Pericardial Disease Flashcards
What are the features of acute pericarditis?
Central chest pain worse on inspiration or lying flat (pleuritic) relieved by sitting forward
Other symptoms include non-productive cough, dyspnoea and flu-like symptoms
Pericardial rub
tachypnoea
tachycardia
What are causes of acute pericarditis?
Viruses - coxsackie Bacteria - TB Fungi - usually in immunocompromised Autoimmune - SLE, RA, vasculitis Drugs - isoniazid, penicillin, chemoptherapy Metabolic - uraemia, hypothyroidism TRauma Malignancy Post-MI
What investigation for acute pericarditis?
Bedside: ECG
Bloods: FBC, U&E, ESR, cardiac enzymes
Imaging: CXR may show cardiomegaly indicating a pericardial effusion, Echo
What are ECG features of acute pericarditis?
Widespread ‘saddle-shaped’ ST elevation
PR depression: most specific ECG marker for pericarditis
How is acute pericarditis treated?
NSAIDs or aspirin with gastroprotection for 1-2 weeks
Rest until resolved
Treat cause
Consider steroids if autoimmune
What is pericardial effusion?
Accumulation of fluid in the pericardial sac
What are the clinical feature of pericardial effusion?
Dyspnoea
Chest pain
Signs of local structures being compressed - hiccoughs (phrenic nerve) nausea (diaphragm) bronchial breathing at left base (compressed left lower lobe)
Muffled heart sounds
what are the causes of pericardial effusion?
Pericarditis Myocardial rupture - haemopericardium Aortic dissection Pus Malignancy
How is pericardial effusion diagnosed?
CXR shows large globular heart
Echo shows echo free zone surrounding heart
how is pericardial effusion managed?
Treat cause
Pericardiocentesis may be diagnostic (bacterial pericarditis - send for culture) or therapeutic (cardiac tamponade)
What is constrictive pericarditis? Causes?
Heart is encased in rigid pericardium
Any cause of pericarditis - often TB
Kussmaul's sign - paradoxical rise of JVP with inspiration Raised JVP Diffuse apex beat Quite heart sounds Pericardial knock - loud S3
What is cardiac tamponade?
Pericardial effusion that raises intrapericardial pressure reducing ventricular filling thus dropping CO
Can lead to cardiac arrest
What are features of cardiac tamponade?
TAchycardia
Hypotension
Pulsus paradoxus (large decrease in systolic BP during inspiration)
Raised JVP
Kussmaul’s sign - paradoxical rise in JVP during inspiration
Muffled heart sounds
How is cardiac tamponade diagnosed?
BEck’s triad - falling BP, rising JVP, muffled heart sounds
Echo is diagnostic - echo free zone around heart ± diastolic collapse of RA/RV
How is cardiac tamponade managed?
Pericardiocentesis
Send for staining and cytology
