Pericardial Disease Flashcards
Causes of acute pericarditis
Idiopathic
Viral
Bacterial
Fungi/Parasites
Autoimmune (SLE, RA, vasculitis, sarcoid)
Drugs
Metabolic (uraemia, hypothyroid)
OTHER - trauma/surgery/malignancy/ radiotherapy
Viral causes of pericarditis
coxsackie
EBV
CMV
Adenovirus
Mumps
Varicella
HiV
Bacterial causes of pericarditis
TB
Lyme disease
Pneumonia
Rheumatic Fever
Mycoplasma
Legionella
Drugs which can cause pericarditis
Hydralazine
Penicillin
Isoniazid
CHemotherapy
Symptoms of pericarditis
chest pain worse lying flat
better sitting forward
Signs of pericarditis on examination
Pericardial rub
Fever
ECG findings in pericarditis
saddle shaped ST elevation
PR depression
CXR findings in pericarditis
may be normal
OR cardiomegaly if pericardial effusion
Treatment of pericarditis
NSAID + PPI for 1-2 weeks
Colchicine can reduce recurrence
If not improving and autoimmune condition evident, add steroids
Causes of pericardial effusion
pericarditis
myocardial rupture (Haemopericardium)
aortic dissection
pus in pericardium
malignancy
Symptoms of pericardial effusion
chest pain
hiccups (local compression of phrenic nerve)
nausea (diaphragm compression)
Signs of pericardial effusion
bronchial breathing at left base due to compression of left lower lobe
muffled heart sounds
Signs of pericardial effusion on CXR
enlarged globular heart
ECG findings in pericardial effusion
low voltage complexes
Treatment of pericardial effusion
pericardiocentesis may be diagnostic or therapeutic
e.g. draining pus or tamponade
Describe constrictive pericarditis and the most likely causes
Rigid pericardium
usually following pericarditis
often linked to TB (in other countries where this is common)
Signs of constrictive pericarditis on examination
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
CXR findings in constrictive pericarditis
Small heart
+/- pericardial calcification
What investigations can be used to distinguish between constrictive pericarditis and restrictive cardiomyopathy?
CT
MRI
?ECHO
Management of constrictive pericarditis
Surgical excision
Treat cause/symptoms
Describe cardiac tamponade
Pericardial effusion which increases intrapericardial pressure and reduces ventricular filling
=> reduces cardiac output
=> can rapidly cause cardiac arrest
Signs of cardiac tamponade on examination
high HR
low BP
pulsus paradoxus
raised JVP
Kussmauls sign (JVP/inspiration)
Muffled heart sounds
ECG findings in cardiac tamponade
low voltage QRS
alternating QRS morphologies
What investigation is diagnostic of cardiac tamponade?
ECHO
- ECHO free zone around heart +/- diastolic collapse of RA and RV
