Pericarditis Flashcards
Define Pericarditis?
Inflammation of the pericardium
What are the three types of Pericarditis?
Acute
Subacute
Chronic
What is the epidemiology of Pericarditis?
Uncommon
<1/100 hospital admissions
More common in males
What is the aetiology of Pericarditis?
Idiopathic Infective Connective tissue disease Post-MI Dressler's Syndrome Malignancy Radiotherapy Thoracic Surgery Drugs
What are the most common causative organisms of Pericarditis?
Coxsackie B Echovirus Mumps Streptococci Fungi Staphylococci TB
What are some examples of some connective tissue diseases that can cause Pericarditis?
Sarcoidosis
SLE
Scleroderma
How soon after MI can Pericarditis occur?
Within 24-72 hrs of MI - occurs in up to 20% of patients
What is Dressler’s Syndrome?
Pericarditis occuring weeks/months after acute MI
What malignancies can cause Pericarditis?
Lung Breast Lymphoma Leukaemia Melanoma
What drugs can cause Pericarditis?
Hydralazine
Isoniazid
What are the presenting symptoms of Pericarditis?
Chest Pain
Dyspnoea
Nausea
What is the characteristics of the chest pain in Pericarditis?
Sharp and Central
May radiate to the neck or shoulders
Worse when coughing and deep inspiration (pleuritic pain)
Relieved by sitting forward
What are the signs of Pericarditis on physical examination?
Fever Pericardial Friction Rub Faint Heart Sounds Cardiac Tamponade Signs Constrictive Pericarditis Signs
Where can the Pericardial Friction Rub be heard best?
At lower left sternal edge, with patient leaning forward during expiration
Why may heart sounds be faint in Pericarditis?
Due to a pericardial effusion
What are the Cardiac Tamponade Signs?
Beck’s Triad
Tachycardia
Pulsus Paradoxus
What is Beck’s Triad?
Signs associated with acute cardiac tamponade
- Raised JVP
- Low BP
- Muffled Heart Sounds
What is Pulsus Paradoxus?
An Abnormally large decrease in SBP (> 10 mm Hg drop) and pulse wave amplitude during inspiration
What are the Constrictive Pericarditis signs?
Kussmaul's Sign Pulsus Paradoxus Hepatomegaly Ascites Oedema Pericardial knock (due to rapid ventricular filling) AF
What would you see on an ECG for Pericarditis?
Widespread saddle-shaped ST elevation
Why do we do an Echocardiography for Pericarditis?
Assesses pericardial effusion and cardiac function
What bloods would you do for Pericarditis?
FBC U&Es ESR/CRP Cardiac Enzymes (usually normal) Other investigations for cause: blood cultures, ASO titres, ANA, rheumatoid factor
What would you see on a CXR for Pericarditis?
Usually normal
May be globular if there is a pericardial effusion
What is the acute management plan for Pericarditis?
Cardiac tamponade is treated with emergency pericardiocentesis
What is the general medical management plan for Pericarditis?
Treat underlying cause
NSAIDs for pain and fever relief
What is the management plan for recurrent Pericarditis?
Low-dose steroids
Immunosuppresants
Colchicine
What is the surgical management plan for Pericarditis?
Pericardiectomy is performed in cases of constrictive Pericarditis
What are the possible complications of Pericarditis?
Pericardial Effusion
Cardiac Tamponade
Cardiac Arrhythmias
