Pericarditis Flashcards
How many layers form the pericardium
2
Where is the visceral pericardium located
Next to epicardium
How thick is the fibrous parietal layer
2mm
What is the pericardium made of
Collagen and elastin fibres
How much serous fluid is contained between the two layers
50ml
Role of serous fluid in pericardium
Lubriates surface of the heart
Is the left atrium located in the pericardium
Mainly outside
Mechanical función of the pericardium
Restrains filling volume of the heart
What happens to the stretchability of the pericardium at higher tension
Stiffer
What happens if we exceed the 50mL serous fluid in the pericardium
Translates pressure to cardiac chambers
What is the Tamponade physiology of the pericardium
Small amount of volume added to space has dramatic effects on heart filling
How does chronic pericardial effusion effect the chambers
Reduces diastolic filling of chambers
What is acute pericarditis
Fibrous material is deposited into pericardial space and pericardial effusion occurs
How is clinical acute pericarditis diagnosed
2 of 4:
- Chest pain
- Friction rub
- ECG changes
- Pericardial effusion
What is the most common cause of pericarditis
Viral caused - Coxsackie B and echovirus
Herpesvirus
How long does viral pericarditis last
Short time + causes pain
When does bacterial pericarditis usually occur
Early postoperative infection (thoracic surgery)
RARELY: Septicaemia or Pneumonia
S. Aureus in HIV patients
Bacteria vs viral
Bacterial can be fatal
How common are fungal pericarditis
Rare - Drug addicts + immunocompromised patients
What two species cause fungal pericarditis
- Histoplasmosis
2. Coccidioidomycosis
What are non-infectious causes of pericarditis
- Autoimmune (rheumatoid arthiritis)
- Primary Tumours (lung, breast and lymphoma)
- Uraemia
What is the most common type of bacterial pericarditis
Tuberculosis Pericarditis
In what two conditions can non-infectious pericarditis have an early onset
- Direct injury (oesophageal perforation + penetrating thoracic injury)
- Indirect Injury (radiation injury)
What patients tend to be effected by pericarditis the most
Higher in young
Chest pain in pericarditis
- Sharp, CENTRAL chest pain
- exacerbated on movement/lying down
- Pain felt in left anterior chest or epigastrium
- Pain radiates to arms
- Relieved by sitting forward
Other symptoms of pericarditis
- Dyspnoea
- Cough
- Hiccups
- Skin rash, joint pain, eye Sx, weight loss
Differential diagnosis of Pericarditis
- Angina
2. Pleurisy
Classic clinical signsof pericarditis
- Pericardial rub occurring heard at the diaphragm via stethoscope (atrial, ventricular systole and ventricular diastole)
- Sinsu tachycardia
- Fever
- Signs of effusion
What is diagnostic for pericarditis
ECG - Concaving ST elevation (differentiate from MI as it will show up in leads other than anterior or inferior leads)
Also:
Bloods
CXR (may demonstrate cardiomegaly)
Echocardiogram (confirm cardiomegaly on CXR)
Characteristics of an ECG in pericarditis
- Diffuse ST segment elevation
- Concave ST segment
- No ST depression
- PR depression
In blood tests, what should we see in FBCs
- Increased in WCC + mild lymphocytosis
In blood tests, what should we see in ESR and CRP
High ESR
ANA in young females
In blood tests, what should we see in troponin levels
Elevation - myopericarditis
In blood tests, what should we see in CXR
Enlargement of cardiac silhouette - rules out effusion
How is Pericarditis manages
- Sedentary activity oil ECG normalises
- NSAID (Ibuprofen 600mg or Aspirin 750-1000mg)
- Colchicine (0.5 mg)
How does Colchicine help
Reduces recurrence
When is Colchicine activity limited
Nausea and diarrhoea
Long-term consequences of major pericarditis
- fever
- Pericardial effusion
- Cardiac tamponade
- Lack of response to aspirin + NSAIDs
Long-term consequences of minor pericarditis
- Myopericarditis
- Immunosuppression
- Trauma
- Oral anticoagulant therapy
How common is cardiac tamponade
Rare - usually effects acute idiopathic pericarditis
What population does Tuberculous effusion Pericarditis effect
HIV positive -> leads to constrictive pericarditis
What is constrictive pericarditis
Pericardium becomes thick, fibrous and calcified - interferes with the diastolic filling of the heart
What is pericardial effusion
Collection of fluid in the space of pericardial sac
What is tamponade
- when volume exceeds 50mL and impairs ventricular filling
