pericarditis

Question 1

what is pericarditis

Answer 1

inflammation of the pericardium, may be acute or chronic

Question 2

acute pericarditis is most commonly caused by

Answer 2

viral infection

Question 3

perimyocarditis/myopericarditis

Answer 3

condition predominantly affecting th myocardium but with pericardial involvement

Question 4

relapsing/recurrent pericarditis

Answer 4

recurrence of symptoms after a symptom-free period of 4-6 weeks

Question 5

constrictive pericarditis

Answer 5

compromised cardiac function caused by a thickened, rigid, and fibrous pericardium secondary to acute pericarditis

Question 6

effusive-constrictive pericarditis

Answer 6

pericardial effusion occurs in addition to a thickened pericardium, which can lead to tamponade

Question 7

causes of pericarditis

Answer 7

idiopathic
infectious
after myocardial infarction
postoperative
uremia eg. due to renal failure
radiation
neoplasms
autoimmune connective tissue diseases
trauma

Question 8

clinical features of acute pericarditis

Answer 8

chest pain, improves on sitting and leaning forward
pericardial friction rub
pericardial effusion
low grade intermittent fever

Question 9

character of pericarditis chest pain

Answer 9

pleuritic chest pain
- acute, charp retrosternal pain caused by inflammation of thee parietal pleura
aggrevated by coughing, swallowing, or deep inspiration

Question 10

other ddx of pleuritic chest pain

Answer 10

Pulmonary embolism
myocardial infarction
pneumothorax

Question 11

pericardial friction rub

Answer 11

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

Question 12

ewart sign

Answer 12

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 `

Question 13

acute pericarditis presents with sharp, retrosternal chets pain exacerbated by

Answer 13

deep inspiration

Question 14

acute pericarditis presents with charp, retrosternal chest paiin that is lessened by

Answer 14

lessened by sitting up and leaning forward

Question 15

clinical findings of constrictive pericarditis

Answer 15

symptoms of fluid overload
increased jugular vein distension
kussmaaul sign
hepatic vein congestion
peipheral oedema or anasarca, ascites with abdominal discomfort

Question 16

kussmaul sign

Answer 16

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

Question 17

symptoms of reduced cardiac output

Answer 17

fatigue, dyspnea on exertion
tachycardia
pericardial knock
pulses paraoxicus

Question 18

ECG features of uraemia pericarditis

Answer 18

may not involve characteristiic ECG changes

Question 19

ECG features of pericarditis

Answer 19

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

Question 20

the goal of imaging is to

Answer 20

identify any new pericardial effusion and rule out alternative aetiologies
echo is first line

Question 21

laboritory

Answer 21

leukocytosis
minimally raised trops
raised ESR
raised CRP - serial values should be used to monitor treatment
raised creatinine kinase

Question 22

pericardiocentesis with pericardial fluid analysis

Answer 22

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

Question 23

medical therapy

Answer 23

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

Question 24

pharmacotherpay

Answer 24

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

Question 25

special circumstances in NSAID use

Answer 25

avoid NSAIDS except for aspirin in post myocardial infarction pericarditis
consider lower doses of NSAIDs for perimyocarditis nd adding beta blocker