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Z Year3 Cardio Conditions > Pericarditis > Flashcards

Pericarditis Flashcards

1
Q

What is pericarditis?

A

inflammation of pericardium (fluid filled sac around heart)

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2
Q

What are the different types of pericarditis?

A
  1. Acute pericarditis
  2. Pericardial effusion
  3. Constrictive pericarditis
  4. Cardiac tamponade
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3
Q

What are the inflammatory causes of pericarditis?

A
  1. Post-MI (1-3 days)
  2. Dressler’s syndrome (weeks months)
  3. Systemic (SLE, sarcoidosis)
  4. Trauma
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4
Q

What are the infection causes of pericarditis?

A
  • Mostly viral:
    1. Coxsackie B / A9
    2. Echovirus
    3. Mumps
  • TB in developing countries
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5
Q

What are the malignancy causes of pericarditis?

A
  1. Malignancy
  2. Radiotherapy
  3. Anti-cancer drugs
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6
Q

What are causes of acute pericarditis?

A
  1. Idiopathic
  2. Viruses: EBV, CMV
  3. Bacteria: TB
  4. Fungi and parasitic
  5. Autoimmune: SLE, RA
  6. Drugs
  7. Metabolic
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7
Q

What are RF for acute pericarditis?

A
  1. Male
  2. 20-50
  3. Transmural MI
  4. Cardiac surgery
  5. Neoplasm
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8
Q

What is chronic pericarditis?

A

chronic inflammation of the pericardium with thickening and scarring

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9
Q

What are causes of chronic pericarditis?

A
  1. Idiopathic
  2. Infectious (TB, Bacterial, Viral)
  3. Acute pericarditis
  4. Cardiac surgery and radiation
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10
Q

What is a pericardial effusion?

A

accumulation of fluid in pericardial sac

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11
Q

What are causes of pericardial effusion?

A
  1. Pericarditis
  2. Myocardial rupture
  3. Aortic dissection
  4. Malignancy
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12
Q

What is cardiac tamponade?

A

Pericardial effusion that raises intrapericardial pressure, reduced ventricular filling and so dropping cardiac output – can lead to cardiac arrest

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13
Q

What are RF for cardiac tamponade?

A
  1. Aortic dissection
  2. Purulent pericarditis
  3. Large idiopathic pericardial effusion
  4. TB
  5. Malignancy
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14
Q

What is the patho of cardiac tamponade?

A

fluid build up in pericardium restricts heart pumping

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15
Q

What is the normal epid for pericarditis?

A

Male 20-50yo

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16
Q

What is the key symptom of pericarditis?

A

pleuritic chest pain

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17
Q

What is the key sign of pericarditis?

A

pericardial friction rub

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18
Q

What are symptoms of acute pericarditis?

A
  1. Chest pain is sharp and central
  2. RELIEVED BY SITTING UP & LEANING FORWARD
  3. fever
  4. dyspnoea
  5. nausea
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19
Q

What is perciardial friction rub?

A
  1. Scratchy sound
  2. Heard at left sternal edge w/ patient leaning forward on expiration
  3. Use diaphragm of stethoscope
20
Q

What are symptoms and signs of chronic pericarditis?

A
  • similar to restrictive cardiomyopathy
    1. RHF presentation (raised JVP, oedema)
    2. Kussmaul’s sign
    3. Diffuse apex beat
    4. S3
21
Q

What are symptoms of pericardial effusion?

A
  1. Dyspnoea
  2. Chest pain
  3. Signs of local structures compressed e.g. nausea, hiccoughs, muffled heart sounds
22
Q

What are symptoms and signs of cardiac tamponade?

A
  1. High pulse
  2. Low BP
  3. Pulsus paradoxus
  4. High JVP
  5. Kussmauls’s signs
  6. Muffled S1 and S2
23
Q

What is Beck’s triad for cardiac tamponade?

A
  1. Distended neck veins
  2. Decreased BP
  3. Distorted (muffled) heart sounds
24
Q

What are possible DDx for acute pericarditis?

A
  1. PE
  2. MI
  3. Pneumonia
  4. Pneumothorax
  5. Costochondritis
25
Q

What are possible DDx for pericardial effusion?

A
  1. Malignancy
  2. Viral pericarditis
  3. Latrogenic
  4. Idiopathic
26
Q

What are possible DDx for cardiac tamponade

A
  1. Constrictive pericarditis
  2. Restrictive cardiomyopathy
  3. Cardiogenic shock
27
Q

What investigation is done for chronic pericarditis?

A
  1. CXR
  2. ECHO
  3. Cardiac CT/MRI
28
Q

What would CXR show in chronic pericarditis?

A

pericardial calcification

29
Q

What would ECHO show in chronic pericarditis?

A

increased pericardial thickness – differentiate from restrictive cardiomyopathy

30
Q

What Ix are done for acute pericarditis?

A
  1. ECG
  2. Pericardicentesis is suspect cardiac tamponade
  3. Echo
31
Q

What does ECG show in acute pericarditis?

A
  1. concave, saddle shape ST segement elevation

2. PR depression (V2-V6)

32
Q

What bloods are done in acute pericarditis?

A
  1. FBC: elevated WBC
  2. ESR/CRP: for inflammation
  3. U+E
  4. Cardiac enzymes: troponin may be raised
  5. LFTs: tamponade means congestion
33
Q

What Ix is done for pericardial effusion?

A
  1. CXR
  2. ECG
  3. ECHO
34
Q

What would CXR show in pericardial effusion?

A

enlarged, globular heart if effusion >300mL

35
Q

What would ECG show in pericardial effusion?

A

low voltage QRS complex

36
Q

What is Ix is diagnostric for cardiac tamponade?

A

echo

37
Q

What would ECG show in cardiac tamponade?

A
  1. Beck’s triad: falling BP, rising JVP, muffled heart sounds
  2. ECG: low voltage QRS
38
Q

How do you manage chronic pericarditis?

A

pericardiectomy can cure not restrictive unless heart transplant

39
Q

How do you treat acute pericarditis?

A
  1. NSAIDs: with gastric protection 1-2 weeks (PPI)
  2. Colchicine 500mcg for 3 months to prevent recurrence : unless TB pericarditis
  3. Treat cause
  4. Steroids/immunosuppressant if not working
  5. Exercise restrict
40
Q

How do you manage acute pericardits if purulent (pus)?

A

IV antibitoics and above and consider pericardicetnesis)

41
Q

How do you manage pericardial effusion?

A
  1. Treat cause
  2. Pericardiocentesis can be diagnostic or therapeutic
  3. Send pericardial fluid for culture
42
Q

What is the 1st line treatment for stable cardiac tampoande?

A

NSAID’s + PPIs + obs

43
Q

What is the 1st line treatment for unstable cardiac tampoande?

A

pericardiocentesis or surgical drainage (consider pericardectomy)

44
Q

What is the process of pericardiocentesis?

A
  1. 45deg to xiphoid process

2. pericardium is aspirated

45
Q

What are possible complications of acute pericarditis?

A
  • Cardiac tamponade for acute pericarditis
    1. Chronic recurrent pericarditis
    2. Constrictive pericarditis
46
Q

What are possible complications of cardiac tamponade?

A
  1. Recurrent pericarditis and pericardial effusion
  2. Cardiac arrest
  3. Organ hypoperfusion
    Arrythmias

Z Year3 Cardio Conditions (22 decks)

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