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A- Resp and cardio > Pericarditis > Flashcards

Pericarditis Flashcards

1
Q

Diagnosis of pericardial disease

A

Over or equal to 2 of following 4
Pericardial chest pain
Pericardial rubs
New widespread ST elecation or PR depression ECG
Pericardial effusion - new or worsening

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2
Q

Supportive findings of pericarditis

A
  • Elevation of CRP/ESR/WCC
  • Evidence of pericardial inflammation on CT/CMR
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3
Q

What is recurrent pericarditis

A

Documented first episode + symptoms free 4-6 weeks
Normally within 18-24 months
15-30% recurrence rate

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4
Q

What is incessant pericarditis

A

> 4-6 weeks of symptoms
<3 months without remission
Chronic >3 months

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5
Q

Vrial causes of pericarditis

A

Viral - enteroviruses - coxsackie, e-coli
Herpes - EBV, CMV, HHV-6

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6
Q

Bacterial course of pericarditis

A

Common - Mycobacterium tuberculosis
Many other rare causes

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7
Q

Fungal causes of pericarditis

A

Histoplasma more likely immunocompetent
Aspergillus, blastomyces spp, candida - more likely in immunocompromised

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8
Q

Non infective causes of pericarditis

A

Autoimmune - common
Neoplastic
Primary tumours eg pericardial mesothlioma (rare)
Secondary metastatc tumours (lung, breast, lymphoma)
Metabolic
Trauma and iatrogenic
Drug related
other - amyloidosis, aortic dissection, pulmonary and arterial HPTN, chronic HF
Congenital partial and complete absence of pericardium

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9
Q

AI causes of pericarditis

A
  • Erythematosus
  • Sjrogen syndrome
  • Rheumatoid arthritis
  • scleroderma
  • Vasculitdes ie Eosinophilic granulomatosis w polyangitis or allergic granulomatosis (churg-strauss sydnrome)
  • Horton disease
  • Takayusus disease
  • Behcet syndrome
  • Sarcodiosis
  • Familial
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10
Q

Metabolic causes of pericarditis

A
  • Uraemia
  • Myxoedema
  • Anorexia nervosa
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11
Q

Trauma and iatrogenic causes of pericarditis

A

Early onset
Direct injusry - oesophageal perforation, penetrating thoracc injury
Indirect injury - eg radiation
Delayed onset - pericardial injury eg post MI syndrome, postpericardiotomy, PCI, pacemaker lead insertion, readio ablation

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12
Q

Drugs causing lupus like syndrome pericarditis

A
  • Procainamide
  • Hydralazine
  • Methyldopa
  • Isoniazid
  • Phenytoin
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13
Q

Antineoplastic drugs pericarditis

A

CM -> percardiopathy
Doxorubicin
Daunorubicin

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14
Q

Drugs causing pericarditis

A

Amiodraone
Methydergide
Mesalazine
Clozapine
Monoxidil
Dantrolene
Practolol
Phenylbutazone
THiazides
Streptomycin
Thiouracils
Streptokinae
P-aminosalicyclic acid
Sulfa drugs
Cyclosporinne
Bromocriptine
Several vaccines
GM-CSF
Anti TNF agents

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15
Q

Major predictors of poor prognosis in pericarditis

A

Fever >38 degrees
Subacute onset
Large pericardial effusion
Cardiac tamponade
Lack of resposne to aspirin or NSAIDs after at least one week of tehrapy

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16
Q

Minor pericarditis prognosis

A

Myopericarditis
Immunosupresson
Trauma
Oral anticoagulatn therapy

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17
Q

When admit to hospital w pericarditis

A

Underlying aetiology or at least one predictor of poor prognosis or major or minor risk factors

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18
Q

How manage pericarditis outside of hospital

A

Outpatient empiric anti inflammatories and short term follow up after 1 weeks assess response

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19
Q

Investigations with pericarditis

A

12 lead ECG
TTE
CXR
Infalm marer - CRP, ESR
MI markers - CK, troponin
ECHO
CMR

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20
Q

First line treatment pericarditis

A

Aspirin/NSAIDs + PPI
Colichine as adjunct

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21
Q

ECG changes pericarditis

A

ST elevation, PR depression in II, aVF
PR elevation in aVR

22
Q

Colichine MOA pericarditis

A
  • Improves response to above
  • Prevents recurrenes
  • halves recurrence rate
23
Q

