Pericardial disease Flashcards
What are symptoms of pericarditis?
sharp, severe retrosternal chest pain worse with inspiration and a supine position ‘pleurtic chest pain’
Relief on sitting up/forwards
Can move to the shoulder
What is the classical finding for pericarditis?
Pericardial friction rub
Low grade fever
Tachycardia
What are diagnostic signs of pericarditis on ECG?
Upward concave ST segment
‘Saddle-shaped ST elevation globally’
PR depression
What is pericarditis?
Inflammation serous layers of the pericardium
2 layers (Outer fibrous, inner serous layers with fluid between them)
Can cause pericardial effusion
What causes pericarditis?
Infectious causes
e.g. viral
Coxacchie virus commonly
Bacterial - group A strep which also causes rheumatic fever
TB
Non-infectious causes
Autoimmune e.g. SLE (immune complex deposition)
Following MI (Dresler’s syndrome)
Drugs
Uraemic pericaridtis - caused by renal failure as urate is inflammatory
What causes dreslers syndrome?
New antigens exposed during MI
Generates immune response and inflammation
Who commonly gets pericarditis?
Young 20-50s
Males
Generally look quite well
What are the 5Ps of pleuritic chest pain?
pneumonia pneumothorax pe pleural effusion pericarditis
Why is pain worse on inspiration in pericarditis?
Fibrous layer of heart continuous with the diaphragm
What are the features of when and how pericarditis presents?
Can present over several days or one day
Viral prodome
What signs of pericarditis can be found on examination?
On auscultation ‘muffling of heart sounds’
Pericardial rub - like someone is stepping on snow, low pitched through the cardiac cycle
What investigations are done for pericarditis?
Bedside - ECG
Saddle shaped ST elevation globally
PR depression
Bloods - CRP, WCC, U+Es, Troponin
Imaging - CXR to rule out other causes of pleuritic chest pain
US of heart, transthoracic echo
Cardiac MRI is definitive
What is the management for pericarditis?
Avoid exercise/lying down
NSAIDs
Gold standard is Colchicine
What do you want to safety net for re pericarditis?
Cardiac tamponade
which is treated via pericardiocentesis
Constrictive pericarditis - fibrosis that causes inflexible pericardium
What are the symptoms of constrictive pericarditis?
Congestion - rasied JVP, peripheral oedema, hepatomegaly
Dypnoea - kussmaul’s sign +ve
Pericardial knock - loud S3
