Pericarditis Flashcards
What is pericarditis?
Inflammation of the pericardium
What is a pericardial effusion?
Buildup of fluid in the potential space of the pericardial cavity
What is cardiac tamponade?
Where the pericardial effusion is large enough to raise the intrapericardial pressure, putting pressure on the heart, and reducing its function
How does cardiac tamponade reduce function?
It causes reduced filling during diastole which in turn causes a reduced cardiac output during systole
What are the two key presenting features of pericarditis?
Chest pain
Low grade fever
What type of chest pain is seen in pericarditis?
Pleuritic (worse with inspiration)
Sharp
Central
Worse on lying down
Relieved on sitting forwards
What are the causes of pericarditis?
Idiopathic
Infection
Autoimmune and inflammatory conditions
Injury to pericardium
Uraemia
Cancer
Medications
What viruses can cause pericarditis?
Coxsackie B
Echovirus
CMV
Herpes
HIV
What bacteria can cause pericarditis?
Staphylococcus
Pneumococcus
Streptococcus
Haemophilus
M. tuberculosis
What types of cancer can casue pericarditis?
Lung cancer
Breast cancer
Hodgkin lymphoma
What drugs can cause pericarditis?
Methotrexate
Isoniazid
Chemotherapies
Methyldopa
Phenytoin
Penicillins
What is the first line investigation for pericarditis? What does it show?
ECG
- PR depression
- Saddle shaped ST elevation
What bloods would be taken in suspected pericarditis?
CRP and ESR
Serial troponins (rule out MI)
Viral serology - help determine cause
What imaging may be used to aid diagnosis of pericarditis?
Echocardiogram
Angiogram
Cardiac MRI
What is the first line management of viral pericarditis?
NSAIDs
Restriction of exercise
What are the second and third line treatments of viral pericarditis?
2nd line - colchicine
3rd line - corticosteroids
What is the treatment of bacterial pericarditis?
IV antibiotics
Pericardiocentesis if purulent exudate is present
What is the treatment of non-infective pericarditis?
Corticosteroids
What are the causes of cardiac tamponade?
Pericarditis
Malignancies
Systemic inflammatory infections
Myocardial rupture after MI
What are the features of cardiac tamponade?
Beck’s triad
Kussmaul’s sign
Pulsus paradoxus
Dyspnoea
Fatigue
What is pulses paradoxus?
A decrease in systolic BP of more than 10, during inspiration
What are the differentials of cardiac tamponade?
Acute heart failure
Pulmonary embolism
Constrictive pericarditis
What is the most useful investigation in cardiac tamponade?
Echocardiogram
What is the definitive management of cardiac tamponade?
Pericardiocentesis
