Pericarditis and Pericardial effusion

Question 1

What can pericardial disease present itself as:

Answer 1

• pericarditis
• pericardial effusion
• cardiac tamponade

Question 2

What is pericarditis?

Answer 2

Inflammation of the pericardium, secondary to infection, localised injury or systemic disorders producing characteristic CP and dysnpnoea. If it persists and isn’t treated, it can lead to pericardial effusion

Question 3

What is constrictive pericarditis?

Answer 3

When the pericardium becomes too stiff or thick

Question 4

What is pericardial effusion?

Answer 4

Build up of fluid in the pericardium

Question 5

What is cardiac tamponade?

Answer 5

This is a dangerous condition, where fluid builds up and puts pressure eon the heart, thus preventing it from filling properly

Question 6

Symptoms of pericarditis:

Answer 6

• fever
  -myalgia
  -chest pain
  -right sided HF
  increased jugular venous pressure
  -oedema

Question 7

Causes of pericarditis

Answer 7

-infection
-post-Mi or post-surgery
-trauma
-drug induced
-post radiotherapy
- uraemia

Question 8

What distinguishes chest pain caused by pericarditis?

Answer 8

• sudden in onset
  -retrosternal
• sharpened when breathing deeply (pleuritic)
  -positional (relieved when sitting forward, worse when lying flat)

Question 9

ECG changes in pericarditis

Answer 9

• saddle shaped ST elevation (concave ST elevation) throughout most of limb leads and precordial leads
  -PR segment depression, due to atrial inflammation
• No pathological Q waves, only reciprocal depression in aVR
• sinus tachy is common due to pain or pericardial effusion

Question 10

What determines the gravity of pericardial effusion?

Answer 10

The amount of liquid accumulated in the pericardial sac and how fast it has accumulated

Question 11

What is the difference between acute pericardial effusion and slow acting?

Answer 11

Acute is life threatening, a chronic slow accumulation of pericardial fluid is benign but may eventially manifest symptoms as it accumulates

Question 12

Causes of pericardial effusion

Answer 12

-accumulation of blood in pericardial sac following rupture of myocardium post-MI
-autoimmune diseases: sarcoidosis
-surgery (CABG)
- trauma
-medication

Question 13

What can pericardial effusion lead to?

Answer 13

Pericardial effusion or bleeding into the pericardium due to injury can limit space available for safe expansion of the heart. If this becomes too sever, pressure around the heart increases, leading to incapability of ventricles to expand during diastole, therefore function of the heart is affected -> cardiac tamponade

Question 14

What can cardiac tamponade cause?

Answer 14

It can cause fixed ventricular volume. This means preload is reduced, causing RV function impairment which can lead to signs/symptoms of RVHF and/or LVHF.

Question 15

Clinical manifestations of cardiac tamponade?

Answer 15

• distended jugular venous pressure
  -low BP
• muffled heart sounds

Question 16

Treatment of cardiac tamponade

Answer 16

• emergency pericardiocentesis; where fluid is drained out and the underlying cause is treated

Question 17

ECG cardiac tamponade

Answer 17

• normal to non-specific ST segment changes
• electrical alternans (QRS complexes of varying heights)