Pericardial Disease Flashcards
Aetiology of pericardial disease
Diagnostic criteria for pericarditis
Triage of Pericarditis
- In all patients with suspected acute pericarditis:
- ECG
- Echo
- CXR
- Biomarkers of inflammation (CRP) and myocardial injury (troponin)
- Hospital admission for high risk patients (at least 1 risk factor)
- Outpatient management for low risk patients
- Review response to anti-inflammatory therapy after 1 week
- Athletes - 3
Management of Acute Pericarditis
- Aspirin or NSAIDs are first line therapy, with gastric protection
- Colchicine is first line therapy, given with NSAIDs or Aspirin
- Consider CRP monitoring to guide treatment
- Consider low dose steroids with colchicine if NSAIDs/Aspirin +colchicine has failure or aspirin/NSAID contraindication, if infection excluded or there is evidence of specific cause (autoimmune).
- Steroids are NOT first line
Recurrent pericarditis drug doses
Therapuetic algorithm for acute and recurrent pericarditis
Myopericarditis
- In pericarditis with suspected associated myocarditis, coronary angiography recommended to exclude ACS (according to presentation and risk factor assessment)
*CMR recommended - Admission recommended for monitoring and diagnostics
- Rest and no more than sedentary activities for 6 months
- Consider empirical anti-inflammatory therapies
Pericardial Effusion - Management
Constrictive Pericarditis
- TTE, CXR and CT/MRI recommended
- Cardiac catheterisation when no clear diagnosis on non-invasive imaging
- Mainstay of therapy is pericardiectomy
- Consider anti-inflammatories if ingoing inflammation
Investigation of pericarditis
- First line:
- Markers of inflammation (ESR, CRP, WBC)
- Renal function, LFT, TFT
- ECG
- Echo
*Second line (if first line not sufficient for diagnosis)
- CT/MRI
- Analysis of pericardial fluid (for cardiac tamponade, for suspected bacterial or neoplastic pericarditis, for moderate or larger effusions not responding to conventional therapies)
Stepwise investigation of suspected TB pericarditis
*Anti-TB drugs (RIPE) for 6 months to prevent constriction
*Pericardiectomy after 4-8 weeks if patient not improving
Post cardiac injury syndrome (Post MI pericarditis)
- Anti-inflammatory therapies recommended
- Aspirin first line for patients already on anti-platelets
- Consider prophylactic colchicine to prevent pericarditis in cardiac surgery
- Careful follow up for constriction with echo every 6-12 months
Neoplastic involvement in the pericardium
- Pericardiocentesis in tamponade
- Cytology recommended on pericardial fluid
- Systemic anti-neoplastic therapy recommended
- Extended pericardial drainage recommended to permit intrapericardial therapy and prevent reaccumulation
Chylopericardium
- May be primary (rare) or secondary to injury of the thoracic duct (n.b. congenital surgery)
- Pericardial fluid - triglyceride level >500ml/dL, cholesterol:TG level <1, negative cultures, lymphocyte predominance
