Pericarditis

Question 1

How many layers form the pericardium

Answer 1

2

Question 2

Where is the visceral pericardium located

Answer 2

Next to epicardium

Question 3

How thick is the fibrous parietal layer

Answer 3

2mm

Question 4

What is the pericardium made of

Answer 4

Collagen and elastin fibres

Question 5

How much serous fluid is contained between the two layers

Answer 5

50ml

Question 6

Role of serous fluid in pericardium

Answer 6

Lubriates surface of the heart

Question 7

Is the left atrium located in the pericardium

Answer 7

Mainly outside

Question 8

Mechanical función of the pericardium

Answer 8

Restrains filling volume of the heart

Question 9

What happens to the stretchability of the pericardium at higher tension

Answer 9

Stiffer

Question 10

What happens if we exceed the 50mL serous fluid in the pericardium

Answer 10

Translates pressure to cardiac chambers

Question 11

What is the Tamponade physiology of the pericardium

Answer 11

Small amount of volume added to space has dramatic effects on heart filling

Question 12

How does chronic pericardial effusion effect the chambers

Answer 12

Reduces diastolic filling of chambers

Question 13

What is acute pericarditis

Answer 13

Fibrous material is deposited into pericardial space and pericardial effusion occurs

Question 14

How is clinical acute pericarditis diagnosed

Answer 14

2 of 4:

1. Chest pain
2. Friction rub
3. ECG changes
4. Pericardial effusion

Question 15

What is the most common cause of pericarditis

Answer 15

Viral caused - Coxsackie B and echovirus

Herpesvirus

Question 16

How long does viral pericarditis last

Answer 16

Short time + causes pain

Question 17

When does bacterial pericarditis usually occur

Answer 17

Early postoperative infection (thoracic surgery)

RARELY: Septicaemia or Pneumonia

S. Aureus in HIV patients

Question 18

Bacteria vs viral

Answer 18

Bacterial can be fatal

Question 19

How common are fungal pericarditis

Answer 19

Rare - Drug addicts + immunocompromised patients

Question 20

What two species cause fungal pericarditis

Answer 20

1. Histoplasmosis

2. Coccidioidomycosis

Question 21

What are non-infectious causes of pericarditis

Answer 21

1. Autoimmune (rheumatoid arthiritis)
2. Primary Tumours (lung, breast and lymphoma)
3. Uraemia

Question 22

What is the most common type of bacterial pericarditis

Answer 22

Tuberculosis Pericarditis

Question 23

In what two conditions can non-infectious pericarditis have an early onset

Answer 23

1. Direct injury (oesophageal perforation + penetrating thoracic injury)
2. Indirect Injury (radiation injury)

Question 24

What patients tend to be effected by pericarditis the most

Answer 24

Higher in young

Question 25

Chest pain in pericarditis

Answer 25

1. Sharp, CENTRAL chest pain 2. exacerbated on movement/lying down 3. Pain felt in left anterior chest or epigastrium 4. Pain radiates to arms 5. Relieved by sitting forward

Question 26

Other symptoms of pericarditis

Answer 26

1. Dyspnoea 2. Cough 3. Hiccups 4. Skin rash, joint pain, eye Sx, weight loss

Question 27

Differential diagnosis of Pericarditis

Answer 27

1. Angina | 2. Pleurisy

Question 28

Classic clinical signsof pericarditis

Answer 28

1. Pericardial rub occurring heard at the diaphragm via stethoscope (atrial, ventricular systole and ventricular diastole) 2. Sinsu tachycardia 3. Fever 4. Signs of effusion

Question 29

What is diagnostic for pericarditis

Answer 29

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)

Question 30

Characteristics of an ECG in pericarditis

Answer 30

1. Diffuse ST segment elevation 2. Concave ST segment 2. No ST depression 4. PR depression

Question 31

In blood tests, what should we see in FBCs

Answer 31

1. Increased in WCC + mild lymphocytosis

Question 32

In blood tests, what should we see in ESR and CRP

Answer 32

High ESR | ANA in young females

Question 33

In blood tests, what should we see in troponin levels

Answer 33

Elevation - myopericarditis

Question 34

In blood tests, what should we see in CXR

Answer 34

Enlargement of cardiac silhouette - rules out effusion

Question 35

How is Pericarditis manages

Answer 35

1. Sedentary activity oil ECG normalises 2. NSAID (Ibuprofen 600mg or Aspirin 750-1000mg) 3. Colchicine (0.5 mg)

Question 36

How does Colchicine help

Answer 36

Reduces recurrence

Question 37

When is Colchicine activity limited

Answer 37

Nausea and diarrhoea

Question 38

Long-term consequences of major pericarditis

Answer 38

1. fever 2. Pericardial effusion 2. Cardiac tamponade 3. Lack of response to aspirin + NSAIDs

Question 39

Long-term consequences of minor pericarditis

Answer 39

1. Myopericarditis 2. Immunosuppression 3. Trauma 4. Oral anticoagulant therapy

Question 40

How common is cardiac tamponade

Answer 40

Rare - usually effects acute idiopathic pericarditis

Question 41

What population does Tuberculous effusion Pericarditis effect

Answer 41

HIV positive -> leads to constrictive pericarditis

Question 42

What is constrictive pericarditis

Answer 42

Pericardium becomes thick, fibrous and calcified - interferes with the diastolic filling of the heart

Question 43

What is pericardial effusion

Answer 43

Collection of fluid in the space of pericardial sac

Question 44

What is tamponade

Answer 44

- when volume exceeds 50mL and impairs ventricular filling