Pericardial Disease

Question 1

What is the difference between acute pericarditis, Constrictive Pericarditis and Cardiac Tamponade?

Answer 1

Acute pericarditis = Inflammation of the pericardium

Constrictive Pericarditis = Fibrosing of the pericardium leading to the heart being encased in a rigid sac

Cardiac Tamponade = Increase in pericardial fluid -> Increase in intrapericardial pressure -> Lower ventricle filling and reduced Cardiac Output

Question 2

What causes acute pericarditis?

Answer 2

Idiopathic
Trauma/Surgery
Bacterial Infection (incl. Rheumatic Fever)
Viral or fungal infection
SLE
MI
Malignancy

Question 3

How does acute pericarditis present?

Answer 3

Central Chest Pain
Pericardial Rub
~ Fever

Question 4

HOw do we test for acute pericarditis?

Answer 4

ECG - Saddle shaped (concave) ST elevation
CXR - May show a pericardial effusion (follow with ECHO)
Bloods - FBC, ESR, U+E, Cardiac enzymes e.g. troponin
Blood cultures & Viral Serology

Question 5

How do we treat acute pericarditis?

Answer 5

With analgesia and by treating the cause

Can also drain the effusion if necessary (pericardiocentesis)

Question 6

What causes constrictive pericarditis?

Answer 6

Often unkown - TB - Post-pericarditis

Question 7

How does constrictive pericarditis present?

Answer 7

Fatigue - Dyspnoea - weakness - Peripheral Oedema (symptoms of RHF)
Raised JVP - Ascites (abdominal swelling) - quiet heart sounds

Question 8

How do we test for constrictive pericarditis?

Answer 8

CXR = May see small heart and calcification
CT/MRI - IF CXR unclear
ECHO
Cardiac Catherterisation

Question 9

How do we treat constrictive pericarditis?

Answer 9

Surgical Excision

Question 10

What causes cardiac tamponade?

Answer 10

Aortic Dissection
Any pericarditis
Warfarin
Surgery gone wrong

Question 11

How does cardiac tamponade present?

Answer 11

Cardiogenic Shock: Dizziness - Weakness/collapse - Dyspnoea - Cough
Central Chest Pain
Increased HR - Drop in BP - Raised JVP - Muffled Heart Sounds

Question 12

How do we diagnose Cardiac Tamponade?

Answer 12

Clinically: Becks Triad (Muffled Heart Sounds, Raised JVP and drop in BP)
CXR: Over 250ml will show a big globular heart
ECG: Low voltage QRS complexes
ECHO: Larger pericardium +/- collapsed ventricles (mainly right heart in diastole)
Aspirate some fluid and send for M,C & S

Question 13

How do we treat Cardiac Tamponade?

Answer 13

Treat the Cause

Drain the fluid (pericardiocentesis)