Pericarditis

Question 1

What is acute pericarditis.

Answer 1

Inflammation of the pericardium.

Question 2

What are the causes of acute pericarditis. (10)

Answer 2

Viral (EBV, HVI, varicella). 
Post-MI. 
Dressler's syndrome. 
Ureamia. 
Tuberculosis. 
Rheumatic fever. 
Fungal. 
Rheumatoid arthritis. 
Connective tissue disorders (sarcoidosis). 
Malignancy.

Question 3

What are the symptoms of acute pericarditis. (4)

Answer 3

Substernal sharp chest pain.
Worse on inspiration and on movement.
Relieved by sitting forward.
Worse on lying flat.

Question 4

What are the clinical signs of acute pericarditis. (3)

Answer 4

Pericardial friction rub.
May be evidence of a pericardial effusion or cardiac tamponade.
Fever.

Question 5

What is seen on an ECG in a patient with acute pericarditis. (2)

Answer 5

Widespread ST elevation (saddle shaped shape).

Followed by T wave inversion.

Question 6

What investigation should you do in a patient if you suspect a pleural effusion (in acute pericarditis).

Answer 6

Echo.

Question 7

What is a pericardial effusion.

Answer 7

Accumulation of fluid in the pericardial sac.

Question 8

What are the cases of a pericardial effusion.

Answer 8

Any cause of pericarditis.

Question 9

What are the clinical features of a pericardial effusion. (4)

Answer 9

Dyspnoea.
Raised JVP (with prominent x descent).
Bronchial breathing at left base (Ewart’s sign).
Look for signs of cardiac tamponade.

Question 10

What is Ewart’s sign.

Answer 10

Large effusion compressing left lower lobe.

Question 11

What is seen on CXR in a patient with pericardial effusion.

Answer 11

CXR shows an enlarged globular heart.

Question 12

What is seen on an ECG of a patient with a pericardial effusion. (2)

Answer 12

Low voltage QRS complexes.

Alternating QRS morphologies (electrical alternans).

Question 13

What is constrictive pericarditis.

Answer 13

Te heart is encased in a rigid pericardium.

Question 14

What are the causes of constrictive pericarditis. (3)

Answer 14

Often unknown (in the UK).
TB.
After any pericardial disease.

Question 15

What are the clinical features of constrictive pericarditis. (9)

Answer 15

Right heart failure signs:
Raised JVP (with prominent x and y descents).
Kussmaul' sign. 
Soft diffuse apex beat. 
Quite heart sounds. 
S3. 
Diastolic pericardial knock. 
Hepatosplenomegaly. 
Ascites. 
Oedema.

Question 16

What is Kussmaul’s sign.

Answer 16

JVP rising paradoxically with inspiration.

Question 17

What is seen on CXR in a patient with constrictive pericarditis. (2)

Answer 17

Small heart.

Pericardial calcification.

Question 18

What is cardiac tamponade.

Answer 18

Accumulation of pericardial fluid raises the intrapericardial pressure, hence poor ventricular filling and a fall in cardiac output.

Question 19

What are the causes of cardiac tamponade. (6)

Answer 19

Any pericarditis. 
Aortic dissection. 
Haemodialysis. 
Warfarin. 
Trans-septal puncture at cardiac catheterization. 
Post cardiac biopsy.

Question 20

What are the signs of cardiac tamponade. (6)

Answer 20

Raised pulse. 
Low BP. 
Pulsus paradoxus. 
Raised JVP. 
Kussmaul's sign. 
Muffled S1 and S2.

Question 21

What is Beck’s triad. (3)

Answer 21

A way of diagnosis cardiac tamponade:
Falling bP.
Rising JVP.
Muffled heart sounds.

Question 22

What is seen on CXR in a patient with cardiac tamponade.

Answer 22

Big globular fluid.

Question 23

What is seen on the ECG of a patient with cardiac tamponade. (2)

Answer 23

Low voltage QRS.

Electrical alternans.