pericarditis

Question 1

Briefly describe the anatomy of the pericardium

Answer 1

• 2 layers
• Visceral single cell layer adherent to epicardium
• Fibrous parietal layer 2mm thick
• Acellular collagen and elastin fibres
• 50ml of serous fluid

Question 2

which atrium is mainly outside the pericardium

Answer 2

left

Question 3

a clinical diagniosis of acute pericarditis is made from 2 of which crieteria

Answer 3

Chest Pain (85-90%)
Friction rub (33%)
ECG changes (60%)
Pericardial effusion (up to 60% usually mild)

Question 4

give 3 causes of acute percarditis

Answer 4

infectious
* * Viral (common): Enteroviruses (coxsackieviruses, echoviruses), herpesviruses (EBV, CMV, HHV-6), adenoviruses, parvovirus B19 (possible overlap with aetiologic viral agents of myocarditis).
* TB
non infectious
* Autoimmune (common):
Sjögren syndrome, rheumatoid arthritis, scleroderma,
systemic vasculitides
* Secondary metastatic tumours (common, above all lung and breast cancer, lymphoma).
* Uraemia, myxoedema,

Other
* Amyloidosis, aortic dissection, pulmonary arterial hypertension and chronic heart failure.
*

Question 5

what are the clinical presenttins of pericarditis

Answer 5

Chest pain
* Severe
* Sharp and pleuritic (without constricting crushing character of ischaemic pain)
* Rapid onset
* Left anterior chest or epigastrium
* Radiates to arm more specifically trapezius ridge (co-innervation phrenic nerve)
* Relieved by sitting forward exacerbated by lying down

Other symptoms
* Dyspnoea
* Cough
* Hiccups (phrenic)
* Systemic disturbance
* Viral prodrome, Antecedent fever
* Skin rash, joint pain, eye Sx, weight loss (Cause)
* PMH
* Cancer, Rheumatological Dx, Pneumonia, Cardiac procedure (PCI, ablation), MI

Question 6

Give a differential diagniosis for pericarditis

Answer 6

Pneumonia
Pleurisy
Pulmonary Embolus
Chostocondritis
Gastro-oesophageal reflux
Myocardial ischaemia/infarction
Aortic dissection
Pneumothorax
Pancreatitis
Peritonitis
Herpes zoster (shingles)

Question 7

how would you investigate pericarditis

Answer 7

• ECG
• Bloods
• CXR
• Echocardiogram
• clinical examination
  -Pericardial rub – pathognomonic, crunching snow
  Sinus tachycardia
  Fever
  Signs of effusion

Question 8

what would an ecg show in pericatditis

Answer 8

• Diffuse, concave, upwards S.T.-segment rise
• P.R. -segment depression are common E.C.G.

Question 9

explain why you would do a FBC to test for pericarditis

Answer 9

Modest increase in WCC, mild lymphocytosis

Question 10

explain why you would do a troponin test for pericarditis

Answer 10

possible MI

Question 11

why would you do a ESR & CRP blood test for pericarditis

Answer 11

High ESR may suggest aetiology
ANA in young females - SLE

Question 12

Discus the managments of pericarditis

Answer 12

• Sedentary activity until resolution of symptoms and ECG/CRP
• NSAID (Ibuprofen 600mg TDS PO 2/52) or Aspirin (750-1000mg BD PO 2/52)
• Colchicine (0.5mg BD PO 3/12) limited by nausea and diarrhoea, reduces recurrence

Question 13

what is the main charcteristic of an ECG of pericarditis

Answer 13

saddle shaped ST segment

Question 14

how would we differentiate Acute STEMI to pericarditis

Answer 14

pericarditis would show saddle ST
STEMI shows conved ST seg