Pericarditis Flashcards
What is pericarditis?
inflammation of pericardium (fluid filled sac around heart)
What are the different types of pericarditis?
- Acute pericarditis
- Pericardial effusion
- Constrictive pericarditis
- Cardiac tamponade
What are the inflammatory causes of pericarditis?
- Post-MI (1-3 days)
- Dressler’s syndrome (weeks months)
- Systemic (SLE, sarcoidosis)
- Trauma
What are the infection causes of pericarditis?
- Mostly viral:
1. Coxsackie B / A9
2. Echovirus
3. Mumps - TB in developing countries
What are the malignancy causes of pericarditis?
- Malignancy
- Radiotherapy
- Anti-cancer drugs
What are causes of acute pericarditis?
- Idiopathic
- Viruses: EBV, CMV
- Bacteria: TB
- Fungi and parasitic
- Autoimmune: SLE, RA
- Drugs
- Metabolic
What are RF for acute pericarditis?
- Male
- 20-50
- Transmural MI
- Cardiac surgery
- Neoplasm
What is chronic pericarditis?
chronic inflammation of the pericardium with thickening and scarring
What are causes of chronic pericarditis?
- Idiopathic
- Infectious (TB, Bacterial, Viral)
- Acute pericarditis
- Cardiac surgery and radiation
What is a pericardial effusion?
accumulation of fluid in pericardial sac
What are causes of pericardial effusion?
- Pericarditis
- Myocardial rupture
- Aortic dissection
- Malignancy
What is cardiac tamponade?
Pericardial effusion that raises intrapericardial pressure, reduced ventricular filling and so dropping cardiac output – can lead to cardiac arrest
What are RF for cardiac tamponade?
- Aortic dissection
- Purulent pericarditis
- Large idiopathic pericardial effusion
- TB
- Malignancy
What is the patho of cardiac tamponade?
fluid build up in pericardium restricts heart pumping
What is the normal epid for pericarditis?
Male 20-50yo
What is the key symptom of pericarditis?
pleuritic chest pain
What is the key sign of pericarditis?
pericardial friction rub
What are symptoms of acute pericarditis?
- Chest pain is sharp and central
- RELIEVED BY SITTING UP & LEANING FORWARD
- fever
- dyspnoea
- nausea
What is perciardial friction rub?
- Scratchy sound
- Heard at left sternal edge w/ patient leaning forward on expiration
- Use diaphragm of stethoscope
What are symptoms and signs of chronic pericarditis?
- similar to restrictive cardiomyopathy
1. RHF presentation (raised JVP, oedema)
2. Kussmaul’s sign
3. Diffuse apex beat
4. S3
What are symptoms of pericardial effusion?
- Dyspnoea
- Chest pain
- Signs of local structures compressed e.g. nausea, hiccoughs, muffled heart sounds
What are symptoms and signs of cardiac tamponade?
- High pulse
- Low BP
- Pulsus paradoxus
- High JVP
- Kussmauls’s signs
- Muffled S1 and S2
What is Beck’s triad for cardiac tamponade?
- Distended neck veins
- Decreased BP
- Distorted (muffled) heart sounds
What are possible DDx for acute pericarditis?
- PE
- MI
- Pneumonia
- Pneumothorax
- Costochondritis
What are possible DDx for pericardial effusion?
- Malignancy
- Viral pericarditis
- Latrogenic
- Idiopathic
What are possible DDx for cardiac tamponade
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Cardiogenic shock
What investigation is done for chronic pericarditis?
- CXR
- ECHO
- Cardiac CT/MRI
What would CXR show in chronic pericarditis?
pericardial calcification
What would ECHO show in chronic pericarditis?
increased pericardial thickness – differentiate from restrictive cardiomyopathy
What Ix are done for acute pericarditis?
- ECG
- Pericardicentesis is suspect cardiac tamponade
- Echo
What does ECG show in acute pericarditis?
- concave, saddle shape ST segement elevation
2. PR depression (V2-V6)
What bloods are done in acute pericarditis?
- FBC: elevated WBC
- ESR/CRP: for inflammation
- U+E
- Cardiac enzymes: troponin may be raised
- LFTs: tamponade means congestion
What Ix is done for pericardial effusion?
- CXR
- ECG
- ECHO
What would CXR show in pericardial effusion?
enlarged, globular heart if effusion >300mL
What would ECG show in pericardial effusion?
low voltage QRS complex
What is Ix is diagnostric for cardiac tamponade?
echo
What would ECG show in cardiac tamponade?
- Beck’s triad: falling BP, rising JVP, muffled heart sounds
- ECG: low voltage QRS
How do you manage chronic pericarditis?
pericardiectomy can cure not restrictive unless heart transplant
How do you treat acute pericarditis?
- NSAIDs: with gastric protection 1-2 weeks (PPI)
- Colchicine 500mcg for 3 months to prevent recurrence : unless TB pericarditis
- Treat cause
- Steroids/immunosuppressant if not working
- Exercise restrict
How do you manage acute pericardits if purulent (pus)?
IV antibitoics and above and consider pericardicetnesis)
How do you manage pericardial effusion?
- Treat cause
- Pericardiocentesis can be diagnostic or therapeutic
- Send pericardial fluid for culture
What is the 1st line treatment for stable cardiac tampoande?
NSAID’s + PPIs + obs
What is the 1st line treatment for unstable cardiac tampoande?
pericardiocentesis or surgical drainage (consider pericardectomy)
What is the process of pericardiocentesis?
- 45deg to xiphoid process
2. pericardium is aspirated
What are possible complications of acute pericarditis?
- Cardiac tamponade for acute pericarditis
1. Chronic recurrent pericarditis
2. Constrictive pericarditis
What are possible complications of cardiac tamponade?
- Recurrent pericarditis and pericardial effusion
- Cardiac arrest
- Organ hypoperfusion
Arrythmias
