L8: Pericarditis/Endocarditis Flashcards
What is pericarditis?
- Inflammation of the pericardial sac
- Leads to potential for an increased production of pericardial fluid (pericardial effusion)
How much fluid does the pericardial sac usually contain?
15-50 mL of an ultrafiltrate of plasma
An increase in pericardial fluid in a closed pericardial sac can lead to:
increased pressure on the ear and surrounding vessels = BAD
_____ is the most common disorder of the pericardium.
Pericarditis
Pericarditis is most common in: (population)
Adult men
No difference b/w etiology, clinical course, and prognosis between elderly and younger patients
How important is it to discover the etiology of pericarditis?
- Low yield info
- Looking for etiology usually unnecessary
- Usually viral or idiopathic but WE DON’T KNOW
What are the most common viruses that cause pericarditis?
Coxsackie and influenza
Pericarditis is an _____ process.
isolated, self-limiting
Pericarditis might be the first manifestation of an ____.
Underling, systemic disease
*in this case you would want to search for etiology
True or false: Pericarditis is only acute.
False - may become chronic
What are the main 4 clinical manifestations of pericarditis? How many do they need to have for dx?
- Chest pain (sharp and pleuritic)**
- Pericardial friction rub (scratchy or squeaking heart sound)
- EKG changes (new widespread ST elevation or PR depression)
- New pericardial effusion
*Must have 2/4 for dx!
95% of people with pericarditis have the primary complaint of:
chest pain
*especially if cause is infectious!
Describe the chest pain associated with pericarditis. (5)
- Sudden onset
- Over anterior chest
- Sharp and pleuritic (unlike ischemic pain)
- Improved by sitting up and leaning forward
- Worsened by lying flat, deep inspiration, coughing, or sneezing
Pericardial friction rub is highly SPECIFIC for ______.
Acute pericarditis
Why does pericardial friction occur?
Friction between the 2 layers due to inflammation
How can you hear pericardial friction best?
- Left sternal border
- Scratchy or squeaking quality
- Heard best when pt is sitting up and leaning forward
*vary in intensity; can come and go
Describe the use of an EKG in regards to dxing pericarditis?
- EKG can show changes with inflammation of the epicardium (changes seen on EKG are diffuse)
- Some cases do not have significant inflammation, therefore WILL NOT ALTER THE EKG
What is the first diagnostic test you should use to assess for pericardial effusion?
Echocardiogram
Why does pericardial effusion occur with pericarditis?
- Pericardial sac = potential space
- As inflammation increases, amount of fluid increases
- Amount of effusion varies greatly
Pericardial tamponade (from pericarditis) may lead to:
Beck’s triad
What is Beck’s triad?
- Hypotension (can’t pump blood out)
- Muffled heart sounds (can’t hear past the fluid)
- JVD (blood backs up)
How do we typically diagnose pericarditis? What is a characteristic physical exam finding for pericarditis that would confirm diagnosis?
- Usually just clinical based on CHARACTERISTIC CHEST PAIN
- Pericardial friction rub = clinically confirms dx
Aside from clinical hx, what else can we use to dx pericarditis?
- Blood work
- CXR
- EKG
- Echocardiogram (urgently if sign of pericardial tamponade)
Specifically what blood work would we order for pericarditis? How is this blood work applicable?
Order: troponin level, ESR, CRP, and CBC (can consider blood cultures if high fever)
-Abnormalities support the dx but are NOT SENSITIVE OR SPECIFIC FOR PERICARDITIS