Pericarditis

Question 1

Define pericarditis

Answer 1

• Inflammation of the pericardium, which is the membrane surrounding the heart
• Also known as Dressler Syndrome

Question 2

Describe the features of the pericardium and pericardial cavity

Answer 2

• The pericardium which surrounds the heart consists of two layers
• In between these two layers is a fluid-filled space called the pericardial cavity

Question 3

What is the fluid for in the pericardial cavity?

Answer 3

so the heart can beat with little friction

Question 4

What nerve innervates the pericardium?

Answer 4

phrenic nerve

Question 5

Describe the pathophysiology of pericarditis

Answer 5

• layers of pericardium become inflamed
• They rub against each other and can cause more inflammation
• It is typically idiopathic or because of a viral or bacterial infection
• This can also be caused by Dressler’s Syndrome (A type of immune reaction in the cardiac proteins released by damage to the myocardium in MI)

Question 6

What can pericarditis also cause?

Answer 6

• can cause exudation which leads to more fluid in the pericardial cavity
• This is known as pericardial effusion
• It creates an inward pressure on the heart

Question 7

What can too much exudation lead to?

Answer 7

Cardiac Tamponade

Question 8

What is Constrictive Pericarditis?

Answer 8

• a late complication where granulation tissue forms in the pericardium and results in impaired diastolic filling due to increased thickness and hardening
• This can lead to heart failure

Question 9

What are the symptoms of pericarditis?

Answer 9

• Sudden onset of sharp, pleuritic chest pain which can spread to the left shoulder tip (phrenic)
• Low grade fever

This is KEY:
- Pain is relieved by LEANING FORWARDS
- Pain is worse LAYING FLAT

• May have RHS Failure signs due to constrictive pericarditis

Question 10

What are RHS failure signs?

Answer 10

Shortness of breath, peripheral oedema and tachycardia

Question 11

What are signs of pericarditis?

Answer 11

• Pericardial Friction Rub on auscultation
• Heard at left sternal edge as patient leans forward
• Squeaky leather “to and fro” sound

Question 12

What is used to diagnose pericarditis?

Answer 12

• ECG
• Transthoracic Echo
• Bloods
• Chest X-Ray

Question 13

What is seen on ECG for pericarditis?

Answer 13

Saddle Shaped ST Elevation, PR Depression

Question 14

Why is a transthoracic echo done for pericarditis?

Answer 14

Diagnose effusion

Question 15

What do bloods show for pericarditis?

Answer 15

Raised inflammatory markers

Question 16

What is seen on chest X-ray for pericarditis?

Answer 16

Water Bottle Heart

Question 17

How do you treat idiopathic and viral pericarditis?

Answer 17

1st Line: NSAIDs + Colchicine
2nd Line: NSAIDs + Colchicine + Low Dose Prednisolone

Question 18

How do you treat bacterial pericarditis?

Answer 18

IV Antibiotics and Pericardiocentesis (sticking in a needle to drain fluid)

Question 19

What is the epidemiology for pericarditis?

Answer 19

Male
20-50 years old