Pericardial disease Flashcards
What is acute pericarditis?
Acute pericarditis is a condition referring to inflammation of the pericardial sac, lasting for less than 4-6 weeks.
What are the aetiologies of acute pericarditis?
Aetiologies include viral infections (Coxsackie), tuberculosis, uraemia, post-myocardial infarction, radiotherapy, and connective tissue diseases such as systemic lupus erythematosus and rheumatoid arthritis.
What are the features of acute pericarditis?
Features include chest pain (may be pleuritic and often relieved by sitting forwards), non-productive cough, dyspnoea, flu-like symptoms, and pericardial rub.
What are the ECG changes associated with acute pericarditis?
ECG changes are often global/widespread with ‘saddle-shaped’ ST elevation and PR depression, which is the most specific ECG marker for pericarditis.
What investigations should be done for suspected acute pericarditis?
All patients should have transthoracic echocardiography and blood tests for inflammatory markers and troponin.
How is acute pericarditis managed?
Most patients can be managed as outpatients, but those with high-risk features should be managed as inpatients. Treatment includes avoiding strenuous activity and using NSAIDs and colchicine for first-line management.
What should be done until symptom resolution in acute pericarditis?
Strenuous physical activity should be avoided until symptom resolution and normalisation of inflammatory markers, usually within 1-2 weeks.
What is cardiac tamponade?
Cardiac tamponade is characterized by the accumulation of pericardial fluid under pressure.
What are the classical features of cardiac tamponade?
Beck’s triad: hypotension, raised JVP, muffled heart sounds.
What are other features of cardiac tamponade?
Dyspnoea, tachycardia, absent Y descent on the JVP, pulsus paradoxus, Kussmaul’s sign, ECG shows electrical alternans.
What is the significance of absent Y descent in cardiac tamponade?
It is due to the limited right ventricular filling.
What is pulsus paradoxus?
An abnormally large drop in BP during inspiration.
What is Kussmaul’s sign?
A sign that is much debated in relation to cardiac tamponade.
What is the key difference in JVP between cardiac tamponade and constrictive pericarditis?
Cardiac tamponade has absent Y descent, while constrictive pericarditis has X + Y present.
What is the difference in pulsus paradoxus between cardiac tamponade and constrictive pericarditis?
Pulsus paradoxus is present in cardiac tamponade and absent in constrictive pericarditis.
