Pericardial Disease Flashcards
Acute Pericarditis
<6 weeks Fibrinous Effusive (serous or sanguinous)
Subacute Pericarditis
6 weeks to 6months effusive-constrictive constrictive
Chronic Pericarditis
>6 months contrictive effusive adhesive (non-constrictive)
Major causes of pericardial disease
● Idiopathic ● Infectious ● Radiation ● Neoplastic ● Cardiac ● Trauma ● Autoimmune ● Drug ● Metabolic
Pericardial Effusion
Diagnostic studies ● CxR ● Normal if effusion is small ● If >250ml, then the heart changes shape
Radiation
related to amount of exposure can lead to restrictive pericarditis
Neoplastic
Metastatic ● Lung, breast, Hodgkin’s, leukemia Primary ● Rhabdomyosarcoma, teratoma, fibroma, lipoma Paraneoplastic
Hemorrhagic pericarditis
● Blood in the pericardium ● Commonly after cardiac surgery ● Malignancy ● Tuberculosis ● Systemic anticoagulation
Young, otherwise healthy
Lupus
With fever, cytopenia
viral
Elderly, hx cancer
cancer
MI 1 month prior
dressler’s
CKD, not on dialysis
Uremic
What pericaditis hurts? doesnt?
infectious/inflammatory uremic and malignant
Pericardial fluid testing
● Culture(s), gram-stain ● Viral PCR/viral culture ● Cell count ● Protein ● LDH ● Glucose
Anatomy of Pericardium
● Pericardium is contiguous with the retropharyngeal space (between the alar fascia and prevertebral fasica ● Abcess can track
Diagnostic Approach
● Echocardiogram − May find a pericardial effusion ● PPD ● Connective tissue screen − ANA, rheumatoid factor − SED rate, ● Mild elevations in cardiac enzymes are typical ● Search for cancer!! − Lung and breast. ● Do a CxR and breast exam.
Physical Exam
● Pericardial friction rub present in 85% of acute pericarditis ● End-expiration, leaning forward, upright position ● Heart sounds may be distant
Treatment of Pericarditis
● Treat underlying cause – SLE, cancer, sarcoidosis, uremia ● NSAIDS – ketorolac, naproxyn, ibuprofen, indomethacin ● Aspirin ● Colchicine ● Limited by renal / GI safety – steroids also effective
Cardiac Tamponade
● Hypotension ● Tachycardia ● JVD ● RV compression on echo ● IVC distension on echo, without respiratory phasic collapse ● May occur with only minimal effusion ● Don’t wait for the echo – get help immediately
Infectious Pericarditis
Viral Pyogenic Tuberculin Fungal Other infection
Noninfective Pericarditis
Acute MI Uremia Neoplasia -primary tumors (benign, malignant, mesothelioma) -tumors metastatic to pericardium (lung, breast, lymphoma, leukemia) Myxedema Cholesterol Chylopericardium Trauma (penetrating, non) Aortic Disection (w leakage) Postirradiation Familial Mediterranean Fever Familial Pericarditis (Mulibrey nanism) Acute idiopathic Whipple’s Disease Sarcoidosis
Pericarditis presumably related to hypersensitivity or autoimmunity
Rheumatic fever collagen vascular disease (SLE, RA, ank spond, scleroderma, acute rheumatic fever, Wegner’s) Drug-induced Postcardiac injury 1. postMI (dressler’s) 2. Postpericardiotomy 3. Posttraumatic
