Pericardial Disease Flashcards
What are the types of Pericardial Disease?
- Acute Pericarditis
- Constrictive pericarditis
- Cardiac tamponade
- Dressler’s syndrome
- Pericardial Effusion
Each type has distinct features and management strategies.
What is Acute Pericarditis?
Inflammation of the pericardial sac lasting less than 4-6 weeks.
It can be caused by viral infections, tuberculosis, connective tissue diseases, and post-myocardial infarction.
What are the pathological causes of Acute Pericarditis?
- Viral (Coxsackie)
- Tuberculosis
- Connective tissue diseases (RA, SLE)
- Hypothyroidism
- Malignancy (lung cancer, breast cancer)
These conditions can lead to inflammation of the pericardium.
What are the early and late post-MI types of pericarditis?
- Early (1-3 days): fibrinous pericarditis
- Late (weeks to months): autoimmune pericarditis (Dressler’s syndrome)
Dressler’s syndrome is a specific type of pericarditis that occurs after myocardial infarction.
Symptoms of pericarditis
- Chest pain (acute onset, pleuritic, relived by sitting forward, worse lying down)
- Non-productive cough
- Dysponea
- Flu-like symptoms
- pericardial rub
What are the characteristic ECG findings in Acute Pericarditis?
- Saddle-shaped ST elevation
- PR depression
Changes are widespread across all leads, unlike those seen in ischemic events.
What blood tests are useful in diagnosing Acute Pericarditis?
- CRP
- Troponin (elevated in 30%)
Elevated troponin levels indicate cardiac muscle damage.
What is the management for Acute Pericarditis?
- Admit if fever or raised troponin
- Avoid exercise + strenuous activity
- NSAIDs + Colchicine
Management focuses on symptom relief and treating underlying causes.
What is Constrictive Pericarditis + most common cause?
Chronic thickening of the pericardium most commonly caused by TB
It often results from infections like tuberculosis.
What are the signs of Constrictive Pericarditis?
- Dyspnoea
- Right-sided heart failure (elevated JVP, ascites, edema, hepatomegaly)
- Kussmaul’s sign
- Pericardial knock - high pitched sound sheard in diastole
These signs indicate impaired heart function due to pericardial constriction.
What is Kassmaul’s sign?
- Paradoxical rise in JVP during indspiration
- Most common in constrictive pericarditis
CXR for constricitve pericarditis
Calcification of pericarium
What is Beck’s Triad in Cardiac Tamponade?
- Hypotension
- Raised JVP
- Muffled heart sounds
This triad is critical for diagnosing cardiac tamponade.
What are the signs of Cardiac Tamponade?
- Dyspnoea
- Tachycardia
- Absent Y descent on JVP
- Pulsus paradoxus
Pulsus paradoxus is characterized by a significant drop in blood pressure during inspiration.
ECG findings: cadiac tamponade
Electrical Alternans (alternating QRS complex amplitude between beats)
What is the first-line treatment for Cardiac Tamponade?
Urgent pericardiocentesis.
This procedure relieves pressure on the heart by removing fluid from the pericardial sac.
What is Myocarditis?
Inflammation of the myocardium.
It is most common in individuals aged 6-30 years.
What are the most common pathogenic causes of Myocarditis?
VIRUS:
* Human herpes virus 6 (60%)
* Parvovirus B-19 (30%)
* Enteroviruses (Coxsackievirus B)
* HIV
* Influenza A
BACTERIA:
- Step A (rheumatic fever)
Viral infections are the leading cause of myocarditis.
What are the most common pathogenic causes of Myocarditis?
AI: SLE, sarcoidosis
Drugs: Clozapine, Pembrolizumab
Radiation
What symptoms are associated with Myocarditis?
- Chest pain
- Systemically unwell (fatigue, fever)
- Tachycardia, palpitations
- Shortness of breath + reduced exercise tolerance
- Sudden cardiac death (8%)
- HF signs
Symptoms can vary widely and may indicate severe complications.
What investigations are useful for diagnosing Myocarditis?
- ECG
- Blood tests (FBC, CRP, creatine kinase + troponin + AI markers)
- Imaging (Echo, Cardiac MRI)
These tests help assess cardiac function and damage.
ECG changes: Myocarditis
- Sinus tachycardia
- Non-specific ST segment and T waves changes
What is the general management approach for Myocarditis?
- Mostly supportive care as usually viral cause
Early intervention is crucial, especially for severe cases.
