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Year 3 > Pericarditis > Flashcards

Pericarditis Flashcards

1
Q

What is pericarditis?

A

Inflammation of the pericardium

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2
Q

What is defined as acute pericarditis?

A

Pericardial inflammation lasting <4-6 Weeks

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3
Q

How can you differentiate different types of pericarditis?

A
  • Fibrinous (dry)/ constrictive
  • Effusive –> pericardial effusion
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4
Q

What is the epidemiology of pericarditis?

A

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

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5
Q

What are the causes for a pericarditis?

A

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.)
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6
Q

What is the pericardium?

A

Layer of the hear that surrounds the myocardium and forms a sack around the heart

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7
Q

What are the different layers of the pericardium?

A

Visceral pericardium (adherent to myocardium)

Parietal pericardium (outer layer

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8
Q

What are risk factors for developing pericarditis?

A

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.
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9
Q

What are the presenting symptoms of pericarditis?

A
  • 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
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10
Q

What are signs of pericarditis on examination?

A
  • 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
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11
Q

What investigations would you do in a patient with suspected pericarditis?

A
  1. ECG
  2. Bloods
    • Culture/pericardial fluid culture
    • Serum troponin
    • ESR
    • CRP
    • Serum URA
    • FBC
  3. Chest X-ray
  4. Echocardiography

+ Consider

  • Chest CT/Cardiac MRI
  • Biopsy
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12
Q

What would raised troponin levels in acute pericarditis indicate?

A

Myocardial involvement (in 35-50% of cases)

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13
Q

Which ECG changes would you expect in someone with pericarditis?

A
  • Global ST-elevation with PR depression
  • (other way around in aVR and V1)
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14
Q

Why do you do serum urea in a patient with actue pericarditis?

A

To determine cause

  • Raised serum urea (>21.4 mmol/l) suggest uraemic cause
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15
Q

What are possible differentials for a pericarditis?

A
  • Ischaemia, MI –> shorter /more acute time frame and absence of pericardial rub
  • PE
  • Pneumonia
  • Pneumothorax
  • Costochondritis
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16
Q

Develop a management plan for a patient with infective pericarditis

A
  • 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
17
Q

What are possible complications of pericarditis?

A
  • Pericardial effusion
    • with clinical tamponade
  • Purulent pericarditis
  • Chronic constrictive pericarditis
    • treated by surgical pericardial resection
18
Q

How should a clinical temponade due to a pericardial effusion be managed?

A

If

  • neoplastic pericarditis
  • or purulent pericarditis suspected
    • see later
  • large and symptomatic
    • Pericardiocentesis
19
Q

How would you treat a purulent pericardial effusion?

A

life-threatening

  • Pericardiocentesis
    • with rinsing of pericardial cavaty
    • culture of fluid
  • Blood cultures
  • Systemic ABX
  • NSAIDS
  • oper surgical drainage
20
Q

How would you treat recurrent pericarditis?

A

NSAID plus colchicine, as well as exercise restriction

21
Q

What is the prognosis for patients with pericarditis?

A

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

Year 3 (52 decks)

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