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CSI- Winter > Pericarditis > Flashcards

Pericarditis Flashcards

1
Q

Pericarditis

A
  • Inflamation of pericardium
  • May contain exudates, adhesions, blood, or serous type fluid.
  • Often not apparent clinically
  • Mortality in untreated purulent pericarditis is nearly 100%
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2
Q

Fibrinous Pericarditis

A

Caused by: Dressler’s syndrome (delayed pericarditis 2-10 wks after mi due to antibodies. Responds well to corticosteroids), Uremia or Radiation

  • Hear loud friction rub
  • “Bread and butter” appearance
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3
Q

Serous Pericarditis

A

-From noninfectious inflammatory diseases:
Rheumatic fever, SLE,
Viral infections (often coxsackie)

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4
Q

Suppurative/Purulent Pericarditis

A

Caused by bacterial, fungal and parasitic infectious agents

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5
Q

Most common form is

A

idiopathic, presumed to be viral (if they can’t pinpoint what’s causing it)

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6
Q

Symptoms

A 
**Chest pain**
Most common symptom
Substernal
Sharp, stabbing, burning, pressing
SOB--especially if pericardial effusion
May radiate to back, neck, shoulder, arm
**Pain referral to left trapezius ridge** (upper back/top of shoulder)
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7
Q

What is pain from pericarditis referred to left trapezius ridge

A

Inflammation of the joining diaphragmatic pleura!!!

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8
Q

Key symptoms in history

A
  • Chest pain worse when supine (laying down), with inspiration (pleuritic), swallowing (dysphasia) and with body motion
  • Chest pain better sitting up, leaning forward
  • This helps sometimes to distinguish angina from pericarditis…in that angina does not change with position.
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9
Q

Other S/S

A

-Fever; usually low grade
-Pericardial friction rub
-Dyspnea; chest pain worse with inspiration
-Dysphagia; irritation of esophagus
-Tachypnea
-Tachycardia
Beck’s triad ON TEST
Hypotension, JVD, muffled heart sounds
cardiac tamponade

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10
Q

What is Beck’s Triad

A

Hypotension, JVD, muffled heart sounds

cardiac tamponade

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11
Q

Drug induced causes

A

Procainamide, hydralazine, isoniazid (INH)

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12
Q

Other causes

A

-Malignancy
-Radiation therapy induced
-Uremia/renal failure
-Acute stemi
Post myocardial infarction (dressler syndrome)
-Autoimmune, rheumatic (SLE, RA, scleroderma, sacrcoidosis)
-Fungal (Histoplasmosis,
coccidiomycosis)
-Tuberculosis
-Hypothyroidism
-Cholesterol

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13
Q

Bacterial causes

A
  • *Staphylococcus most common**
  • Streptococcus
  • pneumococcus
  • Neisseria
  • Legionella
  • Lyme disease
  • Via direct pulmonary extension, endocarditis, penetrating injury, hematogenous spread
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14
Q

Viral causes

A

(VIRAL= most common assumed cause)

  • *Coxsackie**
  • Echovirus
  • HIV
  • Herpes
  • varicella
  • Measles, mumps
  • EBV
  • hepatitis, RSV
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15
Q

Most common and important finding is

A
  • Pericardial friction rub
  • Best with diaphragm of stethascope
  • Lower left sternal border or apex
  • Sitting, leaning forward
  • Intermittent
  • Grating or scratching sound–leather rubbing against leather
  • Three components
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16
Q

EKG findings for pericarditis (KNOW FOR EXAM!)

A

-serious of EKGs taken over days/weeks
4 stages observed:
1- ST elevation (Diffuse, seen in almost all leads); PR depression
2- Still have PR depression (ST segment elevation has resolved)
3- T wave inversion (diffuse)
4- Normalization

17
Q

Pericardial Effusion

A
  • a complication of pericarditis
  • Collection of fluid in the pericardial sac
  • Can be so great as to alter cardiac function (e.g., cardiac tamponade)…death
  • Acute symptoms with 80ml of fluid
  • Chronic build up with collections of 1-2 liters of fluid in sac
  • EKG classically described by low voltage (amplitude of QRS are short, SHORT QRS, they don’t look tall) and electrical alternans; caused by pendular motion of beating heart in a large fluid filled sac.
18
Q

Specific EKG findings for pericardial effusion

A
  • Electrical Alternans
  • See high amp QRS then low amp QRS (tall, short, tall, short)
  • Specific for pericardial effusion!!! NOT specific for pericarditis*
19
Q

Pericardial fat pad sign

A
  • Seen on lateral cxr
  • Epicardial fat allows the silhouette of two layers of pericardium to appear separate from the heart
  • Pericardial effusion
  • Sometimes pericarditis
  • Not commonly seen
20
Q

Test of choice to diagnose pericardial effusion

A
  • Pericarditis is characterized by inflamation of the pericardial layers….this can cause a pericardial effusion
  • can find pericardial effusion as a complication; NOT used to diagnose actual pericarditis
21
Q

CXR may show

A

“Water Bottle Heart”
May see large pericardial effusion

-Can’t diagnose cardiac tamponade (need to use clinical s/s for that)

22
Q

Labs to order

A

-CBC (may reveal elevated WBC or leukemia)
-Chem (may reveal uremia)
-Streptococcal serologic tests
(In pts with hx of rheumatic heard disease or pharyngitis)
-Blood cultures/viral cultures
-UA, UDS
-TB, HIV
-ESR (sed rate)
-Thyroid tests (TSH)
-Rheumatologic studies (ana, rf, etc.)
-Cardiac markers (troponin, cpk-mb)
pericardiocentesis for C&S if purulent expected
-Pericardial biopsy (if no improvement for 3 weeks)

23
Q

Treatment

A
  • If idiopathic or presumed viral use NSAIDs for 1-3 weeks
  • Identify/treat cause
  • If bacterial, treat > 4 weeks w/ antibiotics
  • Pericardiocentesis should be performed
24
Q

Poor prognostic indicators

A
  • Immunosupression
  • Myocarditis
  • Severe pericardial effusion
  • Fever
  • NSAID failure
  • Trauma
  • Oral anticoagulation
25
Q

Constrictive pericarditis is

A
  • A possible result of pericardial injury
  • Fibrous thickening of pericardium
  • Thickened noncompliant pericardial sac
  • Slowly progressive
  • Usually specific cause not determined

*Definition: when such fibrous response results in a decrease in passive diastolic filling of the normally distensible cardiac chambers

26
Q

Constrictive pericarditis most commonly results from

A
  • Cardiac trauma/intrapericardial bleeding
  • Open heart surgery
  • Idiopathic, Fungal, tb (in developing world), viral (in developed world), uremic
27
Q

S/S of constrictive pericarditis

A
  • *Dyspnea, worsening with exertion!!!
  • Chest pain, PND, orthopnea, B/L LE edema, JVD
  • *Pericardial knock (After 2nd heard sound; Due to accelerated RV inflow, followed by abrupt slowing of ventricular expansion)
  • heard during diastole
  • The RA is pouring into RV, but due to poor RV compliance, there is no RV expansion.
28
Q

Cardiac tamponade is

A

compression of heart by fluid in pericardium—blood, effusion, etc

-Equilibration of diastolic pressures in all 4 chambers (ventricles wont fill, atria wont empty, etc, very dangerous)

29
Q

Cardiac tamponade leads to

A
  • Decreased CO
  • Becks triad (low bp, distended neck veins, distant heart sounds)
  • Tachycardia
30
Q

Cardiac tamponade is a complication of

A

pericardial effusion (NOT a complication of pericarditis)

31
Q

A sign of cardiac tamponade is

A

Pulsus paradoxus: decreased SBP by 10 mmHg during inspiration

(also seen in: asthma, obstructive sleep apnea, pericarditis, croup)

CSI- Winter (44 decks)

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