Pericarditis Flashcards
(1) Pericardium surrounds, protects and holds the heart in place.
Two parts of the pericardium:
(a) Fibrous pericardium: Tough, inelastic, and outer connective tissue.
(b) Serous pericardium: Thinner, delicate, and forms a double layer around the heart.
Two parts of the Serous pericardium
1) Parietal layer outside
2) Visceral layer inside (on the heart itself touching the epicardium of the heart).
Anatomy: Pericarditis
Pericardium functions to protect the heart by:
(a) Anchoring the heart in place
(b) Prevents it from overstretching
(c) Has lubricating fluid (pericardial fluid) – prevents friction between membranes.
inflammation of the pericardium
Pericarditis
(1) Pericarditis means inflammation of the pericardium.
(2) It is mainly caused by viral infections in males < 50 yr old.
(a) Most common organisms are Coxsackieviruses and Echovirus.
(b) Other viruses include Influenza, Epstein-Barr, Hepatitis, Mumps, CMV, and HIV.
(c) Bacterial etiologies: Smallpox vaccine, Neisseria gonorrhea, Chlamydia, Mycoplasma, and Lyme.
Pathophysiology: Pericarditis
Most common organisms are of Pericarditis
Coxsackieviruses and Echovirus.
Smallpox vaccine,
Neisseria gonorrhea,
Chlamydia, Mycoplasma,
Lyme.
Bacterial etiologies: Pericarditis
(a) Radiation therapy
(b) Neoplasm
(c) Post-cardiac surgery
(d) Blunt or penetrating trauma.
(e) Uremia
(f) Hypothyroidism
(g) AMI
(h) SLE, Rheumatoid arthritis, vasculitis.
(i) Inflammatory bowel disease.
(j) Drug induced (Penicillin, Minoxidil, procainamide).
Other Causes include: Pericarditis
(1) Substernal chest pain, which is usually pleuritic (sharp), possible radiation to the neck, shoulder, or arm.
(2) Pain is worse when supine and relieved by sitting up and leaning forward.
(3) *Fever
(4) Pericardial friction rub is a most common sign (sounds like Velcro/crunching snow).
*Symptoms and Physical Findings: Pericarditis
(1) CBC may have elevated WBC due to infection and inflammation.
(2) Cardiac enzymes will be elevated if due to myocarditis.
(3) CXR to evaluate for pneumonia or widened mediastinum.
(4) *EKG: diffuse ST-segment elevation.
Labs/Studies/EKG: Pericarditis
(1) Viral pericarditis
(a) Aspirin 325-650 mg every 6 hours or
(b) NSAIDS (Indomethacin, Motrin or Naproxen) for up to 3 weeks.
Treatment: Pericarditis
(1) Aspirin or NSAID administration.
(2) Close follow-up to monitor for any signs of complications.
(3) May keep on board if the patient is stable.
(4) Transfer patients if they do not show signs of improvement or symptoms worsen.
Initial Care: Pericarditis
(1) Pericardial effusion
(2) Pericardial Tamponade
Complications: Pericarditis
ECG of a Pericarditis
