Pericarditis Flashcards
MC pathology affecting the pericardium and classified clinically and etiologically
Pericarditis
Pain resembles that of acute MI
Acute Pericarditis
ACUTE PERICARDITIS
severe, pleuritic, retrosternal or left precordial
pericardial pain:
RELIEVED by sitting and leaning forward
INTENSIFIED by lying supine
pericardial friction rub
High-pitched, rasping, scratchy or grating and heard most frequently at end-expiration w/ patient upright and leaning forward
Healing of an acute fibrinous or serofibrinous pericarditis or the resorption of a chronic pericardial effusion is followed by obliteration of the pericardial cavity w/ formation of granulation tissue
Chronic (Constrictive) Pericarditis
Kussmaul’s sign
increase in systemic venous pressure w/ inspiration, seen as a rise in JVP
NORMAL - decrease pressure in inspiration
Pericardial knock
early diastolic sound in the left sternal border
ECG stages in Acute Pericarditis
Stage 1 - diffuse ST elevations w/ upward concavity and PR segment depression
Stage 2 - ST segments normalize
Stage 3 - T-wave inversions
Stage 4 - ECG returns to normal (weeks or months)
ECG in AMI - convex ST elevations, QRS changes occur and T wave inversion is seen w/o hrs before the ST segments become isoelectric
2D echo findings in acute pericarditis
pericardial fluid or thickening
differentiate pericarditis from MI: wall motion assessment
CT/MRI findings in acute pericarditis
pericardial fluid collection
pericardial thickening
Management of acute pericarditis
bed rest
NSAIDs, colchicine
pericardiocentesis if with tamponade
ECG findings in Chronic Pericarditis
low voltage QRS complexes
diffuse flattening or inversion of T waves
atrial fibrillation in 1/3 of patients
2D echo findings in Chronic Pericarditis
pericardial thickening
dilation of the IVC and hepatic veins
normal ventricular systolic function
flattening of the LV posterior wall
CT/MRI findings in Chronic Pericarditis
pericardial thickening
more accurate for imaging pericardial thickening than 2D echo
Management of Chronic Pericarditis
pericardial resection/pericardiectomy
sodium restriction and diuretics
Anti-Koch’s for TB pericarditis
Steroids (uncertain benefit)
