Pericarditis/Cardiac Tmaponade Flashcards
define acute pericarditis
Inflammation of pericardium
Often asst with pericardial effusion
What demographic group is commonly affected by acute pericarditis?
Males < 50 yrs
What is the most common cause of acute pericarditis?
- Viral
A. May be preceded by flu-like resp. or GI sx’s - Idiopathic
What are other causes of acute pericarditis?
- Autoimmune Dz
- Radiation
- Neoplasm
- Post cardiac surgery or post-MI
A. Dressler syndrome
Define Dressler syndrome
Pericarditis may occur 2-5 days after MI due to an inflammatory reaction to transmural myocardial necrosis; can also occur after cardiac surgery
What are the layers of the heart?
- Visceral – attached to myocardium
- Parietal – surrounds the visceral layer
- Pericardial space - potential space between 2 layers
A. Normally contains small amount of fluid
What is the pathophys of acute pericarditis?
1. Damaged pericardial tissue releases chemical mediators of inflammation into surrounding tissue: A. Prostaglandins B. Histamine C. Bradykinins D. Serotonin 2. Initiate inflammatory response
What does inflammation of the pericardium cause?
- Friction occurs as inflammed pericardial layers rub against each other
- Inflammatory mediators → vasodilation and ↑ capillary permeability
What is a complication of pericarditis?
pericardial effusion
What are the classic sxs of acute pericarditis?
1. Substernal chest pain A. Acute, Sharp & Pleuritic OR B. Dull w/ radiation to trap areas C. Postural: Relieved by sitting up or leaning forward 2. Dyspnea 3. Fever 4. Pericardial friction rub
How is acute pericarditis diagnosed?
Diagnosis is usually clinical
What labs are indicated in acute pericarditis?
- CBC-Leukocytosis
- ↑ CRP
- ESR
- Normal troponin
- Blood Cx if fever > 38° C
- CXR
- Normal ECHO with trivial amount of fluid
- EKG
What may be the EKG findings for an acute pericarditis?
- May have non specific ST-T wave changes & low QRS voltage
- Diffuse ST elevation –> over time, returns to baseline followed by T wave inversion
- Asst PR segment depression
What CXR results may be seen with acute pericarditis?
New cardiomegaly
How is acute pericarditis treated?
- NSAIDs: 1-2 wks or
- ASA: 1-2 wks or
- Prednisone: 1-2 wks
- Colchicine (Always)
What NSAIDs are indicated in acute pericarditis?
- Indomethacin (Indocin) 50 mg po bid
2. Ibuprofen (Motrin) 600-800 mg po tid
What is the dosing and indications for asa use in acute pericarditis?
650-1000 mg po tid
Drug of choice in Dressler Syndrome post MI
Fever, pleuritic pain, effusion or friction rub
When is prednisone used in acute pericarditis?
- refractory cases or autoimmune
2. 0.25-0.5 mg/kg/d
When is colchicine used in acute preicarditis?
Always used!
0.5-0.6 mg po bid x 3 mo
What lifestyle modifications are needed after acute pericarditis?
Limit strenuous activity x 3 mo
What are treatments are indicated in acute pericarditis?
Taper meds as CRP returns to baseline/sx’s improve Cont. Colchicine x 3 mo (no taper) GI protection w/PPI Interventional effusion drainage prn Manage underlying Dz if indicated
What serious complications can occur form acute pericarditis? How is it managed?
Cardiac tamponade
A. Early complication that occurs in <5% of pts
B. Can be asst with uremic pericarditis, neoplastic pericarditis or radiation pericarditis
C. Partial pericardiectomy or “pericardial window” often necessary
What determines the physiologic importance of a pericardial effusion and tamponade?
Speed of accumulation of pericardial fluid determines physiologic importance
How is pericardial tamponade characterized?
Tamponade is characterized by elevated intrapericardial pressure (>15 mm Hg) which restricts venous return and ventricular filling leads to shock & death
