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.
What is the difference in Kussmaul’s sign between cardiac tamponade and constrictive pericarditis?
Kussmaul’s sign is rare in cardiac tamponade and present in constrictive pericarditis.
What is a characteristic feature of constrictive pericarditis?
Pericardial calcification on CXR.
What mnemonic can help remember the absent Y descent in cardiac tamponade?
TAMponade = TAMpaX.
What is the management for cardiac tamponade?
Urgent pericardiocentesis.
What does an ECG show in cardiac tamponade?
Electrical alternans.
What are the causes of constrictive pericarditis?
Any cause of pericarditis, particularly tuberculosis.
What are the features of constrictive pericarditis?
Dyspnoea, right heart failure (elevated JVP, ascites, oedema, hepatomegaly), prominent x and y descent on JVP, pericardial knock (loud S3), and positive Kussmaul’s sign.
What does CXR show in constrictive pericarditis?
Pericardial calcification.
What are the key differences between cardiac tamponade and constrictive pericarditis regarding JVP?
In cardiac tamponade, JVP shows absent Y descent; in constrictive pericarditis, X and Y descents are present.
What is the characteristic feature of constrictive pericarditis?
Pericardial calcification on CXR.
What is the presence of pulsus paradoxus in cardiac tamponade and constrictive pericarditis?
Pulsus paradoxus is present in cardiac tamponade and absent in constrictive pericarditis.
How does Kussmaul’s sign differ between cardiac tamponade and constrictive pericarditis?
Kussmaul’s sign is rare in cardiac tamponade and present in constrictive pericarditis.
What mnemonic can help remember the absent Y descent in cardiac tamponade?
TAMponade = TAMpaX.
What are some causes of pericardial effusion?
Causes include: infectious pericarditis (viral, tuberculosis, pyogenic spread from septicaemia and pneumonia), uraemia, idiopathic, post myocardial infarction (including Dressler’s syndrome), malignancy, heart failure, nephrotic syndrome, hypothyroidism, and trauma.
What is the appearance of the heart in patients with pericardial effusion?
The heart appears enlarged, resembling a ‘water-bottle heart’.
