Pericardial Disease

Question 1

Pericardial Disease

Answer 1

Pericarditis=inflammationof thepericardium, the membrane surrounding the heart. It is made up up of two layers with a potential space between

Question 2

Pericarditis: Aetiology

Answer 2

The most common causes areidiopathic andviral.
- Idiopathic(no underlying cause)
- Injuryto the pericardium (e.g., after myocardial infarction, open heart surgery or trauma)
- Infection(e.g., tuberculosis, HIV, coxsackievirus, Epstein–Barr virus and other viruses)
- Autoimmuneandinflammatory conditions icl connective tissue diseases(e.g., systemic lupus erythematosus and rheumatoid arthritis)
- Uraemia(raised urea) secondary to renal impairment
- Cancer and cancer treatment
- Medications(e.g.,methotrexate immunosuppressant)

Pericardial effusion= fluid in the pericardial cavity. potential space of the pericardial cavity fills with fluid. This creates an inward pressure on the heart, making it more difficult to expand duringdiastole (filling of the heart).

Pericardial tamponade(orcardiac tamponade)= pericardial effusion increases intra-pericardial pressure enough to affect cardiac ability, reducing diastolic heart filling and systolic cardiac output. This is an emergency and requires prompt drainage of the pericardial effusion to relieve the pressure.

Question 3

Pericarditis: Symptoms

Answer 3

Two key presenting features should make you think of pericarditis:
- Pleuritic Chest pain
- Low-grade fever

The chest pain is:
- Sharp
- Central/anterior
- Worse on lying down and better on sitting forward

Auscultation: Pericardial friction ruba rubbing, scratching sound that occurs alongside the heart sounds.

Question 4

Pericarditis: Investigations

Answer 4

Blood testsshowraised inflammatory markers(white blood cells,CRPandESR) and may include raised troponin if the myocardium is also inflammed

ECGchanges include:
- Saddle-shaped ST-elevation (more sensitive)
- PR depression (more specific)

Echocardiogramcan be used to diagnose apericardial effusion.

Question 5

Pericarditis: Management

Answer 5

• Usually outpatient treatment. High risk features (temp>38 or raised troponin) should be managed as inpatient
• Non-steroidal anti-inflammatory drugs(NSAIDs) are the mainstay of treatment (e.g.,aspirin, ibuprofen or naproxen)
• Colchicine(taken longer-term, e.g., 3 months, to reduce the risk of recurrence)

Steroidsmay be used second-line, in recurrent cases or associated with inflammatory conditions (e.g., rheumatoid arthritis)
Underlying causes, such as tuberculosis and renal failure, should be treated appropriately.
Pericardiocentesismay be required to remove fluid from around the heart if there is a significantpericardial effusionortamponade.

Most cases resolve within a month. It can be recurrent or chronic.

avoid strenuous physical activity until symptom resolution and normalisation of inflammatory markers

Question 6

Constrictive Pericarditis

Answer 6

constrictive pericarditis= scarring, thickenening and stiffening of the pericardium
Aetiology: any cause of pericarditis, esp. TB
Features
dyspnoea
right heart failure: elevated JVP, ascites, oedema, hepatomegaly
JVP shows prominent x and y descent
pericardial knock - loud S3
Kussmaul’s sign is positive - JVP increases with inspiration

CXR
pericardial calcification