Pericarditis Flashcards
What is the pericardium?
A fibroelastic sac containing a thin layer of fluid that surrounds the heart and the roots of the great vessels
What does the pericardium do?
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
What is pericarditis?
Inflammation of the pericardium
What are the causes of acute pericarditis?
Viral infection
Bacterial infection
Fungal infection
Uraemia
Autoimmune rheumatic disease
Trauma
MI Dressler’s Syndrome
Malignancy
Which viruses are usually responsible for causing acute pericarditis?
Coxsackie B
Echovirus
HIV
Which bacteria are usually responsible for causing pericarditis?
Tuberculosis pericarditis
Pneumococcus
Which is the most common cause of acute pericarditis?
Virus
What is meant by uraemic pericarditis?
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
What is azotaemia?
Abnormally high levels of nitrogen containing compounds in the blood
- urea
- creatinine
What causes azotaemia?
Poor kidney perfusion
Kidney failure
What is BUN?
Blood urea nitrogen
If high indicates poor renal filtration
What are the clinical features of acute pericarditis?
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.
Diagnosis of acute pericarditis.
ECG: concave upwards (saddle shaped) ST segment elevation across all leads
How can you differentiate ST elevation caused by acute pericarditis from MI?
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
How long is it before acute pericarditis becomes chronic?
6 weeks
What types of acute pericarditis are there?
Serous
Purulent (pus)
Fibrinous (caused by uremic pericarditis usually)
Caseous (TB)
Haemorrhagic
What type of pericarditis is uraemic pericarditis?
Fibrinous
What is the treatment of acute pericarditis?
Treat underlying cause:
- infection
- uraemia
- malignancy
NSAIDs
Occasionally systemic corticosteroids
What complications can arise from acute pericarditis?
Pericardial effusion & tamponade
Chronic pericarditis
What is pericardial effusion?
An abnormal accumulation of fluid around the heart within the pericardial cavity
What problems occur as a result of pericardial effusion?
Build up of fluid in pericardial cavity causes increased intrapericardial pressure
This has adverse effects on the heart function
What are the clinical features of pericardial effusion?
Soft heart sounds
Fluid obscures the apex beat
Chest pressure & pain
Larger p. effusions can lead to cardiac tamponade
What is cardiac tamponade?
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
What are the clinical features of cardiac tamponade?
Dyspnoea
Low BP
Distant, soft heart sounds
Raised JVP
Pulsus paradoxus: a drop of at least 10 in arterial BP with inspiration
Investigations of pericardial effusion & tamponade.
CXR: large globular heart
ECG: low voltage QRS complexes
Echo: shows up the effusion as an echo free space (black)
Treatment of pericardial effusion & tamponade.
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
What is constrictive pericarditis?
How does it cause problems?
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
What are the clinical features of constrictive pericarditis?
Right sided heart failure: Fatigue Swollen abdomen Dyspnoea Oedema
Raised JVP on inspiration
Pulsus paradoxus
Atrial fibrillation
What is pulsus paradoxus?
a drop of at least 10mm/Hg in arterial BP with inspiration
What are the causes of constrictive pericarditis?
Idiopathic usually
Intrapericardial haemorrhage during heart surgery
Investigations of constrictive pericarditis?
CXR: normal sized heart
CT & MRI: show thickening and calcification of pericardium
Treatment of constrictive pericarditis?
Removal of the entire pericardium
Pericardectomy
