Pericardial Disease Flashcards
lab findings acute pericarditis
Mild elevation of WBC count
lymphocytosis
mild ESR elevation
mechanism cholchine
disrupt microtubules > mitotic spindle
significant anti-inflamm
role of pericardial prostaglandin secretion
modulation of coronary vascular tone
two layers of pericardium
visceral - mesothelial cells, adjacent to heart
parietal - collagen and elastic wavy+streight bundles
COPE study outcome
ICAP study outcome
open label randomized trial - addition of cholicincine to ASA, steroids halved the recurrance rate after intiial attack (level B)
reduced rate of incessant or reccurrent pericarditis (**Level A) **
incessant pericarditis
persistent or those with symptom free intervals of less than six weeks
hemopericardium
blood in pericardial sac - trauma or heart/aorta, myocardial rupture post-MI
symptoms acute pericarditis
chest pain - always present
better sitting forward, worse lying down
sharp, pleuretic
trapezius, ubsternal epigastric area
dyspnea, cough, hiccups, fever
physical exam acute pericarditis
fever,
tachycardia
anxiety
Pericardial friction rub (3 components) at LSB (best when pt leaning forward) (dynamic)
ECG findings acute pericarditis
dynamic
ST elevation (diffuse, not in aVR, V1)
ST segemnt concave
no reciprocal changes
Upright Twaves
PR depression (elevation in AVR)
echocardiogram acute pericarditis
small silent effusion
Stages of ECG findings acute pericarditis
1 - diffuse concave ST elevation
2 - ST normalizes, T decreases, PR depression (looks like ST elevation)
3 diffuse T wave inversions, symmetric, deep
- Normalizes, T wave inversions may be permanent
most common cardiac manissfestation of HIV
pericardial effusion
(capillary leak syndrome - serro-effusive process)
fluid volume of normal pericardial space
50ml
Diagnostic criteria acute pericardiits
2:
Typical chest pain (sharp, pleuritic, improved by sitting forward)
pericardial friction rub
ECG - widepread ST elevatior or PR depression
New or worsening pericardial effusion
