Pericardial D/O

Question 1

Acute pericarditis pain characteristics

Answer 1

Sudden onset pain
Stabbing type
↑lying down, deep breath, coughing
↓Leaning forward
?Pluritic rub sound on auscultation

Question 2

Acute pericarditis causes

Answer 2

Idiopathic
Viral
Vasculitis
Trauma
Neoplasm
Inflammation
Uremia
MI .. pericarditis = Dressler syn

Question 3

Acute pericarditis diagnosis

Answer 3

ECG - diagnostic
1. DIFFUSE ST elevation
2. Upright T waves
3. PR depression

No Q waves (unlike MI)
Absence of reciprocal leads

Question 4

Mx of Acute pericarditis

Answer 4

1. NSAIDs
2. Aspirin
3. Steroids
4. Colchicine - can add

Question 5

Pericardial effusion causes

Answer 5

Transudative:
1. Major CHF
2. ↓Proteins
3. Overhydration

Exudative:
1. Injury
2. Serosanguineous - TB, neoplasm
3. Blood - Aortic aneurysm/dissection, trauma, rupture of heart in MI, coagulation d/o

Rapid accumulation - cardiac tamponade
Slow accumulation - pericardium accommodates

Question 6

Pericardial effusion diagnosis

Answer 6

CXR - WATER BOTTLE SIGN (heart)

Best - ECHO

Question 7

Cardiac tamponade

Answer 7

Rapid pericardial effusion a/w compression of heart
Medical emergency

Dyspnoea, orthopnoea
BECKS TRIAD
Pulsus paradoxus (in chronic lung disease, asthma, Severe CHF etc)

Mx: Bedside ECHO and cardiac catheterisation - RA and LA pressures

Rx:
Pericardiocentesis
Subxiphoid surgical drainage

Question 8

Becks triad

Answer 8

Cardiac tamponade
1. Low BP
2. Raised JVP (dilated neck veins)
3. Low (decreased) heart sounds

Question 9

Constrictive Pericarditis

Answer 9

Inflammation … diffuse thickening of pericardium
Diastolic HF

CXR - eggshell sign (calcium deposition in pericardium)

Inv:

Question 10

Best inv for pericarditis, pericardial effusion, cardiav tamponade

Answer 10

Pericarditis - ECG
Effusion, tamponade - ECHO