Pericardial disease Flashcards
pericardium
visceral and parietal layer with pericardial cavity between them
how much fluid is in the pericardium?
15-50ml
pericarditis
inflammation of pericardium
- acute and recurrent pericarditis
- pericaridal effusion without major hemodynamic compromise
- cardiac tamponade
- constrictive pericarditis
acute pericarditis
rapidly inflammation of pericardium
causes of pericarditis
radiation neoplasms: primary, metastatic, or paraneoplastic trauma autoimmune metabolic: hypothyroidism, uremia
infection causes
viral
Bacterial:
fungal:
AIDS
infection causes: viral
coxsackie, echovirus, mumps, adeno, HIV
bacterial causes
TB, pneuomococcus, strept, staph, legionella
infection causes: fungal
histoplasmosis, coccidioidomycosis, candida, blastomycosis
cardiac causes of pericarditis
- early infarction
- late post cardiac injury (Dressler’s)
- myocarditis
- resulting from dissecting aortic aneurysm
drugs that cause pericarditis
procainamide
isoniazide
hydralazine
etiology of acute pericarditis
most idiopathic vial neoplastic TB/histoplasmosis radiation purulent (bacterial) connective tissue disease post-myocardial infarction uremia
pathological anatomy of acute pericarditis
- usually fluid accumulation
- bacterial or tumor
- sometimes bacterial infection causes purulent pericarditis
- fluid may resolve or form adhesions
chest pain
present most the time
sudden onset
anterior chest wall
sharp, pleuritic in nature: inflammation of lining of lungs
worse with laying flat, inspiration or coughing
better when seated, leaning forward
presentation of acute pericarditis
chest pain (unrelated to exertion)
fatigue, dyspnea, malaise
fever
-can mimic onset of the flu
what causes the pericardial friction rub
friction between the two inflamed layers of pericardium
- scratchy, leathery sound-> high pitch than diastolic filling sounds
- triphasic or biphasic
- can come and go, very in intensity
when is it best to hear the pericardial friction rub?
diaphragm over left sternal border
-patient sitting upright or leaning forward
evaluation for acute pericarditis
ESR, CBC, blood chemistries -CXR usually normal echo viral studies autoimmune serologies pericardiocentesis if suspect purulent pericarditis, malignancy or large effusion
evaluation for acute pericarditis
- history, ECG, exam
- ESR, CBC, blood chemistries
- CXR usually normal
- echo
- viral studies
- autoimmune serologies
- pericardiocentesis if suspect purulent pericarditis, malignancy or large effusion
what is seen on ECG with acute pericarditis
seen with visceral inflammation of pericardium
ST and PR segment change:
-convex shape for ST segment
-diffuse ST elevation (acute pericarditis): I, II, III, aVF, V2-6
-PR depression: II, III, aVF
-aVR ST depressions
-aVR PR segment elevation
what is important to do on physical exam for chest pain
- ask where it hurts
- press on the spot-> to see if its musculoskeletal
ECG stages in pericarditis: Stage 1
first hours to days
-ST elevation and PR depression
ECG stages in pericarditis: Stage 2
first week
normalization of ST and PR segment
ECG stages in pericarditis: Stage 3
T wave inversions, AFTER ST have become isoelectrical
ECG stages in pericarditis: Stage 4
hjj
complications of acute pericarditis
- pericardial effusion and tamponade
- constrictive pericarditis (late)
- relapse