Pericardial Disease Flashcards
What time period indicats acute pericarditis? What are the types?
Why time period indicates subacute pericarditis? What are the types?
What time period indicates chronic percarditis? What are the types?
- Acute pericarditis (<6 weeks)
- fibrinous
- effusive (serous or sanguineous)
- Subacute pericarditis (6 weeks to 6 months)
- effusive-constrictive
- constrictive
- Chronic pericarditis > 6 months
- constrictive
- effusive
- adhesive (nonconstrictive)
What are the 3 differentials to consider for pericarditis?
- Infectious pericarditis
- Noninfectious pericarditis
- Pericarditis presumable related to hypersensitivity or autoimmunity
What etiological causes are you considering when screening for viral pericarditis?
- infectious pericarditis
- viral (Coxsackievirus A and B, echovirus, mumps, adenobirus, hepatitis, HIV)
- pyogenic (pneumococcus, streprococcus, staphylococcus, neisseria, Legionella)
- Tuberculosis
- Fungal (histoplasmosis, coccidiodomycosis, Candida, blastomycosis)
- other infections (syphilic, protozoal, parasitic)
What are the 14 causes you are considering when screening for noninfectius pericarditis?
- Noninfectious pericarditis (more common than infectious)
- acute myocardial infarction
- uremia
- neoplasia
- primary tumors
- metastatic tumors to pericardium
- myxedema
- cholesterol
- chylopericardium
- trauma
- penetrating chest wall
- nonpenetrating
- aortic dissection (with leakage into pericardial sac)
- post-radiation
- familial mediterranean fever
- familial pericarditis
- mulbery nanism
- acute idiopathic
- Whipples disease
- Sarcoidosis
What causes are you considering when the pericarditis is presumably related to hypersensitivity or autoimmunity reactions?
- pericarditis presumably related to hypersensitivity or autoimunity
- rheumatic fever
- Collagen vascular disease (lupus, rheumatoid arthritis, ankylosing spondylitis
- drug-induced (procainamide, hydralazine, phentoin, isoniazid, minoxidil, anticoagulants, methysergide)
- post cardiac injury
- post myocardial infarction
- postpericardiotomy
- post-traumatic
Identify the indicated features of the pericardium
What are the 9 majore causes of pericardial disease?
- idiopathic
- infectious
- radiation
- neoplastic
- cardiac
- trauma
- autoimmune
- drug
- metabolic
What diagnostic studies would be use to detect pericardial effusion?
- Chest X-Ray
- Normal if effusion is small
- if >250mL, the heart changes shape
- “water bottle heart”
Radiation can lead to what type of pericarditis?
The amount of radiation is directly proportional to what variable??
restrictive pericarditis (acts like tamponade, but no fluid)
directly related to the amout of effusion
What are the most common causes of neoplastic pericardial effusion?
- Metastatic
- lung, breast, Hodgkin’s, leukemia, lymphoma
- Primary (rare)
- rhabdomyosarcoma, teratoma, fibroma, lipoma
- Paraneoplastic
What is hemorrhagic pericarditis?
When does hemorrhagic pericarditis most commonly occur?
blood in the pericardium
- Commonly after cardiac surgery
- Malignancy
- Tuberculosis
- Systemic anticoagulation
Most common cause of pericarditis in:
young, otherwise healthy people?
Lupus
Most common cause of pericarditis in:
fever, cytopenias
viral
Most common cause of pericarditis in:
elderly, with history of cancer
Most common cause of pericarditis in:
MI about a month ago
Dressler’s
will take about a month for fluid to accumulate after a MI
Most common cause of pericarditis in:
CKD, not on dialysis
uremic
Which types of pericardial effusions hurt?
Which types do not hurt?
Infectious and inflammatory hurt
uremic and malignant don’t hurt
What cause of pericarditis is common elsewhere in the world, but uncommon in the US?
tuberculosis
What testing woudl we order of pericardial fluid?
- culture(s), gram-stain
- Viral PCR/viral culture
- cell count
- Protein
- LDH Glucose
Fill out the provided table
How would you describe the characteristics of exudative fluid vs. transudative fluid?
- Transudative
- serous, watery, thin, hypocellular compared to exudative
- Exudative
- high protein, thick, puss, more LDH relative to blood, low glucose
THe pericardium is contiguous with what spaces?
Why is this important?
pericardium is contiguous withthe retropharyngeal space (between the alar fascia and prevertebral fascia)
Abcess can track
Describe the diagnostic approach you would take if someone showed up with a painful pericardial effusion.
- Echocardiogram
- may find pericardial effusion
- If reason to believe TB, perform a PPD
- Connective tissue screen
- ANA (antinuclear antibody–autoimmune disorder0, rheumatoid factor
- SED rate (looking for body-wide inflammation)
- If fluid, not uncommon to see mild elevations in cardiac enzymes: troponin (released when heart is damaged), total CPK(injury/stress), CPK-MB (found primarily in the heart)
- Search for cancer
- lung & breast
- Do a chest X-ray and breast exam
Pericardial friction rub is present in what percent of acute pericarditis?
In what position is this most prominent?
85%
End-expiration, leaning forward, upright position
Heart sounds may be distant
What are the 5 treatments for pericarditis?
- Treat underlying cause
- lupus, cancer, sarcoidosis, uremia
- NSAIDS
- ketorolac, naproxyn, ibuprofen, indomethacin
- Aspirin
- Colchicine
- Limited by renal / GI safety - steroids also effective
What are symptoms that would suggest cardiac tamponade?
If cardiac tamponade is suspected, what should you do?
- hypotension
- tachycardia (before hypotension)
- Jugular venous distent
- Right ventricular 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
This echo is performed from what view?
Identify the indicated features
Parasternal long axis view
What finding on an ECG is suspect for pericarditis?
universal ST elevation
What finding on an ECG is suspect for pericarditis?
electrical alternans
In what situations would you perform a pericardiocentesis?
In which situations would you not?
Attempt if patient is unstable & tamponading
NOT if patient is stable
When performing a pericardiocentesis with the assistance of an ECG, what does the elevated ST indicate?
that the needle is touching the heart and you need to back it up
