Pericardial disease

Question 1

What are the causes of pericarditis?

Answer 1

• Viral infections (coxsackie)
• Tuberculosis
• Uraemia,
• Post-myocardial infarct: fibrinous pericarditis (early) or Dressler’s syndrome (late).
• Radiotherapy,
• Connective tissue risease
• Hypothyroidism,
• Malignancy,
• Trauma

Question 2

What are the symptoms of pericarditis?

Answer 2

Chest pain which may be pleuritic. May be releaved sitting forwards.
Pericardial rub
Fever
Others: Non-productive cough, dyspnoea and flu-like symptoms

Question 3

What are the investigations for pericarditis?

Answer 3

• ECG: saddle shaped global ST elevation and PR depression
• Bloods: Inflammatory markers and may have elevated troponin

Question 4

What is the management of pericarditis?

Answer 4

NSAIDs and colchicine.
If bacterial then give antibiotics

Question 5

What are the complications of pericarditis?

Answer 5

Pericardial effusions

Question 6

What are the causes of constrictive pericarditis?

Answer 6

Anything that cause pericarditis and TB

Question 7

What are the signs and symptoms of constrictive pericarditis?

Answer 7

• Dyspnoea,
• Right heart failure,
• JVP shows X and Y descent
• Loud S3 (pericardial knock)
• Kussmaul’s sign is positive
• Pericardial calcifications on chest x ray

Question 8

What are the differences between cardiac tamponade and constrictive pericarditis?

Answer 8

Cardiac tamponade - Absent Y decent on JVP (TAMponade = TAmpaX), pulsus paradox and negative kaussmaul sign
Constrictive pericarditis - Y and X descent on JVP, no pulsus paradoxus, positive kussmaul’s

Question 9

What can cause pericardial effusion?

Answer 9

Inflammation causing accumulation of fluid in pericarditis

Question 10

What are the causes of cardiac tamponade?

Answer 10

Accumulation of fluid, blood or purulent exudate or air in the pericardial space. This reduces diastolic filling.

Question 11

What are the symptoms of cardiac tamponade?

Answer 11

• Shortness of breath,
• Tachycardia,
• Confusion,
• Chest pain,
• Abdominal pain

Question 12

What are the signs of cardiac tamponade?

Answer 12

Becks triad:
1. Hypotension,
2. Quiet heart sounds,
3. Raised JVP
Can also get pulsus paradoxus (pulse fades on inspiration)

Question 13

WHat are the investigations for cardiac tamponade?

Answer 13

ECG - Low QRS and electrical alternans
CXR - large, globular heart
TTE - fluid around the heart
Pericardiocentesis - sampling of fluid

Question 14

What is the management of cardiac tamponade?

Answer 14

If haemodynamically unstable then pericardiocentesis.
If stable then observe and give IV fluids