Pericarditis Flashcards
What are 7 clinical features of pericarditis?
- Chest pain - may be pleuritic, relieved by sitting forwards
- Non-productive cough
- Dyspnoea
- Flu-like symptoms
- Pericardial rub
- Tachypnoea
- Tachycardia
What is the definition of pericarditis?
inflammation in the pericardium
What are 12 causes of pericarditis?
- Uraemia
- Viral
- Bacterial
- Malignancy
- Tuberculosis
- Vasculitis
- Autoimmune: SLE, RA, scleroderma, sarcoid
- Radiation, drugs
- Trauma
- Post-myocardial infarction→ Dressler’s syndrome
- Connective tissue disease
- Hypothyroidism
What are 5 viral causes of pericarditis?
- coxsackie
- echovirus
- CMV
- herpesvirus
- HIV
What are 5 bacterial causes of pericarditis?
- Staphylococcus
- Pneumococcus
- Streptococcus (rheumatic carditis)
- Haemophilus
- M. tuberculosis
What types of malignancy can cause pericarditis? 3 types
- lung cancer
- breast cancer
- Hodgkin lymphoma
What are 2 cardiac causes of percarditis?
- Heart failure
- Post-cardiac injury syndrome (Dressler syndrome) including post-trauma
What are 6 drug causes of pericarditis?
- Anthracycline chemotherapy (doxorubicin)
- hydralazine
- isoniazid
- methyldopa
- phenytoin
- penicillins (hypersensitivity)
What are 4 autoimmune causes of pericarditis?
- Systemic lupus erythematous (SLE)
- Rheumatoid arthritis
- Sarcoidosis
- Vasculitides (Takayasu’s, Behcet’s)
What are 2 key ECG changes in pericarditis?
- Saddle-shaped ST elevation
- PR depression
Which ECG leads show changes in pericarditis?
often global/widesppread as opposed to territories
What is the most specific ECG marker for pericarditis?
PR depression
How do ECG changes in pericarditis change over time? 3 stages
- 1-3 weeks: normalisation of ST changes, T wave flattening
- 3-8 weeks: flattened T waves become inverted
- 8+ weeks: ECG returns to normal
What investigation must all patients with suspected acute pericarditis undergo?
transthoracic echocardiography
What are the 4 key investigations to perform in pericarditis?
- ECG
- Troponin
- Echo
- CXR
What changes do troponins tend to show in pericarditis?
30% of cases - will be elevated. tend not to peak like MIs but stay constantly elevated in the acute phase
When is a chest x-ray indicated for pericarditis?
if tamponade suspected
What are 3 aspects of the first-line management of viral or idiopathic pericarditis?
- Exercise restriction
- NSAIDS
- Colchicine
In which groups of patients should colchicine be used with caution to treat pericarditis?
patients with renal or hepatic impairment
What is the second-line treatment of pericarditis providing it is non-viral?
corticosteroids for patients unable to tolerate or refractory to NSAIDs
Why shouldn’t corticosteroids be used in viral pericarditis?
risk of re-activation
What are 3 aspects of management of bacterial pericarditis?
- IV antibiotics
- Pericardiocentesis if purulent exudate present
- Pericardectomy can be performed if adhesions or recurrent tamponade occurs
What are 3 possible complications of pericarditis?
- Cardiac tamponade
- Pericardial effusion requiring pericardiocentesis
- Occasionally constrictive pericarditis in long-term
What is constrictive pericarditis?
result of scarring and loss of elasticity of the pericardial sac - upper limit of cardiac volume constrained by rigid pericardium, which prevents normal cardiac filling
as a result of resitriction on ventricular volume, stroke volume and cardiac output are limited
What often causes constrictive pericarditis? 2 things
often idiopathic
can occur after any pericardial disease process such as previous acute pericarditis
What are 2 symptoms that patients with constrictive pericarditis may experience?
- Fluid overload
- Poor exercise tolerance/ exertional dyspnoea
What are 5 possible clinical features of constrictive pericarditis on examination?
- Raised JVP
- Kussmaul’s sign (paradoical rise in JVP with inspiration)
- Pulsus paradoxus (drop in cardiac output on inspiration)
- Heart sounds may also be quiet (if pericardial effusion also present)
- Third heart sound (S3) may be present (due to rapid early diastolic ventricular filling)
What is Kussmaul’s sign?
paradoxical rise in JVP with inspiration
What is pulsus paradoxus?
drop in cardiac output on inspiration
What can cause a third heart sound (S3) aka pericardial knock to be present in constrictive pericarditis?
rapid early diastolic ventricular filling
Which cause of pericarditis particularly predisposes to constrictive pericarditis?
TB
What is a key investigation to perform in constrictive pericarditis and what will it show?
CXR → pericardial calcification
What are 3 differences between signs of cardiac tamponade and constrictive pericarditis?
- Y descent of JVP absent in cardiac tamponade but X+Y present in CP
- Kussmaul’s sign present in CP but not cardiac tamponade
- Pericardial calcification on CXR characteristic of CP but not cardiac tamponade
