pericarditis Flashcards
another term for pericarditis
dressler syndrome
what nerve innervates the pericardium?
phrenic nerve
pathology of pericarditis
- visceral and parietal pericardium layers become inflamed and rub against each other
- inflammation
- cause exudate and adhesions within pericardial sac
1) may stay dry (no extra fluid needed to compensate for friction)
2) develop pericardial effusion (extra fluid) - if it becomes large enough to affect heart function = cardiac tamponade
aetiology of pericarditis
- commonly idiopathic or viral
- enterobacteria TB can also cause it
- in addition to Dressier’s syndrome - an immune reaction
other:
- radiation
- injury
- rheumatoid arthirits
what is constrictive pericarditis
- late complication of pericarditis
- where granulation tissue forms in pericardium
- results in impared distolic filling
- can lead to heart failure
epidemiology pericarditis
- common
- 80-90% is idiopathic
- males
- 20-50yrs
describe the chest pain associated with pericarditis
- severe
- sharp and pleuritic - not constricting and crushing like ischemia
- rapid onset
- left anterior chest or epigastrium - radiate to arm and trapezius
- relieved by sitting forward
- exacerbated by lying down
symptoms of pericarditis
- chest pain
- dyspnoea
- cough
- virus-like symptoms
- fever
- joint pain
- weight loss
- cancer
signs of pericarditis
- pericardial rub
- sinus tachycardia
- fever
- signs of effusion eg pulse paradox
- becks triad - cardiac temponade - hypertension + elevated JVP + quiet heart sounds
what is the pericardial friction rub?
- heard at left sternal edge as patient leans forward
- leather squeaky to and fro sound
diagnosis
ECG - saddle shaped ST elevation and PR depression
transthoracic echo - exclude pericardial effusion or tamponade
bloods - raised C-reactive peptide, erythrocyte sedation rate and WBC count
chest x-ray - water bottle heart
management + treatment
- sedentary activity until resolved
- NSAID / ibuprofen 600mg 3X a week, orally, for 2 weeks
OR - aspirin - 750-1000mg 2X a day, orally, for 2 weeks
- colchicine - 0.5mg X2 a day, orally for 3 months
Complications of pericarditis (3)
1) Pericardial effusion—> cardiac tamponade
2) Myocarditis
3) Constrictive pericarditis
Prognosis of pericarditis
Majority of cases (viral and Idiopathic) are self limiting, whereas bacterial (purulent) pericarditis can be fatal if untreated.
Treatment for bacterial pericarditis (2)
IV antibiotics and pericardiocentesis with washout, culture and sensitivities
What is pericarditis? (2)
Typically acute (can be chronic); inflammation of pericardium +/- effusion
-pericardium has two layers and innervated by phrenic hence inflammation results in pain
