Pericarditis

Question 1

acute pericarditis

Answer 1

idopathic syndrome
self-limited
Sx: sharp substernal pleurotic positional pain, pericardial friction rub
EKG: ST elevation not confined to a coronary territory

Question 2

serous pericarditis

Answer 2

smooth, effusion of serous fluid (low protein)
scant neutrophils, lymphocytes, macrophages
causes: HF, lymphatic obstruction by tumor, hypoalbuminemia

Question 3

fibrinous pericarditis

Answer 3

dry, rough, shaggy
neutrophils, lymphocytes, macrophages
if it has effusion: serofibrinous
causes: viral myopericarditis, uremia (symptomatic high uric acid), acute MI, metastatic malignancy, autoimmune

Question 4

hemorrhagic pericarditis

Answer 4

serous, fibrinous, or purulent plus hemorrhage
can have effusion or exudate
associated with: metastatic carcinoma, leukemia (thrombocytopenia), TB

Question 5

purulent pericarditis

Answer 5

suppurative pericarditis
red, granular surface with pus
LOTS of neutrophils, exudate in pericardium

Question 6

constrictive pericarditis

Answer 6

rare
encasement of heart in dense fibrous or fibrocalcific scar preventing hypertrophy or dilation
cause: previous purulent or TB pericarditis
Tx: surgical stripping

Question 7

pericardial effusion

Answer 7

normal: 15-50ml serous fluid in pericardium
sudden increase: up to 250ml OK, 250-300ml: fatal
slow increase: can tolerate up to 1 liter
causes: viral myopericarditis, metastatic malignancy, autoimmune, drug-induced, renal failure, hemopericardium

Question 8

hemopericardium

Answer 8

bleeding into pericardium

Question 9

cardiac tamponade

Answer 9

syndrome
Sx: jugular venous distension, muffled heart sounds, hypotension, pulsus paradoxus
echo: diastolic collapse of right atrium and ventricle
swap-ganz: equalization of pressures
Tx: pericardiocentesis

Question 10

forms of post-MI pericarditis

Answer 10

1. extension of visceral pericarditis to parietal over large transmural infarct
2. dresseler syndrome (2-12 weeks after infarct): probably autoimmune

Question 11

autoimmune pericarditis

Answer 11

lupus and RA patients (due to polyserositis with simultaneous pleuritic and peritonitis)

Question 12

drug induced pericarditis

Answer 12

procainamide and hydralazine

Question 13

adenocarcinoma

Answer 13

can metastasize to lung

cytology mucin production, large nucleus, big cells