INFECTIOUS AND INFLAMMATORY CARDIAC CONDITIONS Flashcards
What are the viral etiologies of acute pericarditis ?
Coxackeiviruses A and B, Echovirus, Mumps, adenovirus, EBV, HIV, and Influenza.
What are the bacterial etiologies of acute pericarditis ?
Pneumococcus, streptococcus, staphylococcus, legionella, M. tuberculosis and avium.
What are the fungal etiologies of acute pericarditis ?
Histoplasmosis, coccidioidomycosis, candidiasis, and balastomycosis.
What are the non-infectious etiologies of acute pericarditis ?
ideopathic, neoplasms and metastasis, Mesothelioma, renal failure and MI, hypothyroidism, aortic dissection with hemopericardium, and pneumonia.
What are the auto-immune causes of acute pericarditis ?
SLE, RA, Scleroderma, Mixed arteritis, Polyarteritis nodosa, temporal arteritis, IBD and post MI syndrome.
What are the drugs that can cause acute pericarditis ?
Procainamide, Hydralazine, Isoniazide, Cyclosporin and Phenytoin.
What are the traumatic causes of acute pericarditis ?
Throacic duct injury and mediastinal irradiation.
What is the clinical presentation of acute pericarditis ?
- Sharp retrosternal CP that radiates to trapezius ridge and worse on inspiration and lying flat. Relief when sitting up or leaning forward.
- Pericardial friction rub +/- Fever.
What are the ECG changes in Acute pericarditis ?
- Stage 1:
– Widespread ST elevation with ST
depressions in AVR &/or V1
– PR depressions - Stage 2: (days later)
– Return of ST segments to baseline - Stage 3: (days later)
– T wave inversion - Stage 4: (weeks later)
– Return to baseline
What is the diagnostic criteria for acute pericarditis ?
A Dx of inflammatory pericardial syndrome require 2 of the 4 following criteria:
1) Pericarditic CP
2) Pericardial rubs
3) New widespread STE or PR depression in ECG
4) pericardial effusion.
What are the supporting findings of acute pericarditis ?
- Blood works showing elevated ESR< CRP and WBC
- CT or CMR evidence of pericardial inflammation.
What is the diagnostic criteria for incessant pericarditis ?
Pericarditis lasting for > 4 to 6 weeks, but less than 3 months without remission.
What is recurrent pericarditis ?
Recurrence of pericarditis episode with symptom free intervals of 4 to 6 week or longer.
What is chronic pericarditis ?
Pericarditis lasting for > 3 months.
what is the acute pericarditis risk stratification ?
https://www.escardio.org/static-file/Escardio/Medias/working-groups/myocardial-pericardial/2015.11-Paper-Tab1.2-DiagnosticCriteriaAndDefinition.png?mts=1592522397000.png
What are the factors to consider in treating acute pericarditis ?
- Rule out myocardial infarction
- Anti-Inflammatory.
- Antibiotics (if bacterial cause)
- Discontinue anticoagulant therapy – may lead to haemopericardium
What is the pharmacological management of pericarditis ?
https://www.escardio.org/static-file/Escardio/Medias/working-groups/myocardial-pericardial/2015.11-Paper-Tab2.1-TherapeuticSchemesForAcutePericarditis.png?mts=1592522679000.png
What is the treatment algorithm of acute and recurrent pericarditis ?
https://www.escardio.org/static-file/Escardio/Medias/working-groups/myocardial-pericardial/2015.11-Paper-Tab2.2-TherapeuticSchemesForAcutePericarditis.png?mts=1592522228000.png
What are the causes of pericardial effusion ?
- Infections and cancer
- trauma and autoimmune diseases.
- Iatrogenic: post cardiac surgery pericardial effusion.
- Associated with heart failure, liver cirrhosis, CKD & kidney failure
- ideopathic.
What is the clinical presentation of pericardial effusion ?
- Small or slowly accumulating pericardial effusions may be asymptomatic or cause only mild symptoms.
- DOE and fatigue
- Orthopnea and PND
- Cough and CP
- Sxs of local compression:
– Nausea (diaphragm)
– Dysphagia (oesophagus)
– Hoarseness (recurrent
laryngeal nerve)
– Hiccups (phrenic nerve)
What are the physical examination findings in pericardial effusion ?
- May be normal
- May have friction rub if
pericarditis also present - Large volumes:
– Muffled heart sounds
– Neck vein distension
– Pulsus paradoxus
What are the clinical signs of pericardial effusion ?
*Water bottle sign: Enlargement of the cardiac silhouette on CXR.
* Ewart’s sign: Base of left lung compressed by pericardial fluid
and Causes dullness, increased
fremitus & egophony beneath
angle of left scapula.