Pericardial Disease Flashcards
Functions of the pericardium
- Stabilizes and restricts chamber dilatation
- Minimizes friction b/w heart and pulmonary pleura/vessels
Causes of pericardial disease?
- Infection (viral MC)
- Idiopathic
- Systemic (mets neoplasm, rheumatic fever)
- Trauma (s/p acute MI - Dressler’s syndrome)
- Cardiac surgery
- Mediastinal radiation
- Uremia
Categories of pericardial disease by chronicity
-Acute
Categories of pericardial disease by pathology
- Fibrous (dry, no effusions)
- Effusive (purulent, hemorrhagic exudate)
- Constrictive (impedes diastolic filling, occurs after acute pericarditis)
Which types of pericardial disease can lead to tamponade?
- Effusive
- Constrictive
What are the MC causes of acute pericarditis?
Viral and idiopathic make up 90% of cases
What viruses cause acute pericarditis?
- Coxsackie virus A/B
- Echo virus 8
- Mumps
- Adenovirus
- Hepatitis
- HIV
Who is affected by pericarditis?
- Onset at 20-50 yo
- Males > females
- Approx 5% of chest pain complaints in the ED
Cardinal manifestations of acute pericarditis
- Chest pain
- Pericardial friction rub (along LSB)
- ECG changes
- Pericardial effusion (w or w/o tamponade)
Presentation of patient with acute pericarditis
- Few days or more with low grade fever and myalgias/weakness
- Sudden onset of severe anterior chest pain that worsens with breathing and lying down
When is a pericardial friction rub heard best?
- Sitting up/leaning forward at end of expiration
- LSB
What diagnoses acute pericarditis?
- Diffuse ECG ST elevations, PR depressions, NO Q waves
- Pericardial effusion on echo
- Systemic inflamm markers (CRP, ESR, high WBC)
Describe the chest pain a/w acute pericarditis
- Pain is positional (lying, coughing, swallowing) and not related to exertion
- Pain does not respond to nitroglycerine
- Radiates to trapezius ridge
What can a CXR show with acute pericarditis?
“Water bottle” heart silhouette
What diagnostic tool can assess for tamponade?
Echo
1st line treatment for acute pericarditis
- 2 weeks NSAIDs (or ASA for post-MI)
- 3 months colchicine
- PPI
Treatment for severe symptomatic acute pericarditis
1-2 weeks prednisone + colchicine
Why aren’t NSAIDs a part of post-MI pericarditis (Dressler’s) treatment?
- Can slow myocardial healing
- So ASA is used instead
Non-pharm treatments of acute pericarditis
- Pericardiocentesis (tap)
- Pericardiectomy (stripping)
When is pericardiectomy indicated to treat pericarditis?
- Recurrent pericarditis
- Constrictive with adhesions
- Resistant to meds
What are the 2 main complications of pericarditis?
- Cardiac effusion
- Cardiac tamponade
Define cardiac tamponade
Compression of the heart due to fluid accumulation within the pericardium
What determines seriousness of tamponade?
Rate of effusion accumulation
How does tamponade affect the heart?
- All chambers compressed d/t increased intrapericardial pressure
- Decreased chamber size = decreased diastolic compliance = decreased venous return
Beck’s triad of tamponade
- JVD (MC finding)
- Hypotension
- Distant to absent heart sounds
Pulsus paradoxus
- 10+ mm Hg drop in SBP with inspiration
- Consequence of ventricular interdependence (competition for space)
- RV bulges into LV = decreased filling/EDV = decreased SV = decreased BP
- Complication of pericarditis
Define ventricular interdependence
To fill one ventricular chamber, the other has to fill less
competition for space
Treatment of tamponade
- If stable and small effusion = monitor through JVD, paradoxical pulses, serial echo
- If necessary, pericardiocentesis
