Pericardial Disease Flashcards
What is pericarditis?
Inflammation of the pericardium, the membrane surrounding the heart.
The most common causes are idiopathic and viral.
What is the pericardium?
Membrane surrounding the heart.
It plays a crucial role in protecting the heart and maintaining its position.
What is pericardial effusion?
Potential space of pericardial cavity fills with fluid, creating inward pressure on heart, making it more difficult to expand during diastole.
This can lead to complications if the pressure becomes significant.
What is pericardial tamponade?
Pericardial effusion large enough to raise intra-pericardial pressure, squeezing the heart and affecting its ability to function.
This is a medical emergency requiring prompt drainage.
List some common causes of pericarditis.
- Idiopathic
- Infection (e.g., tuberculosis, HIV)
- Autoimmune diseases (e.g., SLE, rheumatoid arthritis)
- Injury (e.g., post-MI, open heart surgery)
- Uraemia
- Malignancy
- Medications (e.g., methotrexate)
Each cause can lead to inflammation of the pericardium.
What are the key clinical features of pericarditis?
- Chest pain (sharp, central/anterior, worse with inspiration and lying down, better sitting forward)
- Low-grade fever
- Pericardial friction rub
The friction rub is a hallmark sign heard during auscultation.
What investigations are used to diagnose pericarditis?
- Raised WCC, CRP, ESR
- ECG showing saddle-shaped ST-elevation and PR depression
- Transthoracic echo
The echo is particularly important for confirming the diagnosis.
What is the gold standard management for pericarditis?
- NSAIDs (e.g., aspirin, ibuprofen)
- Colchicine for longer-term prevention of recurrence
Treating underlying causes is also essential.
What is cardiac tamponade?
A life-threatening emergency where fluid accumulates rapidly in the pericardial sac, compressing the heart and impairing ventricular filling.
This leads to reduced cardiac output.
List the components of Beck’s triad in cardiac tamponade.
- Hypotension
- Raised JVP
- Muffled heart sounds
These signs indicate reduced cardiac output and impaired venous return.
What are other clinical signs of cardiac tamponade?
- Pulsus paradoxus (drop in SBP on inspiration)
- Tachycardia
- Dyspnoea
- Chest pain or fullness
These signs can help in the clinical assessment of the condition.
What investigations are used for cardiac tamponade?
- ECG showing low voltage QRS and electrical alternans
- CXR revealing an enlarged ‘globular’ heart
- Echo for diagnosis
These tests are critical for confirming the diagnosis and assessing severity.
What is constrictive pericarditis?
A chronic condition where the pericardium becomes thickened, fibrotic, and non-compliant, restricting diastolic filling of the heart.
This condition can lead to significant heart failure if not treated.
List some causes of constrictive pericarditis.
- Post-viral pericarditis
- Tuberculosis
- Post-cardiac surgery
- Radiation therapy
- Connective tissue disease (e.g., SLE, RA)
Each of these factors can lead to the chronic thickening of the pericardium.
What are the clinical features of constrictive pericarditis?
- Fatigue
- Dyspnoea
- Raised JVP
- Peripheral oedema
- Ascites
- Splenomegaly
- Kussmaul’s sign
- Pericardial knock
These features indicate impaired heart filling and systemic congestion.
What is the management for constrictive pericarditis?
- Diuretics for symptom relief
- Pericardiectomy as a definitive treatment
Surgical intervention may be necessary for long-term resolution.
