Pericarditis & tamponades Flashcards
What is acute pericarditis?
Inflammation of pericardial layers
Can be with or without myocardial involvement (myocarditis)
May present with pericardial effusion
What are the main causes of acute pericarditis?
Mainly:
idiopathic or viral
Also: bacterial post MI perforation dissection of proximal aorta Cancer
What are the symptoms of acute pericarditis?
Chest pain with pleuritic features
Sitting forward usually improves it lying back makes it worse
Fever
What are the signs of acute pericarditis?
Pyrexia
Pericardial rub Left sternal edge
Hypotension
Elevated JVP & muffled heart sounds = (indicates pericardial effusion)
What are the investigations for acute pericarditis?
ECG - ST ‘saddle’ elevation and PR depression
ECHO
Bloods - troponin levels will rise if myocardial involvement as well
How is acute pericarditis treated?
Viral = conservative
Idiopathic = colchicine and limited use of NSAIDs
Bacterial = always drained even if small effusion and antimicrobials, high death rate
If large effusion present and some haemodynamic effects then drain
What is cardiac tamponade?
Haemodynamically significant pericardial effusion - ie one that compresses the heart and stops effective filling and all that shite
Often due to same causes or comes with acute pericarditis
Symptoms of cardiac tamponade?
fatigue
SOB
dizzy (hypotension)
occasionally chest pain
Often presents with AP so will have it’s symptoms
Signs of cardiac tamponade?
pulsus paradoxus, JVP raised, low BP, +/- rub, +/- muffled HS. Pulmoary oedema is very rare in pericardial effusions/tampaonade
Signs and symptoms dont seem to be very important
Investigation of cardiac tamponade?
urgent ECHO
CXR - can show large cardiac shadow
ECG
Send for MCS, neoplasic cells, protein and LDH, most are exudates
How is cardiac tamponade treated?
Drainage
Persistent effusion = surgical window to allow drainage into abdomen
What causes constrictive pericarditis?
Idopathic Radiation Post surgery Autoimmune Renal failure Sarcoid
Its rare btw
Basically anything that causes mad fibrosis of the pericardium
Symptoms and signs of constrictive pericarditis?
fatigue, SOB, cough
RIGHT HEART FAILURE: oedema, ascites, high JVP
jaundice, hepatomegally, AF, TR, pleural effusion, pericardial knock
What is the investigative route for constrictive pericarditis?
ECHO & Right heart catheterisation
These differentiate from restrictive cardiomyopathy which can be very difficult
treatment for constrictive pericarditis
Treatment is with careful and limited diuretics and pericardectomy
