Pericardial disease Flashcards
What is pericardial disease
refers to any condition that affects the pericardium
can cause inflammation, fluid accumulation or constriction of pericardium
What is acute pericarditis
condition referring to inflammation of the pericardial sac
lasting for less than 4-6 weeks
What is the aetiology of acute pericarditis
viral infections - Coxsackie
tuberculosis
uraemia
post MI
- early fibrinous pericarditis
-late autoimmune pericarditis
radiotherapy
connective tissue disease- SLE, RA
hypothyroidism
malignancy - lung or breast cancer
trauma
What may someone with acute pericarditis present with
Chest pain - sharp and pleuritic in nature
worsens on inspiration and relieved by sitting forwards
SOB
non-productive cough
fever
fatigue
palpitations
What may be revealed on examination
signs of pericardial effusion
muffled heart sounds , pericardial rub
What may be seen in a patient with constrictive pericarditis
Right heart failure signs - elevated JVP, ascites , oedema, hepatomegaly
pericardial knock - loud S3
positive kussmaul’s sign - paradoxical rise in JVP during inspiration
What investigations are required for pericardial disease
First line ECG
PR depression
Saddle shaped ST elevation
blood tests for raised CRP and ESR
raised troponin indicates myopericarditis
Chest X ray
for constrictive pericarditis
pericardial calcification
What investigation should all patients with suspected acute pericarditis have
transthoracic echocardiography
What is the management for pericardial disease
combination of NSAIDs and colchicine for patients with acute idiopathic or viral pericarditis
patients with high risk features should be kept as an inpatient
treat any underlying cause
When might pericardiocentesis be necessary
if pericardial effusion is causing significant symptoms
What may be needed in cases of chronic/ constrictive pericarditis
surgical interventions
pericardiectomy / pericardial window
