Pericardial Disease

Question 1

Clinical Features:

Answer 1

Central chest pain worse on inspiration or lying flat with relief from sitting forward.
A pericardial friction rub may be heard.
Fever

Question 2

ECG classically shows

Answer 2

concave ST segment elevation (saddle shaped – clearest in V5 + V6).

Question 3

Treatment:

1st line?

for recurrence?

Answer 3

NSAIDs or Aspirin with gastric protection for 1-2 weeks

Add colchicine to reduce risk of recurrence.

Question 4

A 41-year-old man is admitted with left-sided pleuritic chest pain. He has a dry cough and reports that the pain is relieved by sitting forward. For the past three days he has been experiencing flu-like symptoms. Given the likely diagnosis of acute pericarditis, what is the most likely finding on ECG?

AF
widespread ST elevation
Hyperacute T waves
ST depression

Answer 4

widespread ST elevation

Question 5

A 51-year-old male with a history of tuberculosis presents to the Emergency Department with worsening dyspnoea over the past few weeks associated with mild central chest pain. He struggles to lie flat on the examination couch, and his pain is relieved by leaning forwards.

A chest x-rays shows pericardial calcification.

Given the likely diagnosis which jugular venous pressure (JVP) sign is most likely to be present?

JVP decreases with inspiration
JVP increases with inspiration
Loud s2

Answer 5

JVP increases with inspiration

The JVP increasing with inspiration is known as Kussmaul’s sign and can be a feature of constrictive pericarditis.

Question 6

what is kussmaul’s sign?

Answer 6

The JVP increasing with inspiration is known as Kussmaul’s sign and can be a feature of constrictive pericarditis.

Question 7

A 55-year-old HIV positive man presents to the Emergency Department with sudden onset of chest pain. A more detailed history is taken which reveals that his pain is sharp and improves when he sits forward. Examination shows that he has a temperature of 38.1ºC and his heart rate is 115 beats/min. An ECG is carried out soon after and based on this man’s symptoms, what would be the most likely initial finding?

absent p wave
concave ST depression
concave ST elevation
T wave inversion

Answer 7

concave ST elevation

Saddle-shaped ST elevation is often seen in the ECG of a patient with acute pericarditis