Pericardial disease

Question 1

how the pericardial disease is common ?

Answer 1

its common in male and the incidence is 2-6%

Question 2

what’re the types of the pericardial disease ?

Answer 2

• acute last (1-2 week)
• chronic more than 2 weeks
• recurrent with repeat attack

Question 3

what’re the causes of the pericardial disease ?

Answer 3

1- most of the cause is unknown Idiopathic 
2- may be infectious from viral , bacterial TB ,fungal 
3- Immuno-inflammtory  disease 
4- CT disease 
5- post MI or post cardiac disease 
6- rheumatic fever 
7- drug induce 
8- trauma , tumor, radiation 
9- uremia 
10 - hypothyrodism 

اهم الاسباب الشائعه هي unknown , immune , ct , post MI ,uremia , hypothyrodism , TB

Question 4

what’re the clinical feature of the pericardial disease ?

Answer 4

1- history of the pt of some disease

2- typical pleural pain

3-pt will have respiratory symptomas as dyspnea , cough , hiccup

4- other associated signs as fever , tachycrdia

5- pt releif when sit and lay forward

6- auscultation of the pericardial rub

Question 5

how to diagnosis the pt with pericardial disease ?

Answer 5

1- pt history

2- lab tests

-blood test will have high WBC count (11000-13000)
mild lyphocytosis and raised ESR

• cardiac marker is normal as Troponin & CK-MB

-ECG
show diffuse concave ST elevation in all lead except the V1 & avR
while PR depression
then T wave depression

• Chest X-ray is normal unless there is large pericardial volume

-ECHO
normal in most pt خصوصا
pt with mild pricardial
pt with myocarditis and MI

Question 6

what the treatment of the pericardial disease ?

Answer 6

• we could give symptomatic drugs as NSIDs as ibuprofen 600-800 x2 for 3 week
• pericardiadiocentesis with antibiotic acourding the culture
• give specfic therpay for bacterail pericarditis
• give Anti -TB for the TB pericarditis
• if the case is unresponsive or recurrent we give steroid for 2-3 weeks or colchicine 1mg /day
• but when the pt is uremic we do dialysis

Question 7

what the complication of the pericardial disease ?

Answer 7

1- pericardial effusion & tampondate

2- constrictive pericarditis

3- recurrance in 15-30 %

Question 8

whats the clinical feature of the pericardial effusion ?

Answer 8

1- asymptomatic in chronic case but symptomatic in tamponade or any underlying cause

2- pericardial pain
3- dyspnea

Question 9

what’re the signs of the tamponade ?

Answer 9

1- dyspnea and tachypnea

2- shock state , cold extremities , peipheral cynosis

3- high pulse rate is more 100
but low blood pressure less than 100
pulsus pardoxical more than 10

4- raised JVP with prominant x descent

5- muffling S1 & S2

Question 10

what’re the diagnostic method for pericardial effusion ?

Answer 10

1- ECG
low voltage ECG
with electric alternans of QRS

2- X ray
show large globular heart

3-ECHO
free space ECHO
if there is cardiac tamponade there will be RV & LV collapse

4- CT & MRI
to check the amount of the fluid and the thickness of the pericardium

5- pericardial fluid analysis
for WBC , SUGAR , PROTIEN , GRAM STAIN , CULTURE & SENSIVITY ,
Acid-fast bacilli (AFB) FOR TB ,
ADENOSINE DEAMINASE ENZYME ACTIVITY enzyme that increases in TB
PCR Polymerase chain reaction

Question 11

whats the treatment of the pericardial effusion ?

Answer 11

1- if its mild and no sign of temponade give conservitive treatment and follow up

2-if moderate with signs give pericadiocentesis

Question 12

what’s the differential diagnosis of cardiac tamponade ?

Answer 12

1- pulmonary embolism
2- Rt ventricular infraction
3- Rt ventricular failure
4- asthma