapy for 6 months
Pericardectomy if 4-8 weeks without improving symptoms
How to make diagnosis of Chylopericardium?
- Milky opalescent pericardial effusion
- TG > 500 mg/dl
- TC : TG < 1
Review therapy for recurrent pericarditis
