Pericardial Disease Flashcards
What are causes of percarditis?
- Idiopathic
- Viral - Most common. Last 1-3 weeks. Due to coxsackievirus B, influenza etc
- Bacterial - Hematogenous spread from pulmonary infection, trauma, endocarditis
- TB
- Systemic inflammatory diseases
What are the symptoms of pericarditis?
Chest pain - Sharp and pleuritic - Worse on inspiration - Better on leaning forward and sitting up Fever Breathlessness - May indicate pericardial effusion Cough
What signs suggest pericarditis?
- Pericardial rub on auscultation
What investigations are warranted?
- Bloods
- FBC, U+E, CRP, Troponin - ECG
- Echo if suspected pericardial effusion
- CXR - Exclude an alternative diagnosis eg pneumonia. Can also show cardiomegaly in significant effusion
What does an ECG show in pericarditis?
- ST elevation in most leads which is concave and saddle shaped
What is the treatment for pericarditis?
- NSAIDs or aspirin for 1-2 weeks with gastric protection
- Add colchicine to reduce the risk of reoccurrence for 3 months
- Rest until symptoms resolve
- May need oral steroids
What are complications of pericarditis?
- Cardiac tamponade
- Chronic pericarditis
- Constrictive pericarditis
- Pericardial effusion
What are causes of pericardial effusion?
- Pericarditis
- Myocardial rupture (haemopericardium)
- Aortic dissection
- Pericardium filling with pus
- Malignancy
What are signs of pericardial effusion?
- Dyspnoea, chest pain Local compression of structures - Hiccoughs (phrenic nerve) - Nausea (diaphragm) - Bronchial breathing at left base Muffled heart sounds
What is the management for pericardial effusion?
Pericardiocentesis may be diagnosis (suspected bacterial infection) or therapeutic
- Send aspirate for culture, TB culture and cytology
What is constrictive pericarditis?
When does it occur?
The heart is encased in a rigid pericardium
Occurs idiopathically, after pericarditis, or with TB
What clinical features suggest constrictive pericarditis?
- Right sided heart failure (raised JVP)
- Soft, diffuse apex beat
- Quiet heart sounds
- Ascites
- Oedema
What investigations would you do for constrictive pericarditis?
CXR - Small heart and pericardial calcification
What is the management for constrictive pericarditis?
Surgical excision
What is cardiac tamponade?
A pericardial effusion that raises intrapericardial pressure, reducing ventricular filling and dropping cardiac output. It can lead rapidly to cardiac arrest.
