Pericarditis / Constrictive Pericarditis Flashcards
What is constrictive pericarditis?
Chronic inflammation of the pericardium which has lead to fibrosis
What are the symptoms present in pericarditis?
Severe, sharp retrosternal chest pain upon inspiration
Pain worsens when person is supine and improves when person is upright and leaning forward
What clinical signs may be found in pericarditis -
On auscultation and on ECG
Pericardial rub on auscultation
ECG will show ST segment elevation in several leads.
ECG will also show PR segment depression
What investigations may be done aside from an ECG for pericarditis?
Bloods - increased WBC, ESR, CRP.
Obtain troponins to rule out MI/other conditions
Transthoracic echocardiography - to find pericardial effusion and wall motion abnormalites (widespread in pericarditis)
Usually pericarditis has no clear cause or is viral. What treatment is given?
NSAIDS, colchicine (inhibits neutrophil motility and has anti-inflammatory effect).
Also treat underlying cause e.g. via chemo/Abx depending on cancer/infection
Corticosteroids given as a last resort as it reduces inflammation but is a RF for recurrence
Large pericardial effusions may cause symptoms of cardiac tamponade. What is cardiac tamponade and what does it cause
Its when fluid prevents ventricle from relaxing fully so cardiac output decreases. It may lead to haemodynamic compromise which can cause shock
What are the symptoms of cardiac tamponade
- Becks triad - hypotension, jugular venous distension and muffled heart sounds
- Larger effusions can cause Ewart’s sign which is a dullness to percussion over left subscapular area due to compression of left lung base
What ECG findings may be found in cardiac tamponade
Sinus tachycardia and low QRS complex voltage
What ECG findings may be found in pericardial effusions
Low voltages across many leads + electrical alternans (readings shift from heartbeat to heartbeat)
What is the main diagnostic tool in diagnosing pericardial effusion?
Echocardiography - finding an echo-free space between pericardial layers
How are pericardial effusions treated
Small ones often resorb by themselves.
Larger ones that persist over a month may be drained.
How is cardiac tamponade treated
Emergency drainage via pericardiocentesis
In constrictive pericarditis, what may be heard on auscultation?
Pericardial knock during diastole
In 2d echocardiography, what findings may be there for constrictive pericarditis
Thickened pericardium
Abrupt cessation of LV and RV diastolic filling
Biatrial filling
Interventricular septal shift w flattening and left sided deviation
Doppler echocardiography may show abnormally rapid early diastolic filling
What is the treatment for constrictive pericarditis
It is usually permanent and progressive, and treatment is often pericardiectomy whereby the entire pericardium is surgically removed
