Pericardial Disease Flashcards
What are the two layers of the pericardium?
Visceral pericardium - inner serosal layer
Parietal pericardium - outer fibrous layer
What happens to the intrapericardial pressure (i.e. the pressure on fluid in pericardium) with breathing?
Negative pressure on inspiration
Positive pressure on expiration
But normally should only vary +/- 5 mm Hg
What is the definition of pericarditis?
Inflammation of pericardium
What are the two types of causes of acute pericarditis and which is more common?
Infectious - more common
Non-infectious
What type of infections cause acute pericarditis and which is more common?
Viral - more common
TB
Pyogenic bacteria
Which viruses typically cause viral (“idiopathic”) pericarditis?
Echovirus
Coxsackie B
Is it helpful to get viral titers of someone with acute pericarditis?
No
By the time results are available, symptoms have abated
How does acute pericarditis appear?
Serofibrinous pericarditis - plasma proteins like fibrinogen, rough & shaggy, red and inflammed
“Bread and butter”
What are clinical features of acute pericarditis?
Pleuritic chest pain - relieved by leaning forward, sitting up
Fever
Pericardial friction rub - 3 components
EKG abnormalities
Describe the pericardial friction rub that occurs in acute pericarditis
Will have scratching sounds when ventricles contract and relax, and when atria contract (3 components)
Sounds like creaking leather
Describe the EKG abnormalities that occur in acute pericarditis
DIFFUSE ST elevation in all leads
PR depression - subtle, diagnostic of pericarditis
What is the treatment for acute pericarditis?
Self limiting - only need bed rest and NSAIDs
AVOID anticoagulants - will bleed into pericardium
What organisms will cause purulent pericarditis?
Staph and other gram negative rods
How does purulent pericarditis appear?
Intense inflammatory response
Serosa is erythematous and coated with purulent exudate
How does hemorrhagic pericarditis appear?
Gross blood in pericardium
Usually due to trauma, TB, or cancer
What is the treatment for purulent pericarditis?
Catheter drainage
Antibiotics
Mortality very high
What is the treatment for TB pericarditis?
Anti-TB meds
What are possible non-infectious causes of pericarditis?
Post MI Uremia Cancer Radiation induced Connective-tissue disease Drug-induced
What are the two forms of post MI pericarditis?
Early form - hear rub in 10-15% of STEMI patients
Late form - Dressler’s syndrome
Hear rub 2 weeks-several months after STEMI, possible autoimmune related
Which cancers typically can cause non-infectious pericarditis?
Lung
Lymphoma
Breast