Pericarditis

Question 1

Define Pericarditis?

Answer 1

Inflammation of the pericardium

Question 2

What are the three types of Pericarditis?

Answer 2

Acute
Subacute
Chronic

Question 3

What is the epidemiology of Pericarditis?

Answer 3

Uncommon
<1/100 hospital admissions
More common in males

Question 4

What is the aetiology of Pericarditis?

Answer 4

Idiopathic
Infective 
Connective tissue disease
Post-MI
Dressler's Syndrome 
Malignancy 
Radiotherapy 
Thoracic Surgery 
Drugs

Question 5

What are the most common causative organisms of Pericarditis?

Answer 5

Coxsackie B 
Echovirus 
Mumps 
Streptococci
Fungi 
Staphylococci 
TB

Question 6

What are some examples of some connective tissue diseases that can cause Pericarditis?

Answer 6

Sarcoidosis
SLE
Scleroderma

Question 7

How soon after MI can Pericarditis occur?

Answer 7

Within 24-72 hrs of MI - occurs in up to 20% of patients

Question 8

What is Dressler’s Syndrome?

Answer 8

Pericarditis occuring weeks/months after acute MI

Question 9

What malignancies can cause Pericarditis?

Answer 9

Lung
Breast 
Lymphoma 
Leukaemia 
Melanoma

Question 10

What drugs can cause Pericarditis?

Answer 10

Hydralazine

Isoniazid

Question 11

What are the presenting symptoms of Pericarditis?

Answer 11

Chest Pain
Dyspnoea
Nausea

Question 12

What is the characteristics of the chest pain in Pericarditis?

Answer 12

Sharp and Central
May radiate to the neck or shoulders
Worse when coughing and deep inspiration (pleuritic pain)
Relieved by sitting forward

Question 13

What are the signs of Pericarditis on physical examination?

Answer 13

Fever 
Pericardial Friction Rub
Faint Heart Sounds 
Cardiac Tamponade Signs 
Constrictive Pericarditis Signs

Question 14

Where can the Pericardial Friction Rub be heard best?

Answer 14

At lower left sternal edge, with patient leaning forward during expiration

Question 15

Why may heart sounds be faint in Pericarditis?

Answer 15

Due to a pericardial effusion

Question 16

What are the Cardiac Tamponade Signs?

Answer 16

Beck’s Triad
Tachycardia
Pulsus Paradoxus

Question 17

What is Beck’s Triad?

Answer 17

Signs associated with acute cardiac tamponade

• Raised JVP
• Low BP
• Muffled Heart Sounds

Question 18

What is Pulsus Paradoxus?

Answer 18

An Abnormally large decrease in SBP (> 10 mm Hg drop) and pulse wave amplitude during inspiration

Question 19

What are the Constrictive Pericarditis signs?

Answer 19

Kussmaul's Sign
Pulsus Paradoxus 
Hepatomegaly 
Ascites 
Oedema 
Pericardial knock (due to rapid ventricular filling)
AF

Question 20

What would you see on an ECG for Pericarditis?

Answer 20

Widespread saddle-shaped ST elevation

Question 21

Why do we do an Echocardiography for Pericarditis?

Answer 21

Assesses pericardial effusion and cardiac function

Question 22

What bloods would you do for Pericarditis?

Answer 22

FBC 
U&Es 
ESR/CRP
Cardiac Enzymes (usually normal)
Other investigations for cause: blood cultures, ASO titres, ANA, rheumatoid factor

Question 23

What would you see on a CXR for Pericarditis?

Answer 23

Usually normal

May be globular if there is a pericardial effusion

Question 24

What is the acute management plan for Pericarditis?

Answer 24

Cardiac tamponade is treated with emergency pericardiocentesis

Question 25

What is the general medical management plan for Pericarditis?

Answer 25

Treat underlying cause

NSAIDs for pain and fever relief

Question 26

What is the management plan for recurrent Pericarditis?

Answer 26

Low-dose steroids
Immunosuppresants
Colchicine

Question 27

What is the surgical management plan for Pericarditis?

Answer 27

Pericardiectomy is performed in cases of constrictive Pericarditis

Question 28

What are the possible complications of Pericarditis?

Answer 28

Pericardial Effusion
Cardiac Tamponade
Cardiac Arrhythmias