2nd line treatment pericarditis

A

Low dose corticosteroids

24
Q

Maanagemnet of recurrent pericaridtis

A

1 - Aspirin or NSAID eg ibuprogen, indomethacin + colichine + exercise restriction
Decrease dose 250-500mg every 1-2 weeks
2 - low dose CCS
3 - IV immunoglobulin or anakinra or azathioprine
4 - pericardectomy

25
Complications of percarditis
Cardiac tamponade Constricitve pericarditis More likely in bacterial
26
What is cardiac tamponade
Life threatening slow or rapid compression of the heart due to pericardial accumulation of fluid, pus, blood, clots or gas
27
Classification of cardiac tamponade
Acute or subacute or chronic >3 months Size - mild <10mm, large >20mm Circumferential or loculated
28
What amount of pericardial fluid can cause tamponade
300-600ml
29
Causes of cardiac tamponade
- Pericarditis - TB - Iatrogenic - Trauma - Neoplasm/malignancy Uncommon causes - Collagen vascular diseases - SLE - Rheumatoid arthritis - Scleroderma - Radiation induced - post MI - Uraemia - Aortic dissection - Bacterial infection - Pneumopericardium
30
Characteristics of cardiac tamponade
- Elevated intra cardiac pressures - Progressive limitation of ventricular diastolic filling - Reduced in CO
31
Signs and symptoms of pericarditis
- Dyspnoea + chest discomfort - Agitation + restlessness - Palpitation - Drowsiness or stupor - Decrease urine output - Weakness - Anorexia - Weight loss with chronic effusion
32
Becks triad
Hypotension Increasing JVP Small, quiet heart
33
Physical findings cardiac tamponade
Raised Central venous pressure Tachypnoea Tachycardia Diminished heart sounds through fluid Pericardial friction rub Pulsus paradoxus
34
What is pulsis paradox
inspiratory decline in systolic BP >10mmhg -Increase venous return during inspiration
35
Features of pericarditis on ECHO
- Chamber collapse - Doppler signs increased ventricular interdependence - Inferior vena cava plethora
36
Right atrial chamber collapse - inversion
- R atrial chamber begins late diastole - Sensitive but not specific - Early diastole, goes for longer the worse the haemodynamics are
37
Features of pericarditis on ECHO
Chamber collapse Atria compressed in systole IVC plethora - Dilated IVC >2.1cm with<50% resp change (elevated intrapericacrdial pressure)
38
What are benefits of needle paricardiocentesis
- Allows rapid drainage - Less invasive - Minimal preparation
39
Complications of needle paracentesis
Laceratons of heart, coronaries or lungs Incomplete drainage or recurrence Not recommended for small effusions<1cm, loculation, adhesions or fibrinous standing
40
Treatment for cardiac tamponade
Needle paracentesis Surgical drainage Percutaneous balloon pericardiotomy
41
+ and negatives of surgical drainage for cardiac tamponade
More complete drainage Less likely recurrence Access for tissue biospy Drain loculated effusions Complciations - more pain, longer recovery, more morbidity
42
When do Percutaneous balloon pericardiotomy
- Large effusions esp malignant - Limited complication - Recurrence rare
43
Medical therapy in cardiac tamponade
If hypotensive For volume expansion, inotropic supprt Avoidance of diuretics or vasodilators
44
How to score for cardiac tamponade
Step 1 - score aetiology 2 - score clinical presentation 3 - score imagine Cumulative score
45
What score in aetiology of cardiac tamponade
Malignant disease - 2 TB - 2 Recent radiotherapy Recent viral infection Recurrent PE, previous pericardiocentesis Chronic terminal renal failure IMMUNODEFICIENCY or immunosupression Hypo or hyperthyroidism or systemic AI disease = -1
46
Clinical presenation scoring cardiac tamponade
Dyspnoea Orthopneoa Hypotnesion Progressiec sinus tachycardua Oliguria Pulsus paradoxus >10 mmHg Friction rub Rapid worsenging symptoms Slow evolution of disease = -1
47
Imaging scoring for cardiac tamponade
Cardiomegaly ECHO ECG changes PE IVC > 2.1cm RV collapse L atrial collapse Swinging heart
48
Urgent surgical management for cardiac tamponade causes
Type A aortic dissecction Ventricular free wall rupture after acute MI Severe recent chest trauma Iatrogenic haemopericardium when bleeding cannot be controlled percutaneoisly
49
Score for urgent pericardiocentesis vs postponing
>6
50

A- Resp and cardio (58 decks)

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