Pericarditis

Question 1

Definition

Answer 1

Inflammation of the pericardium with/without effusions
- Dry/ fibrinous
- Wet (MC) = exudate (infection/malignancy)
- haemorrhagic (bleeding; BAD)

Question 2

Epidemiology

Answer 2

Men
20-50 years

Question 3

Risk Factors

Answer 3

Transmural MI
Viral or bacterial infection
Systemic autoimmune disorders
Cardiac Surgery

Question 4

Aetiology

Answer 4

Idiopathic
Viral (Coxsackievirus, Mumps, EBV, CMV, VZV, HIV) = MC
Bacterial (TB)
Fungal (VERY RARE) - Histoplasmosis; IMMUNOCOMPROMISED Px
Dressler’s Syndrome - post MI inflammation
Uraemia secondary to kidney disease
Systemic autoimmune disorders - SLE, Sjogren’s, RA (COMMON)
Hypothyroidism
Trauma
Malignancy - Lung, Breast
Certain medications e.g., penicillin’s, anticonvulsants

Question 5

Pathophysiology

Answer 5

Inflammation in the pericardium which means fluid + immune cells move from blood vessels in the fibrosis + serious pericardium into the tissue interstitial of those layers = Inflamed pericardial layers rub against each other (as narrowed pericardial space narrowed w/ inflammation) and exacerbate further inflammation.
This may remain dry (no extra fluid; not as bad, don’t need to compensate for friction) or become effusive (extra fluid needed to compensate for friction)
CHRONIC: if pericardium becomes so inelastic as to interfere with diastolic filling of the heart = CONSTRICTIVE PERICARDITIS -> hard for ventricles to compensate = decrease in SV and Increase in HR to compensate

Question 6

Signs

Answer 6

Pericardial friction rub heard on left sternal edge on auscultation - heard when patient leans forward, sqeaky leather ‘to and fro’ sound
Tachycardia
Tachypnoea
Diminished heart sounds
May have signs of RSHF (constrictive pericarditis) - granulation tissue formation, in pericardium = impaired diastolic filling, late complication of acute pericarditis + sign of poor prognosis: Peripheral oedema, SOB, tachycardia

Question 7

Symptoms

Answer 7

Central chest pain = sharp, pleuritic, rapid onset which radiates to trapezius ridge
- Worsened: when lying down or heavy breathing
- Better: sitting up + leaning forward
Fever
Myalgia
Dyspnoea
CHRONIC =
Kussmauls Breathing
- Increased JVP
- Pulsus paradoxus
- Diffuse heart sounds
- RSHF
- Ascites
- Oedema
- A.fib

Question 8

Diagnosis

Answer 8

ECG =
Saddle shaped ST elevation
PR depression
Inverted T waves (first flattened)
CXR - pericardial effusion may cause cardiomegaly + classic water bottle sign from pooling fluid. Pneumonia commonly seen with bacterial pericarditis = commonly seen as consolidation in lungs.
Echo - Pericardial effusion shows a dancing heart + constrictive pericarditis shows stiff serous pericardium restricting heart movement
High ESR = autoimmune, increase WCC in infective

Question 9

Treatment

Answer 9

ACUTE = FIRST LINE = NSAIDS with gastric protection (PPI)
COLCHICINE for 3 months to reduce recurrence rate
SECOND LINE = NSAIDS + COLCHICINE + LOW DOSE PREDNISOLONE
Bacterial = IV antibiotics + pericardiocentesis

Question 10

Complications

Answer 10

Constrictive pericarditis -> RSHF
Pericardial effusion -> Cardiac tamponade,
Myocarditis