pericarditis Flashcards
describe the structure of the pericardium
Pericardium is made up of visceral (inner) and parietal (outer) layers with a small space in the middle
what is pericarditis?
Inflammation of the visceral and parietal layers of the pericardium
what does pericardial effusion, constrictive pericarditis and cardiac tamponade mean?
Pericardial effusion = fluid between the layers of the pericardium
Constrictive pericarditis = occurs due to adhesions between the two layers of the pericardium leading to restrictive movement
Tamponade = pericardium filled with so much fluid that the heart can no longer contract rhythmically
list the possible causes of pericarditis
HINT - viral, bacterial, inflammatory, renal, cardiac etc
Viral = Coxsackie, Epstein Barr, HIV
idiopathic
Bacterial = TB, pneumonia, Rheum fever, endocarditis, penetrating injury
inflammatory = sarcoidosis, RA, SLE
Renal = uraemic, CKD
Cardiac = Dresslers, MI
drugs = isoniazid, penicillin, procainamide
Neoplasm - direct spread, lung tumour, mets
what are the symptoms of pericarditis?
sharp, central pericardial pain - worse on inspiration, relieved by leaning forward
tachycardia, tachypnoea
pericardial rub
related features: possible fever, signs of cancer
What is Kussmaul sign?
raised JVP on inspiration
What is pulsus paradox?
large drop in BP on inspiration
usual drop only 10mmHg
What is Beck’s triad for Tamponade?
Raised JVP
Quiet heart sounds
Low BP (low CO)
What are the differing symptoms of Tamponade depending on whether it comes on suddenly or gradually?
Sudden = Hypotension, confusion, shock
Gradual = SoB, cough, hiccups and dysphagia
What investigations would you want to do if suspecting pericarditis?
Bloods: FBC, U&E, LFT, CRP
- CK and troponin may be raised
- virology screen
- blood cultures
- ANA Ab
- Rheum fever
- Tuberculin test
ECG
CXR
ECHO
CT/MRI
What changes would an ECG show in pericarditis?
Saddle shaped ST elevation - after several days this returns to baseline & T wave inversion occurs
What changes would an ECG show in Tamponade?
low QRS voltages and alternating QRS morphology
What could you see on ECHO if a large effusion or tamponade?
right ventricle can become compressed
Septum can bend
What is the management of pericarditis?
- Bed rest
- NSAIDs/aspirin - high dose(no NSAIDs after MI as associated with myocardial rupture)
- Steroids if it still does not subside
- for persistent pericarditis:
- pericardial window can be made to drain fluid
- pericardectomy
- Colchicine
How is pericardiocentesis performed?
needle inserted at level of Xiphisternum and aim for tip of the scapula (USS guided)
Send MC&S and cytology
Drain may temporarily be left in to allow sufficient release
