Pericardial Disease

Question 1

what is pericarditis

Answer 1

inflammation of the pericardium

Question 2

what can cause pericarditis

Answer 2

viral infections -- coxsackie 
TB
Post MI -- Dresslers syndrome
SLE 
drugs -- hydralazine, procainamide

Question 3

classical symptom of pericarditis

Answer 3

chest pain which is worse lying down and relieved by sitting forward

Question 4

signs of pericarditis

Answer 4

pericardial rub
fever
tachypnoea / tachycardia

Question 5

ECG changes in pericarditis

Answer 5

widespread saddle shaped ST elevation

Question 6

tx pericarditis

Answer 6

NSAIDs

+ colchicine if viral / idiopathic

Question 7

what is constrictive pericarditis

Answer 7

rigid, fibrotic pericardium

Question 8

what can cause constrictive pericarditis

Answer 8

often idiopathic
may follow acute pericarditis
- particularly TB

Question 9

signs + symptoms of constrictive pericarditis

Answer 9

Right ventricular failure – SOB, hepatomegaly, peripheral oedema, raised JVP + Kussmaul’s sign (raised JVP on inspiration)
muffled heart sounds
Loud S3 - pericardial knock

Question 10

diagnostic Ix of constrictive pericarditis

Answer 10

echo

Question 11

tx of constrictive pericarditis

Answer 11

pericardiectomy

Question 12

what is a pericardial effusion

Answer 12

fluid in the pericardial sac

Question 13

what causes a pericardial effusion

Answer 13

usually a complication of acute pericarditis

may also be caused by cancer

Question 14

appearance of heart of CXR in a pericardial effusion

Answer 14

globular heart

Question 15

echo findings in pericardial effusion

Answer 15

echo-lucent area around the heart

Question 16

tx of a pericardial effusion

Answer 16

treat underlying cause

• NSAIDS for pericarditis
• chemo for cancer

pericardiocentesis for impending tamponade (a complication of effusion)

Question 17

what is cardiac tamponade

Answer 17

fluid in pericardial sac accumulates until increased pressure causes decreased ventricular filling – decreased cardiac output

Question 18

causes of cardiac tamponade

Answer 18

Trauma
Aortic dissection
Medical – warfarin, cardiac catheterisation
Pericardial effusion / pericarditis

Question 19

what is Becks triad

Answer 19

hypotension
raised JVP
muffled heart sounds
- seen in cardiac tamponade

Question 20

what type of pulse is seen in cardiac tamponade

Answer 20

pulsus paradoxus

- drop in BP during inspiration

Question 21

ECG changes in cardiac tamponade

Answer 21

electrical alternans

- different amplitude of alternate QRS complexes

Question 22

tx of cardiac tamponade

Answer 22

urgent pericardiocentesis