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AIP Chest pain > Pericarditis > Flashcards

Pericarditis Flashcards

1
Q

What are 7 clinical features of pericarditis?

A
  1. Chest pain - may be pleuritic, relieved by sitting forwards
  2. Non-productive cough
  3. Dyspnoea
  4. Flu-like symptoms
  5. Pericardial rub
  6. Tachypnoea
  7. Tachycardia
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2
Q

What is the definition of pericarditis?

A

inflammation in the pericardium

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3
Q

What are 12 causes of pericarditis?

A
  1. Uraemia
  2. Viral
  3. Bacterial
  4. Malignancy
  5. Tuberculosis
  6. Vasculitis
  7. Autoimmune: SLE, RA, scleroderma, sarcoid
  8. Radiation, drugs
  9. Trauma
  10. Post-myocardial infarction→ Dressler’s syndrome
  11. Connective tissue disease
  12. Hypothyroidism
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4
Q

What are 5 viral causes of pericarditis?

A
  1. coxsackie
  2. echovirus
  3. CMV
  4. herpesvirus
  5. HIV
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5
Q

What are 5 bacterial causes of pericarditis?

A
  1. Staphylococcus
  2. Pneumococcus
  3. Streptococcus (rheumatic carditis)
  4. Haemophilus
  5. M. tuberculosis
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6
Q

What types of malignancy can cause pericarditis? 3 types

A
  1. lung cancer
  2. breast cancer
  3. Hodgkin lymphoma
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7
Q

What are 2 cardiac causes of percarditis?

A
  1. Heart failure
  2. Post-cardiac injury syndrome (Dressler syndrome) including post-trauma
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8
Q

What are 6 drug causes of pericarditis?

A
  1. Anthracycline chemotherapy (doxorubicin)
  2. hydralazine
  3. isoniazid
  4. methyldopa
  5. phenytoin
  6. penicillins (hypersensitivity)
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9
Q

What are 4 autoimmune causes of pericarditis?

A
  1. Systemic lupus erythematous (SLE)
  2. Rheumatoid arthritis
  3. Sarcoidosis
  4. Vasculitides (Takayasu’s, Behcet’s)
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10
Q

What are 2 key ECG changes in pericarditis?

A
  1. Saddle-shaped ST elevation
  2. PR depression
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11
Q

Which ECG leads show changes in pericarditis?

A

often global/widesppread as opposed to territories

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12
Q

What is the most specific ECG marker for pericarditis?

A

PR depression

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13
Q

How do ECG changes in pericarditis change over time? 3 stages

A
  1. 1-3 weeks: normalisation of ST changes, T wave flattening
  2. 3-8 weeks: flattened T waves become inverted
  3. 8+ weeks: ECG returns to normal
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14
Q

What investigation must all patients with suspected acute pericarditis undergo?

A

transthoracic echocardiography

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15
Q

What are the 4 key investigations to perform in pericarditis?

A
  1. ECG
  2. Troponin
  3. Echo
  4. CXR
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16
Q

What changes do troponins tend to show in pericarditis?

A

30% of cases - will be elevated. tend not to peak like MIs but stay constantly elevated in the acute phase

17
Q

When is a chest x-ray indicated for pericarditis?

A

if tamponade suspected

18
Q

What are 3 aspects of the first-line management of viral or idiopathic pericarditis?

A
  1. Exercise restriction
  2. NSAIDS
  3. Colchicine
19
Q

In which groups of patients should colchicine be used with caution to treat pericarditis?

A

patients with renal or hepatic impairment

20
Q

What is the second-line treatment of pericarditis providing it is non-viral?

A

corticosteroids for patients unable to tolerate or refractory to NSAIDs

21
Q

Why shouldn’t corticosteroids be used in viral pericarditis?

A

risk of re-activation

22
Q

What are 3 aspects of management of bacterial pericarditis?

A
  1. IV antibiotics
  2. Pericardiocentesis if purulent exudate present
  3. Pericardectomy can be performed if adhesions or recurrent tamponade occurs
23
Q

What are 3 possible complications of pericarditis?

A
  1. Cardiac tamponade
  2. Pericardial effusion requiring pericardiocentesis
  3. Occasionally constrictive pericarditis in long-term
24
Q

What is constrictive pericarditis?

A

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

25
Q

What often causes constrictive pericarditis? 2 things

A

often idiopathic

can occur after any pericardial disease process such as previous acute pericarditis

26
Q

What are 2 symptoms that patients with constrictive pericarditis may experience?

A
  1. Fluid overload
  2. Poor exercise tolerance/ exertional dyspnoea
27
Q

What are 5 possible clinical features of constrictive pericarditis on examination?

A
  1. Raised JVP
  2. Kussmaul’s sign (paradoical rise in JVP with inspiration)
  3. Pulsus paradoxus (drop in cardiac output on inspiration)
  4. Heart sounds may also be quiet (if pericardial effusion also present)
  5. Third heart sound (S3) may be present (due to rapid early diastolic ventricular filling)
28
Q

What is Kussmaul’s sign?

A

paradoxical rise in JVP with inspiration

29
Q

What is pulsus paradoxus?

A

drop in cardiac output on inspiration

30
Q

What can cause a third heart sound (S3) aka pericardial knock to be present in constrictive pericarditis?

A

rapid early diastolic ventricular filling

31
Q

Which cause of pericarditis particularly predisposes to constrictive pericarditis?

A

TB

32
Q

What is a key investigation to perform in constrictive pericarditis and what will it show?

A

CXR → pericardial calcification

33
Q

What are 3 differences between signs of cardiac tamponade and constrictive pericarditis?

A
  1. Y descent of JVP absent in cardiac tamponade but X+Y present in CP
  2. Kussmaul’s sign present in CP but not cardiac tamponade
  3. Pericardial calcification on CXR characteristic of CP but not cardiac tamponade

AIP Chest pain (9 decks)

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