Pericardial diseases Flashcards
What are the causes of acute pericarditis?
- viruses - coxsackie, EBV, flu
- TB
- bacteria - pneumonia, rheumatic fever, staph, strep
- Post MI - Dressler’s syndrome
- Uraemia - ‘fibrinous’ pericarditis
- SLE, sarcoidosis
What is the typical presentation of pericarditis
pleuritic chest pain relieved by sitting forward and worse on inspiration
non-productive cough
SOB and fever
pericardial rub
What ECG changes can be seen in pericarditis?
saddle sT elevation
PR depression
widespread changes
What may XR show in pericarditis?why
cardiomegaly due to pericardial effusion
Rx of pericarditis
- treat cause
- NSAIDs
- colchicine if recurring
What are the clinical features of a pericardial effusion
- SOB
- raised JVP
- Bronchial breathing at L base
- signs of cardiac tamponade
What investigations point to a diagnosis of pericardial effusion?
- CXR - enlarged globular
- ECG - low voltage QRS, alternating QRS morphology
- Echo
What is the treatment of pericardial effusion?
treat the cause
What can cause constrictive pericarditis?
any cause of pericarditis - is a complication of it
TB
What are the sx of constrictive pericarditis?
SOB
oedema
What are the signs of constrictive pericarditis?
That of RHF: raised JVP, ascites, hepatomegaly \+ve Kussmaul's sign Pericardial knock S3 JVP w prominent X and Y descent
What is kussmauls sign
JVP rising paradoxically w inspiration
What can be seen on XR in constrictive pericarditis?
pericardial calcification
What is the treatment of constrictive pericarditis?
surgical excision
what is cardiac tamponade?
accumulation of pericardial fluid leading to raised intrapericardial pressure -> poor ventricular filling -> reduced CO
What are the features of cardiac tamponade?
BECKS triad:
- hypotension
- raised JVP
- Muffled heart sounds
What are the causes of cardiac tamponade?
pericarditis
aortic dissection
haemodialysis
What is diagnostic of cardiac tamponade?
echo
what is the treatment of cardiac tamponade
urgent pericardiocentesis + culture fluid
Explain how cardiac tamponade and constrictive pericarditis differ
Tamponade
JVP: Absent Y descent
PP: present
K’s sign: absent
CP JVP: X + Y present PP: absent K's sign: present Features: pericardial calcification
