Pericarditis. Pericardial effusion Flashcards
1
Q
What is Pericarditis ?
A
- inflammation of the pericardium
2
Q
State the 2 subtypes of pericarditis:
A
- acute pericarditis, last a few weeks
- chronic pericarditis, last more than 6 months
3
Q
What is the pericardium ?
A
- a cavity where the heart sits inside
- composed of the serous and fibrous pericardium
- Fibrous pericardium is the outer layer, keeps the heart in place within the chest cavity
- Serous pericardium, contains the pericardial cavity, filled with fluid, that lets the heart slip around. Cells of the serous pericardium secrete and reabsorb this fluid.
4
Q
Acute pericarditis: causes
A
- idiopathic: mostly
- Viral: Coxsakie B virus
- Dressler’s syndrome -> occurs month after an MI
- Uremic pericarditis: when uremia (nitrogen waste products) get really high, usually due to kidney problems. High blood urea irritates the serous pericardium, making it secrete a thick pericardial fluid full of fibrin strands and WBCs
- Autoimmune diseases: rheumatoid artheritis, scleroderma, systemic lupus erythematosis (SLE). Where the immune system attacks the pericardium
- Cancer and radiation therapy
- Medication: like penicillin, and some anti-convulsants
=> results in: fluid and immune cells move into the pericardial tissues, making it thicker
5
Q
Pericardial effusion: what is it, how can it happen, and consequences of it
A
Pericardial effusion -> occurs when pericardial fluid pulls into the pericardial space
- Happens because the serous pericardium can not remove it as quickly as it comes in.
- if pericardial effusion gets big -> it puts pressure on the heart -> prevents it from fully stretching out and relaxing, can lead to tamponade physiology.
6
Q
Tamponade physiology: what is it
A
- too much fluid found in the pericardial cavity -> preventing the heart chambers to fill properly -> causes a decrease in the CO: which is an emergency
7
Q
Chronic pericarditis, def
A
- chronic pericarditis is the inflammation of the pericardium that lasts for months (6 months at least)
8
Q
Chronic pericarditis, pathomechanism and complications
A
- here, the immune cells cause fibrosis of the serous pericardium, producing a sort of inelastic shell around the heart, making it hard for the ventricles to expand
- over time, it becomes hard for the heart to relax and expand, causing a decrease in SV
- to compensate, HR increases
- similar to tamponade physiology, but occurs more gradually, and is a result of a change in the composition of the serous pericardium, rather than a fluid collection around the serous pericardium
9
Q
Chronic pericarditis: Symptoms
A
- fever
- chest pain: worse with heavy breathing, but butter when sitting up and leaning forwards
- Large pericardial effusion, (more than 100mL fluid in pericardial cavity), leads to
. decrease heart sounds
. decreased CO -> leading to: shortness of breath, low BP, and lightheadedness
10
Q
Pericarditis: Diagnosis
A
- friction rub, upon occultation: the thick layers rub against each other
- ECG
- X-ray: big silhouette -> “water bottle” sign
- Echo: Pericardial effusion makes it look like the heart is dancing within the pericardial effusion. Whereas, chronic pericarditis, shows the stiffening of the heart, preventing its movement
11
Q
ECG findings for acute pericarditis
A
- Stage I: PR segment depression, ST elevation
- Stage II: flattened T waves
- Stage III: inverted T waves, for a few weeks
- Stage IV: ECG goes back to normal
12
Q
ECG findings for pericardial effusion
A
- low QRS complex voltage, or
- electrical alternans, where the QRS complex has different heights as a result of the heart going back and forth in a pool of pericardial fluid
13
Q
Pericarditis: Treatment
A
- main goal is to relieve pain with analgesic medication
- treat the underlying cause of inflammation
- Aspirin + other NSAIDS (ibuprofen), opioids
- corticosteroids (except in infective pericarditis)
- colchicine
- in case of severe pericardial effusion: pericardiocentesis: insert a needle in the pericardial cavity -> draining the excess fluid
