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Cardiovascular > Pericarditis > Flashcards

Pericarditis Flashcards

1
Q

What is the pericardium?

A

A fibroelastic sac containing a thin layer of fluid that surrounds the heart and the roots of the great vessels

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2
Q

What does the pericardium do?

A

Sets heart in mediastinum and limits its motion

Protects it from infections coming from other organs (such as lungs)

Prevents excessive dilation of the heart in cases of acute volume overload

Lubricates the heart

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3
Q

What is pericarditis?

A

Inflammation of the pericardium

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4
Q

What are the causes of acute pericarditis?

A

Viral infection
Bacterial infection
Fungal infection

Uraemia

Autoimmune rheumatic disease

Trauma

MI Dressler’s Syndrome

Malignancy

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5
Q

Which viruses are usually responsible for causing acute pericarditis?

A

Coxsackie B
Echovirus
HIV

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6
Q

Which bacteria are usually responsible for causing pericarditis?

A

Tuberculosis pericarditis

Pneumococcus

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7
Q

Which is the most common cause of acute pericarditis?

A

Virus

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8
Q

What is meant by uraemic pericarditis?

A

Pericarditis caused by azotaemia: abnormally high levels of nitrogen-containing compounds in the blood

BUN (blood urea nitrogen) is very much higher than the normal level

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9
Q

What is azotaemia?

A

Abnormally high levels of nitrogen containing compounds in the blood

  • urea
  • creatinine
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10
Q

What causes azotaemia?

A

Poor kidney perfusion

Kidney failure

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11
Q

What is BUN?

A

Blood urea nitrogen

If high indicates poor renal filtration

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12
Q

What are the clinical features of acute pericarditis?

A

Sharp retrosternal chest pain which is relieved by leaning forward

Pain may be worse on inspiration

Pain may radiate to neck or shoulders

Pericardial friction rub sound

Systemic symptoms like fever, malaise etc.

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13
Q

Diagnosis of acute pericarditis.

A

ECG: concave upwards (saddle shaped) ST segment elevation across all leads

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14
Q

How can you differentiate ST elevation caused by acute pericarditis from MI?

A

ST elevation in MI will have flatter shape and will only be in some leads

In pericarditis the elevation is concave saddle shaped and is in all leads

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15
Q

How long is it before acute pericarditis becomes chronic?

A

6 weeks

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16
Q

What types of acute pericarditis are there?

A

Serous

Purulent (pus)

Fibrinous (caused by uremic pericarditis usually)

Caseous (TB)

Haemorrhagic

17
Q

What type of pericarditis is uraemic pericarditis?

A

Fibrinous

18
Q

What is the treatment of acute pericarditis?

A

Treat underlying cause:

  • infection
  • uraemia
  • malignancy

NSAIDs

Occasionally systemic corticosteroids

19
Q

What complications can arise from acute pericarditis?

A

Pericardial effusion & tamponade

Chronic pericarditis

20
Q

What is pericardial effusion?

A

An abnormal accumulation of fluid around the heart within the pericardial cavity

21
Q

What problems occur as a result of pericardial effusion?

A

Build up of fluid in pericardial cavity causes increased intrapericardial pressure

This has adverse effects on the heart function

22
Q

What are the clinical features of pericardial effusion?

A

Soft heart sounds
Fluid obscures the apex beat

Chest pressure & pain

Larger p. effusions can lead to cardiac tamponade

23
Q

What is cardiac tamponade?

A

A serious complication where there is compression of the heart as a result of fluid build up in the pericardial cavity

The compression means the heart can’t beat properly

24
Q

What are the clinical features of cardiac tamponade?

A

Dyspnoea
Low BP
Distant, soft heart sounds
Raised JVP

Pulsus paradoxus: a drop of at least 10 in arterial BP with inspiration

25
Q

Investigations of pericardial effusion & tamponade.

A

CXR: large globular heart

ECG: low voltage QRS complexes

Echo: shows up the effusion as an echo free space (black)

26
Q

Treatment of pericardial effusion & tamponade.

A

Treat the underlying cause

Emergency pericardiocentesis:
- aspiration of the pericardium by sticking a needle in using USS guidance

Excision of a pericardial segment so allow the fluid to drain out and be absorbed by the pleura & mediastinal lymphatics

27
Q

What is constrictive pericarditis?

How does it cause problems?

A

A type of chronic pericarditis

Results in a thickened/fibrous pericardium

This restricts the function of the heart because it can’t stretch when it fills with blood

28
Q

What are the clinical features of constrictive pericarditis?

A 
Right sided heart failure:
Fatigue
Swollen abdomen
Dyspnoea
Oedema

Raised JVP on inspiration
Pulsus paradoxus
Atrial fibrillation

29
Q

What is pulsus paradoxus?

A

a drop of at least 10mm/Hg in arterial BP with inspiration

30
Q

What are the causes of constrictive pericarditis?

A

Idiopathic usually

Intrapericardial haemorrhage during heart surgery

31
Q

Investigations of constrictive pericarditis?

A

CXR: normal sized heart

CT & MRI: show thickening and calcification of pericardium

32
Q

Treatment of constrictive pericarditis?

A

Removal of the entire pericardium

Pericardectomy

Cardiovascular (18 decks)

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