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Cardiology > pericarditis > Flashcards

pericarditis Flashcards

1
Q

do the part of the great vessels lie within the pericardium?

A

yes

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2
Q

the two layers of pericardium are continuous with each other, T of F?

A

true

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3
Q

what are the functions of the pericardium?

A

Fixes the heart in the mediastinum and limits its motion – this is due to its attachment to the diaphragm, the sternum and the tunica adventitia (outer layer) of the great vessels
Prevents overfilling of the heart – relatively inextensible fibrous layer
Lubrication – A thin film of fluid between the two layers of the serous pericardium reduces the friction generated by the heart as it moves within the thoracic cavity
Protection from infection – The fibrous pericardium serves as a physical barrier between the muscular body of the heart and adjacent organs prone to infection, such as the lungs.

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4
Q

what are the two main layers of pericardium called?

A

fibrous and serous

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5
Q

What layers is the serous pericardium divided into?

A

parietal and visceral

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6
Q

what is the alternative name given to the visceral pericardium?

A

epicardium

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7
Q

what are the layers of pericardium made from?

A

Each layer is made up of a single sheet of epithelial cells, aka mesothelium.

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8
Q

what is the transverse pericardial sinus?

A

it is located posteriorly to the ascending aorta, anterior to the SVC and superior tot he left atrium
it separates the arterial (aorta and pulmonary trunk) from the venous vessels (SVC and pulmonary veins)
this can be used to identify and ligate the arteries of the heart

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9
Q

explain the physiology of the pericardium and tamponade physiology

A

Small amount of volume added to space (ie the pericardial space) has dramatic effects on filling but so does removal of a small amount
the pericardium is initially stretchy and then become stiff at a higher tension, which restrains the filling volume of the heart
this means the pericardial sac has a small reserve volume

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10
Q

What happens in chronic pericardial effusion?

A

Chronic accumulation allows adaptation of the parietal pericardium
This compliance reduces the effect on diastolic filling of the chambers

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11
Q

What is acute pericarditis?

A

an inflammatory pericardial syndrome with or without effusion

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12
Q

What is the most common symptom of pericarditis?

A

chest pain

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13
Q

What is the most common cause of pericarditis?

A

viruses eg enteroviruses such as coxsackieviruses, echoviruses and herpesviruses
adenoviruses
parvovirus

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14
Q

what is the most common bacterial cause of pericarditis?

A

Mycobacterium tuberculosis

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15
Q

What are the non-infectious causes of pericarditis?

A 
autoimmune
neoplastic 
metabolic
traumatic and iatrogenic 
other
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16
Q

give examples of autoimmune conditions that can lead to pericardtitis

A

Sjörgen’s syndrome
rheumatoid arthritis
scleroderma
systemic vasculitides

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17
Q

What are the causes of neoplastic related pericarditis?

A

secondary metastatic tumours such as lung, breast cancer and lymphoma

18
Q

what are the metabolic causes of pericarditis?

A

uraemia
myxodema - swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands (can also happen in hyperthroidism)

19
Q

what are the causes of traumatic or iatrogenic pericarditis?

A

direct injury - eg penetrating thoracic injury or oesophageal perforation
indirect injury- non-penetrating thoracic injury, radiation injury
post-cardiac injury syndromes eg due to MI or iatrogenic trauma like PCI, pacemaker lead insertion and radiofrequency ablation

20
Q

What are some other causes of pericarditis?

A

Amyloidosis, aortic dissection, pulmonary arterial hypertension and chronic heart failure

21
Q

What is the reason for 80-90% of pericarditis cases?

A

idiopathic!

22
Q

what is the clinical presentation for the chest pain part of pericarditis?

A

severe chest pain
sharp and pleuritic pain
rapid onset of chest pain
pain in the left anterior chest or epigastrium
radiation of pain to arm ie trapezius ridge - due to irritation of PHRENIC nerve
relieved by sitting forward and exacerbated by lying down

23
Q

what are the other symptoms of pericarditis other than chest pain?

A

dyspnoea
cough
hiccups (phrenic nerve irritation)
systemic disturbance - viral prodrome, fever, skin rash, joint pain, eye symptoms, weight loss
past medical history of cancer, rheumatological disease, pneumonia, cardiac procedure eg PCI and ablation and MI

24
Q

what are the differential diagnoses of pericarditis?

A 
MI or ischaemia 
Pneumonia
Pleurisy
Pulmonary Embolus
Chostocondritis
Gastro-oesophageal reflux
Aortic dissection
Pneumothorax
Pancreatitis
Peritonitis
Herpes zoster (shingles)
25
Q

What are the signs of pericarditis on clinical examination?

A

pericardial rub
sinus tachycardia
fever
signs of effusion - eg pulsus paradoxus and Kussmaul’s sign

26
Q

What investigations are done for pericarditis?

A

ECG
bloods
CXR
echocardiogram - if suspicion of pericardial effusion

27
Q

What are the ECG changes seen with someone who has pericarditis?

A

ST segment elevation across all leads or patchy ST elevation
concave ST segment ‘saddle shape’
NO reciprocal ST depression in the opposite leads
PR depression

28
Q

What is the mechanism of the ECG changes seen in pericarditis?

A

epicardial inflammation as the parietal pericardium is intert

29
Q

How are the ECG changes seen in STEMI different to that seen on pericarditis?

A

ST segment not concaved like a saddle
there are reciprocal changes seen in the opposite leads as ‘lost R waves’
NO PR depression

30
Q

What would be found on a blood test for pericarditis?

A

increase in white cell count ie mild lympnocytosis
High ESR adn CRP
high antinuclear antibbodies (ANA) in sb with SLE
troponin elevation suggests myopericarditis

31
Q

what may be seen on CXR with sb who has pericarditis?

A

normal if the cause is idiopathic
pneumonia if the cause is bacterial
enlargement of cardiac sillhouette if large effusion is present

32
Q

How is pericarditis managed?

A

NSAIDs eg ibuprofen or aspirin (aspirin is an NSAID)
Colchicine (but limited by the side effects of nausea and diarrhoea)
sedentary activity until resolution of symptoms and ECG/CRP (particularly for athletes who can get myocardial rupture post pericarditis)

33
Q

What are the major predictive factors that may point to increased complications?

A 
Fever >38°C
Subacute onset
Large pericardial effusion
Cardiac tamponade
Lack of response to aspirin or NSAIDs after at least 1 week of therapy
34
Q

What are the minor predictive factors that may point to increased complications?

A

Myopericarditis
Immunosuppression
Trauma
Oral anticoagulant therapy

35
Q

What is the prognosis for sb with pericarditis?

A

mopst pts have a good long term prognosis
cardiac tamponade rarely occurs if acute idiopathic cause
the risk of developing constrictive pericarditis is highest with bacterial causes and lowest with idiopathic and viral causes, other causes have an intermediate risk of constrictive pericarditis

36
Q

What percentage of people will develop a recurrence of pericarditis?

A

15-30%

37
Q

Is viral serology needed in viral pericarditis?

A

no as it is a self-limiting illness

38
Q

what bacteria are responsible for purulent bacterial pericarditis and effusion?

A

Staph
Strep
pneumococci

39
Q

what bacteria are responsible for purulent bacterial pericarditis and effusion?

A

Staph

Strep incl. Strep pneumoniae

40
Q

How long will it take after an MI to develop Dressler’s syndrome or post cardiac injury syndromes?

A

1-2 weeks post MI

Cardiology (7 decks)

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