Pericardial disease + aneurysm

Question 1

Pathophysiology of pericarditis

Answer 1

Inflammation of the pericardium

Often preceded by an URTI

Question 2

Presentation of pericarditis

Answer 2

Pain worse when lying flat 
Relieve when lying forward 
Pericardial rub on auscultation 
Pleuritic chest pain
Fever

Question 3

Investigations of pericarditis

Answer 3

Bloods - Troponin I, LFTs, U+Es, CRP, FBC
ECG - saddle shaped ST
Transthoracic echocardiogram
CXR - check for pericardial effusion

Question 4

ECG changes of pericarditis

Answer 4

Saddle shaped ST segment
PR depression
Reciprocal ST depression and PR elevation in AVR and V1

Question 5

Management of pericarditis

Answer 5

• self limiting normally
• treat underlying cause such as uraemia
• colchicine - 3 months with gastric protection

Question 6

Aneurysm presentation

Answer 6

• 4-6wk
• Angina
• Recurrent VT
• Systemic emboli

ECG: can show persistent ST elevation

Question 7

Mx of aneurysm

Answer 7

• Anticoagulate

* Consider Excision

Question 8

Dressler’s Syndrome

Answer 8

Pericarditis 2 - 6 wks after MI or heart surgery do to auto-immune cause

Question 9

Causes of pericarditis

Answer 9

Viral: coxsackie, flu, EBV, HIV
Bacterial: pneumonia, rheumatic fever, TB, staphs
Fungi
MI, Dressler’s
Drugs: penicillin, isoniazid, 
Other: uraemia, RA, SLE

Question 10

Pericardial effusion

Answer 10

Any cause of pericarditis

Question 11

Features of pericardial effusion

Answer 11

• Dyspnoea
• ↑JVP
• Bronchial breathing at left base

Question 12

Pericardial effusion on CXR

Answer 12

Meniscus

Shadowing of costophrenic angles

Question 13

Mx of pericardial effusion

Answer 13

Treat cause
Pericardiocentesis may be diagnostic or therapeutic

Culture- ZN stain and cytology

Question 14

Acute Myocarditis

Answer 14

Idiopathic
Viral: coxsackie B, flu, HIV
Bacterial: S. aureus, syphilis
Drugs: cyclophosphamide, Herceptin, phenytoin
Autoimmune: Giant cell myocarditis assoc. with SLE

Question 15

Symptoms of acute myocarditis

Answer 15

Flu-like prodrome: fever, sore throat, myalgia
Dyspnoea, fatigue
Chest pain
Arrhythmia → palpitations

Question 16

Investigations for acute myocarditis

Answer 16

Ix
ECG:
- ST-elevation or depression
- T wave inversion
- Transient AV block

Bloods: +ve trop, ↑CK

Question 17

Acute myocarditis tx

Answer 17

Supportive

Tx cause