Microbiology DSA Flashcards
Essentials of diagnosis of Acute Inflammatory Pericarditis
o Anterior pleuritic chest pain worse supine than upright
o Pericardial rub
o Fever common
o Erythocyte sedimentation rate elevated
o ECG: diffuse ST-segment elevation with associated PR depression
Viral causes of pericarditis
o Coxsackieviruses o Echoviruses o Influenza o Epstein Barr o Varicella o Hepatitis o Mumps o HIV
Viral pericarditis dx
o dx made clinically, leukocytosis often present
o Rising viral titers – rarely done
o Cardiac enzymes slightly elevated – epicardial myocarditis component
o Echocardiogram normal, or trivial amount of extra fluid during acute inflammatory process
Tuberculous Pericarditis
direct lymphatic or hematogenous spread
o Clinical pulmonary involvement absent or minor, pleural effusions common
o S/S: subacute, fever, night sweats, fatigue for days to months
o Acid-fast bacilli found elsewhere
o Low yield of organisms by pericardiocentesis, pericardial biopsy higher yield but may also be negative, pericardiectomy may be required
o Tx: antituberculous drug therapy, constrictive pericarditis can occur
Bacterial pericarditis
direct extension from pulmonary infections
o Pneumococci
o Borrelia burgdorferi – myopericarditis, occasional heart block
o Patients appear toxic, often critically ill
o Suspected on clinical grounds, pericardiocentesis confirmatory
Uremic pericarditis
complication of CKD
o Untreated uremia and stable dialysis patients
o w/ or w/o symptoms – fever absent
o If not on dialysis – incidence correlates to level of BUN and Cr
o “Shaggy” pericardium and effusion is hemorrhagic and exudative
o Tx dialysis
Myxedema pericarditis
hypothyroidism
cholesterol crystals within fluids
Neoplastic pericarditis
most frequent causes of pericardium tamponade
• Hodgkin Disease
• Lymphomas
• Painless, presenting symptoms related to hemodynamic compromise or primary disease
• Pericardial effusion may be very large, consistent with chronic nature
• Cytologic examination of effusion or pericardial biopsy
• Difficult to establish clinically if medialstinal radiation within previous year
• Pericardial effusions develop over long period of time, may become quite large (2L+)
• Poor prognosis, drain effusion percutaneously initially, pericardial window
• Chemotherapeutic agents or tetracycline reduce recurrence rate
Radiation pericarditis
4000 cGy delivered to 30%+ of heart
• Initiate fibrinous and fibrotic process in pericardium
• Presents as subacute pericarditis or constriction
• Within first year, may delayed for many years before constriction evident
• Symptomatic therapy, recurrent effusions and constriction require surgery
Drug toxicity causing pericarditis
- Minoxidil
- Penicillins
- Clozapine
Dressler Syndrome
postcardiotomy pericarditis, post MI
o Days to weeks after MI or open heart surgery
o Recurrence of pain with pleural-pericardial features
o Rub audible
o Repolarization changes on ECG may be confused with ischemia
o Pain, fever, malaise, leukocytosis
o Autoimmune disorder symptoms – joint pain, fever
o Tamponade rare after MI, but not postoperatively
o High sedimentation rate helps confirm dx
o Large pericardial effusions and accompanying pleural effusions frequent
Pericarditis post MI
occur 2-5 days after infarct due to inflammatory reaction to transmural myocardial necrosis
S/S of pericarditis
- Substernal pain, may radiate to neck, shoulders, back, or epigastrium
- Dyspnea
- Febrile
- Characteristic pericardial friction rub with or without evidence of fluid accumulation or constriction
ECG findings in pericarditis
- ST and T wave changes
- Begins with diffuse ST elevation
- Followed by return to baseline
- Then to T wave inversion
• Atrial injury manifested by PR depression in limb leads
CXR findings in pericarditis
frequently normal, may show cardiac enlargement if pericardial fluid present
• Pulmonary disease signs
• Mass lesions and enlarged LNs suggest neoplastic process
Echocardiography in pericarditis
mild pericardial effusion in 60%
