pericarditis Flashcards
what is pericarditis
inflammation of the pericardium, may be acute or chronic
acute pericarditis is most commonly caused by
viral infection
perimyocarditis/myopericarditis
condition predominantly affecting th myocardium but with pericardial involvement
relapsing/recurrent pericarditis
recurrence of symptoms after a symptom-free period of 4-6 weeks
constrictive pericarditis
compromised cardiac function caused by a thickened, rigid, and fibrous pericardium secondary to acute pericarditis
effusive-constrictive pericarditis
pericardial effusion occurs in addition to a thickened pericardium, which can lead to tamponade
causes of pericarditis
idiopathic
infectious
after myocardial infarction
postoperative
uremia eg. due to renal failure
radiation
neoplasms
autoimmune connective tissue diseases
trauma
clinical features of acute pericarditis
chest pain, improves on sitting and leaning forward
pericardial friction rub
pericardial effusion
low grade intermittent fever
character of pericarditis chest pain
pleuritic chest pain
- acute, charp retrosternal pain caused by inflammation of thee parietal pleura
aggrevated by coughing, swallowing, or deep inspiration
other ddx of pleuritic chest pain
Pulmonary embolism
myocardial infarction
pneumothorax
pericardial friction rub
high pitched scratching on auscultation
indicates friction between the visceral and parietal pericardial tissue
best heart over the left sternal border during expiration which the patient is sitting up and leaning forward
present in 85% of people presenting with pericarditis
ewart sign
clinical fiding of dullness at the base of the left lung with increased vocal fremitus and bronchial breathing
secondary to compression of the lung parenchyma by a large pericardial effusion `
acute pericarditis presents with sharp, retrosternal chets pain exacerbated by
deep inspiration
acute pericarditis presents with charp, retrosternal chest paiin that is lessened by
lessened by sitting up and leaning forward
clinical findings of constrictive pericarditis
symptoms of fluid overload
increased jugular vein distension
kussmaaul sign
hepatic vein congestion
peipheral oedema or anasarca, ascites with abdominal discomfort
kussmaul sign
normally the decrease in intrathoracic pressure during inspiration results in the exapnsion of the compliant right ventricle, leading to decrease in JVP
in constrictiive pericarditis, complaince of the right ventricle is decreased and the right ventricle fails to expand during inspiration
therefore, JVP increases during innspiratiion instead of decreasing
symptoms of reduced cardiac output
fatigue, dyspnea on exertion
tachycardia
pericardial knock
pulses paraoxicus
ECG features of uraemia pericarditis
may not involve characteristiic ECG changes
ECG features of pericarditis
stage 1: diffuse ST elevations, ST depressions in aVR and V1, PR segment depression
stage 2: ST segment normalisees in one week
Stage 3: inverted T waves
stage 4: ECG returns to baseline
the goal of imaging is to
identify any new pericardial effusion and rule out alternative aetiologies
echo is first line
laboritory
leukocytosis
minimally raised trops
raised ESR
raised CRP - serial values should be used to monitor treatment
raised creatinine kinase
pericardiocentesis with pericardial fluid analysis
indicated in large effusion, tamponade, suspected malignant or purulent pericarditis
investigations may include:
- gram stain
bacterial culture
acid-fast bacillus smear microscopy and culture
PCR
cytology
medical therapy
often self limiting but NSAIDs can alleviate symptoms and prevent a recurrence
and treat any known underlying cause eg. antibiotics, tuberculosis therapy, immunosuppressants, dialysis
restrict physical activity
pharmacotherpay
NSAID - aspirin, ibuprofen, indomethacin
colchicine in combination with NSAID or as monotherapy
consider prenisolone in severe cases or in cases caused by uremia, connective tissue disease or autoreactivity
special circumstances in NSAID use
avoid NSAIDS except for aspirin in post myocardial infarction pericarditis
consider lower doses of NSAIDs for perimyocarditis nd adding beta blocker
