Pericarditis (3) Flashcards
Most cases are idiopathic (w/o an underlying cause). What are some of the underlying causes?
What is Dressler Syndrome?
➊ • Infection
• Post-MI – 1-3 days after an MI due to the healing necrotic heart tissue interacting with the pericardium
• Cancer
• Autoimmune e.g. RA, SLE etc.
• Drug-induced e.g. Methotrexate, Hydralazine
• Uraemia – seen in ESRF
➋ Occurs weeks to months after an MI as an autoimmune response, triggering systemic inflammation (affects other serous membranes like the pleura)
Presentation:
What is the main presenting complaint?
→ What features of this symptom is typical?
What other symptoms may be present?
What may be found O/E?
➊ Pleuritic chest pain (>90%)
→ • Retrosternal
• Radiation to ridge of the trapezius
• Relieved by sitting forwards
➋ • Fever
• Dyspnoea
➌ • Pericardial rub – Due to friction between layers, typically loudest at the left lower sternal border, best heard on leaning forward
• Signs of effusion
• Beck’s Triad if cardiac tamponade
Investigations:
What’re the typical findings on an ECG?
→ How does this ECG change over the next 8+ wks?
Which bloods should be done?
What else may be done?
➊ • Widespread saddle-shaped ST elevation
• PR depression
• Small QRS
→ ST normalises first, followed by the T waves flattening, then inverting, then normalising
➋ • FBC – Infection and inflammation markers
• Troponin – Myocarditis
• U&Es, LFTs
➌ • Basic obs – Check for signs of haemodynamic compromise
• Echo
Management:
What is 1st line in idiopathic and Viral pericarditis?
→ When is Aspirin favoured?
→ What should be co-prescribed?
What is 2nd line here?
→ When is this used?
What is the management of Bacterial pericarditis?
→ When should a pericardectomy be done?
➊ Exercise restriction, NSAIDs e.g. Ibuprofen and Colchicine
→ If pt already needs antiplatelet therapy
→ PPI
➌ Steroids
→ Those unable to tolerate or refractory NSAIDs
➍ IV Abx and pericardiocentesis if purulent exudate present
→ If adhesions or recurrent tamponade occurs
Constrictive Pericarditis:
Which type of pericarditis is this complication highest with?
What occurs here?
Why does this complication not present with life-threatening changes?
Which symptoms may pts present with?
What is the definitive treatment here?
➊ Bacterial
➋ Inflammation causes fibrosis and calcification, with adhesions forming between the pericardial layers
• Pericardium can become stiff and inelastic to a point where it hinders diastolic filling (+ CO) = Constrictive Pericarditis
➌ The changes are chronic, therefore the body is able to compensate
➍ Those of fluid overload, and poor exercise tolerance/SOBOE
➎ Surgical pericardiectomy
