Pericardial Disease

Question 1

Causes of acute pericarditis

Answer 1

Idiopathic
Viral
Bacterial
Fungi/Parasites
Autoimmune (SLE, RA, vasculitis, sarcoid)
Drugs
Metabolic (uraemia, hypothyroid)
OTHER - trauma/surgery/malignancy/ radiotherapy

Question 2

Viral causes of pericarditis

Answer 2

coxsackie
EBV
CMV
Adenovirus
Mumps
Varicella
HiV

Question 3

Bacterial causes of pericarditis

Answer 3

TB
Lyme disease
Pneumonia
Rheumatic Fever
Mycoplasma
Legionella

Question 4

Drugs which can cause pericarditis

Answer 4

Hydralazine
Penicillin
Isoniazid
CHemotherapy

Question 5

Symptoms of pericarditis

Answer 5

chest pain worse lying flat
better sitting forward

Question 6

Signs of pericarditis on examination

Answer 6

Pericardial rub
Fever

Question 7

ECG findings in pericarditis

Answer 7

saddle shaped ST elevation
PR depression

Question 8

CXR findings in pericarditis

Answer 8

may be normal
OR cardiomegaly if pericardial effusion

Question 9

Treatment of pericarditis

Answer 9

NSAID + PPI for 1-2 weeks
Colchicine can reduce recurrence

If not improving and autoimmune condition evident, add steroids

Question 10

Causes of pericardial effusion

Answer 10

pericarditis
myocardial rupture (Haemopericardium)
aortic dissection
pus in pericardium
malignancy

Question 11

Symptoms of pericardial effusion

Answer 11

chest pain
hiccups (local compression of phrenic nerve)
nausea (diaphragm compression)

Question 12

Signs of pericardial effusion

Answer 12

bronchial breathing at left base due to compression of left lower lobe
muffled heart sounds

Question 13

Signs of pericardial effusion on CXR

Answer 13

enlarged globular heart

Question 14

ECG findings in pericardial effusion

Answer 14

low voltage complexes

Question 15

Treatment of pericardial effusion

Answer 15

pericardiocentesis may be diagnostic or therapeutic

e.g. draining pus or tamponade

Question 16

Describe constrictive pericarditis and the most likely causes

Answer 16

Rigid pericardium
usually following pericarditis
often linked to TB (in other countries where this is common)

Question 17

Signs of constrictive pericarditis on examination

Answer 17

RV failure
- raised JVP
- Kussmaul’s sign (JVP rising paradoxically with inspiration)
- diffuse apex beat
- reduced heart sounds +/- S3
- diastolic pericardial knock
- hepatomegaly/ascites/oedema

Question 18

CXR findings in constrictive pericarditis

Answer 18

Small heart
+/- pericardial calcification

Question 19

What investigations can be used to distinguish between constrictive pericarditis and restrictive cardiomyopathy?

Answer 19

CT
MRI
?ECHO

Question 20

Management of constrictive pericarditis

Answer 20

Surgical excision
Treat cause/symptoms

Question 21

Describe cardiac tamponade

Answer 21

Pericardial effusion which increases intrapericardial pressure and reduces ventricular filling

=> reduces cardiac output
=> can rapidly cause cardiac arrest

Question 22

Signs of cardiac tamponade on examination

Answer 22

high HR
low BP
pulsus paradoxus
raised JVP
Kussmauls sign (JVP/inspiration)
Muffled heart sounds

Question 23

ECG findings in cardiac tamponade

Answer 23

low voltage QRS
alternating QRS morphologies

Question 24

What investigation is diagnostic of cardiac tamponade?

Answer 24

ECHO
- ECHO free zone around heart +/- diastolic collapse of RA and RV