Pericarditis Flashcards
What is pericarditis?
Inflammation of the pericardium
What is defined as acute pericarditis?
Pericardial inflammation lasting <4-6 Weeks
How can you differentiate different types of pericarditis?
- Fibrinous (dry)/ constrictive
- Effusive –> pericardial effusion
What is the epidemiology of pericarditis?
Large number undiagnosed, about 5% of Emergency chest pain presentation and 0.1% of Hospital admissions
More common in 20-50Y
More common in Men
What are the causes for a pericarditis?
Majority ideopathic but might be due to
- infective (viral) pericarditis (together 90%)
- autoimmune underlying condition (e.g. Lupus, RA)
- 1-3 days after MI
- other, less common causes (traume, other conditions, bacterial/fungal infections etc.)
What is the pericardium?
Layer of the hear that surrounds the myocardium and forms a sack around the heart
What are the different layers of the pericardium?
Visceral pericardium (adherent to myocardium)
Parietal pericardium (outer layer
What are risk factors for developing pericarditis?
Key risk factors include
- male sex,
- age 20 to 50 years,
- transmural MI,
- cardiac surgery,
- neoplasm,
- viral and bacterial infection,
- uraemia,
- dialysis treatment, and
- systemic autoimmune disorders.
What are the presenting symptoms of pericarditis?
- chest pain (might be similar to MI)
- sharp
- stabbing
- pleuritic
- constant, not worse on exertion
- Trapezius ridge pain
- the bottom portion of scapula on the back
- relief of pain when sitting up + leaning forwards
What are signs of pericarditis on examination?
-
Pericardial rub (<33% of cases)
- high-pitched or squeaky. It is heard best at the left sternal edge with the patient leaning forward at end-expiration.
- uncommon
- fever
- malaise
- signs of right-sided heart failure
- uncommon
What investigations would you do in a patient with suspected pericarditis?
- ECG
- Bloods
- Culture/pericardial fluid culture
- Serum troponin
- ESR
- CRP
- Serum URA
- FBC
- Chest X-ray
- Echocardiography
+ Consider
- Chest CT/Cardiac MRI
- Biopsy
What would raised troponin levels in acute pericarditis indicate?
Myocardial involvement (in 35-50% of cases)
Which ECG changes would you expect in someone with pericarditis?
- Global ST-elevation with PR depression
- (other way around in aVR and V1)
Why do you do serum urea in a patient with actue pericarditis?
To determine cause
- Raised serum urea (>21.4 mmol/l) suggest uraemic cause
What are possible differentials for a pericarditis?
- Ischaemia, MI –> shorter /more acute time frame and absence of pericardial rub
- PE
- Pneumonia
- Pneumothorax
- Costochondritis
Develop a management plan for a patient with infective pericarditis
- Admit to Hospital if anything suggest underlying aetiology + risk factors for complications
- Determine cause
Management as outpatient
- Give NSAIDS as symptomatic management
- PPI for 4/52(Ibuprofen, after MI Aspirin)
- Exercise restriction
- If tamponade or symptomatic effusion:
- consider pericardiocentesis
- Purulent
- consider pericardectomy
- Non-purulent
- colchicine
- if idiopathic or viral: anti-viral therapy
What are possible complications of pericarditis?
- Pericardial effusion
- with clinical tamponade
- Purulent pericarditis
- Chronic constrictive pericarditis
- treated by surgical pericardial resection
How should a clinical temponade due to a pericardial effusion be managed?
If
- neoplastic pericarditis
- or purulent pericarditis suspected
- see later
- large and symptomatic
- Pericardiocentesis
How would you treat a purulent pericardial effusion?
life-threatening
- Pericardiocentesis
- with rinsing of pericardial cavaty
- culture of fluid
- Blood cultures
- Systemic ABX
- NSAIDS
- oper surgical drainage
How would you treat recurrent pericarditis?
NSAID plus colchicine, as well as exercise restriction
What is the prognosis for patients with pericarditis?
Dependant on cause + other risk factors
- Ideopathic
- normally self-limiting in 70-90% of cases
- purulent:
- fatal without treatment, 40% mortality with treatment
- Other aetiologies also have different prognosis
