Pericardial disease Flashcards
What is the normal pericardium?
A fibroelastic sac containing a thin layer of fluid (50mL) that surrounds the heart and roots of the great vessels
What are the most common causes of acute pericarditis?
Most commonly due to viral infection- Coxackie B, echovirus, HIV infection- or following on from MI
What are the other causes of acute pericarditis?
Uraemia Autoimmune rheumatic disease Trauma Bacterial/tuberculosis/fungal infection Malignancy- breast, lung, leukaemia and lymphoma
What is the characteristic pain of acute pericarditis? How is it relieved? What exacerbates the pain?
Sharp retrosternal chest pain which is characteristically relieved by leaning forward. Worse on inspiration
Where does the pain of acute pericarditis radiated?
The neck and shoulders
What is heard on auscultation of a patient with acute pericarditis?
Pericardial friction rub
How is acute pericarditis diagnosed?
ECG?
What does the ECG look like in a patient with acute pericarditis?
Global, saddle shaped ST elevation
How is a pericardial friction rub best heard?
Lower left sternal edge with the patient leaning forward
How is acute pericarditis managed?
Treatment of underlying disorder + NSAIDs
Systemic corticosteroids are used in resistant cases
When should NSAIDs not be used to treat acute pericarditis? Why?
In the first few days following MI. This is because they are associated with a higher rate of myocardial rupture
What are the complications of acute pericarditis?
Pericardial effusion Chronic pericarditis (>6-12 months)
What is pericardial effusion?
An accumulation of fluid in the pericardial sac
What causes pericardial effusion
Any of the causes of acute pericarditis
Hypothyroidism also causes pericardial effusion
What is pericardial tamponade?
A medical emergency which occurs when a large amount of pericardial fluid which has often accumulated rapidly restricts diastolic ventricular filling and causes a marked reduction in cardiac output
What is the main clinical feature of pericardial effusion?
The effusion obscures the apex beat and heart sounds are soft
What are the signs of pericardial tamponade?
Hypotension
Tachycardia
Elevated JVP which rises with inspiration
Pulsus paradoxus
What is seen on an X ray in pericardial effusion?
Large globular heart
What is seen on an ECG in pericardial effusion?
Low voltage complexes
What is the diagnostic test for pericardial effusion? What does it show?
Echo
Shows an echo free space around the heart
When are invasive tests to establish the cause of a pericardial effusion necessary?
If the effusion is persistent
If a purulent or tuberculosis effusion is suspected
If the effusion is not known to be secondary to an underlying illness
What invasive tests might be used to establish the cause of a pericardial effusion?
Percardiocentesis: aspiration of fluid under echocardigram guidance
Pericardial biopsy for culture, cytology/histololgy and PCR (for TB) give a greater diagnostic yield with larger effusions
How is cardiac tamponade treated?
Emergency pericardiocentesis
Pericardial fluid is dained percutaneously by introducing a needle into the pericardial sac. If the effusion recurs, in spite of treatment of the underlying cause, excision of a pericardial segment may be necessary. Fluid is then absorbed through the pleural and mediastinal lymphatics
What is constrictive pericarditis?
The heart becomes encased within a rigid fibrotic pericardial sac which prevents adequate diastolic filling of the ventricles.
