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
4 third line immunosuppressants?
anakinra
rilonacept
ivig
azathiprine
What is exercise restriction in pericarditis for non athletes? athletes?
Non athletes: CP free and CRP normalization
Athletes: 3 months
In what situation can you start Anti TB therapy for pericardial effusion without confirming serology?
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)
What three therapies can you use for treatment of pericarditis in pregnancy (safe throughout pregnancy and breast feeding)
- 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
What are 4 things needed to return to exercise after Pericarditis?
Resolution of symptoms, CRP, ECG and Echocardiogram
above and 3 months in athletes
At what CrCl level to avoid Colchicine?
CrCl < 10
