Pericarditis

Question 1

acute pericarditis

Answer 1

most common pathologic involving the pericardium
viral infections are the most common
males < 50 most commonly affected

Clinical classification:
Acute < 6 wK associated with fibrous or effusion

subacute pericarditis > 6 weeks to 6 months associated with effusion or constrictive

chronic pericarditis > 6 months with constrictive

Question 2

etologic classification of acute pericarditis

Answer 2

infections ( viral or bacterial)

non-infections idiopathic, renal failure aortic dissection)

hypersensitivity or autoimmunity ( RA, lupus , granulomatosis)

Question 3

etiology of pericarditis

Answer 3

viral: coxsackieviruses and echoviruses,
influenza, Epstein Barr, varicella, hepatitis, mumps, and HIV

Bacterial etiology uncommon
pneumococcus, streptococcus, staphylococcus
barriella burgdorferi ( lyme disease)

CKD
uremic pericarditis

Post MI or cardiac surgery
Dressler syndrome

Question 4

pericarditis etiology

Answer 4

neoplastic disease
lung and breast ca
renal cell ca
Hodgkins disease and lymphomas

radiation
fibortic process
subacute pericarditis or constritction

Question 5

signs and symptoms

Answer 5

Four diagnostic features
chest pain
pleurtic and postural
substernal and radiation
neck, shoulders back or epigastrium

dyspnea and fever
pericardial friction rub
occur with or without accumulation or constriction

widespread ST elevation
pericardial effusion

Question 6

signs and symptoms pericarditis

Answer 6

bacterial pericarditis
toxic and critilly ill

uremic pericarditis
present with or without symptoms
fever usually absent

Dessler syndrome
pain, fever, malaise, and leukocytosis
if recurrent, consider autoimmune syndrome

neoplastic pericardidts
painless
hemodynamic compromise or primary disease
usually large effusions

Question 7

acute pericarditis dx

Answer 7

viral pericarditis
clinical diagnosis with the presence of leukocytosis

bacterial pericarditis
diagnostic pericardocentesis

uremic pericarditis
correlates with bun and creatinine: correlates with level of bun and creatine w pt not on HD
pericardium is shaggy
effusions hemorrhagic and exudative

neoplastic pericarditis
cytologic examination of effusion or by cardio-biopsy

laboratory;
cbc, cmp, esr, crp

Question 8

pericarditis treatment

Answer 8

asprin 1000mg q 8 1-2 week with taper + NSAIDs 600-800 mg tid

PPI

Add colchicine 0.5 to 0.6 mg QD and < 70kg or twice daily > 70kg for at least 3 months.

Colchicine enhances the NSAID response.

Avoid NSAIDs and steroids in post-MI
adverse effects on myocardial healing

Taper when CRP trending down

glucocorticoids: prednisone 1mg kg day, then taper
suppresses clinical manifestations

does increase the risk of subsequent recurrence

activity resrtiction

Question 9

cardiac tamponade

Answer 9

accumulation of fluid in pericardial space
hemodynamic compromise
fluid necessary 200ml to 2000ml to produce tamponade

elevated intrapericardial pressure > 15 (normal is -5 to 5 mmHg)
restricts venous return and ventricular filling

severe obstruction to the ventricles
shock and death

most common causes
idiopathic pericarditis
pericarditis secondary to neoplastic dx,TB, or bleeding into pericardial space

Question 10

clinical findings of tamponade

Answer 10

hallmark; Becks triad
hypotension, muffeled heart sounds and JVD

hemodynamic compromise
decrease stroke volume and arterial pulse pressure
increase in heart rate and venous pressure
shock

electrical alternans
fluctuation of QRS amplitude

pulsus paradoxus
decline in SBP > 10 mmgh upon inspiration

chest x-ray
enlargement of cardiac silhouette

Question 11

treatment of cardiac tamponade

Answer 11

consult cardiothroacic surgery
manage shock
pericardiocentesis
needle inserted into the pericardial cavity
left in place to allow drainage
analyze pericardial fluid
RBC , WBC cytolgy and culture