265 Pericardial Disease

Question 1

Most common pathologic process involving the pericardium

Answer 1

Acute pericarditis

Question 2

Amount of pericardial fluid

Answer 2

15-50 ml

Question 3

What is the characteristic pain of pericarditis?

Answer 3

Radiates to trapezius ridge, intensified by lying supine and relieved by sitting up and leaning forward

Question 4

How many percent is pericarditis accompanied by pericardial friction rub and when it frequently heard?

Answer 4

Pericardial friction rub occurs in 85% of patient with pericarditis and heard frequently at end expiration

Question 5

Clinical classification of pericarditis

Answer 5

Acute less than 6 weeks. Subacute 6 weeks to 6 months. Chronic more than 6 months

Question 6

ECG stages of pericarditis

Answer 6

Stage 1: widespread ST segment elevation
Stage 2: ST segments return to normal
Stage 3: T waves became inverted
Stage 4: ECG back to normal

Question 7

Patch of dullness and increased fremitus beneath angle of Left scapula

Answer 7

Ewarts signs

Question 8

Most widely used imaging technique in pericarditis

Answer 8

Echocardiography

Question 9

Therapy for acute pericarditis. How long?

Answer 9

Bed rest
aspirin 2-4 g/day
NSAID: ibuprofen 600-800 mg TID or indomethacin 25-50 mg TID
Along with gastric protection
1-2 weeks if responsive

Question 10

Add on to usual therapy in acute pericarditis. Enhances response to NSAIDs and aids in reducing risk of recurrent pericarditis

Answer 10

Colchicine 0.5 mg once a day for more than 70 Kg or 0.5 mg BID if more than 70 kg for 3 months

Question 11

Alternative therapy for acute pericarditis not tolerant to NSAID + colchine. How long is this therapy given?

Answer 11

Glucocorticoids (prednisone 1 mg/kg/day) given for 2-4 days only

Question 12

True or false: pericarditis patient should be on anticoagulant

Answer 12

False. Anticoagulants avoided as it can cause bleeding in pericardial cavity and tamponade

Question 13

Therapy for patients with multiple and frequent recurrences for more than 2 years not prevented by colchicine, NSAIDs or glucocorticoids

Answer 13

Azathioprine. Anakinra

Question 14

When is pericarditis patient advised hospitalization?

Answer 14

Causes: tuberculous, neoplastic, bacterial. Fever, Subacute onset, large pericardial effusion

Question 15

Accumulation of fluid in pericardial space in a quantity sufficient to cause serious obstruction of the inflow of blood into the ventricles

Answer 15

Cardiac tamponade

Question 16

Most common causes of cardiac tamponade

Answer 16

Idiopathic pericarditis
Pericarditis sec to neoplastic disease
Tuberculosis
Bleeding into pericardial space after leakage from an aortic dissection, cardiac operation, trauma and treament with anticoagulants

Question 17

When is pericardiectomy carried out in tuberculous pericardial disease

Answer 17

2-7 weeks of antituberculous therapy and biopsy still show a thickened pericardium

Question 18

Only definitive treatment of constrictive pericarditis

Answer 18

Pericardial resection