9 - Pericardial Disease Flashcards
Pericardial fluid
Normal 15-50ml
Pathologic 200-250ml
Purpose of pericardium
Immobilization of the heart
Prevents extreme dilation of heart (intracardiac volume raise)
Limits spread of infection
Acute Pericarditis
Acute inflammation of pericardium due to individual cause or systemic disease
- pleuritic chest pain (95%)
- EKG changes
- pericardial friction rub
- fever (+/-)
Acute pericarditis infectious causes
Idiopatihic/viral (most common) -coxsackie -CMV -Herpes -HIV Bacterial TB Fungal
Acute paracarditis non-infectious
Post MI Post cardiac surg Metabolic Neoplasm Connective tissue disease Drug induced
Drug induced pericarditis
Drug induced SLE like syndrome
- hydralazine (resistant HTN)
- methyldopa (pregnancy HTN)
- isoniazid (INH)
- phenytonin
Acute Pericarditis pathogenesis stages
- Local vasodilation w transudation fluid into pericardial sack
- Increased vascular permeability
- Leukocyte exudation
Acute pericarditis pathogenesis line of badness
Causative agent -> local vasodilation -> increased vascular permeability -> infiltration of pericardiumj w leukocyte exudate -> deposition of fibrin -> inflammation -> rub/pain
Pericarditis highest mortality?
Purulent pericarditis has almost 50% mortality
Acute pericarditis pathophysiology
Serous: thin exudate
Serofibrinous: bread and butter (yellow exudate, looks rough and shaggy)
Suppurative: bacterial (purulent)
Hemorrhagic: TB/Cancer (bloody)
Clinical manifestations of acute pericarditis
Chest pain 95% -“pleuritic” Friction rub (highly specific) ECG changes (90% are abnormal) -new widespread/diffuse st elevations maybe PR depression Fever
Acute pericarditis HX
L-OPQRST
Location - retrosternal Onset - sudden (hours/days) Palliative - sitting up/leaning forward Quality - goes up w provocative maneuvers Radiation - to trapezius ridge and neck Severity - varied Timing - worse w provocative factors
High risk acute pericarditis
Fever Large pericardial effusion Tamponade Immunocompromised Hx of warfarin Acute trauma No improvement w/in 7 days of NSAID Cardiac troponin
Acute pericarditis PE
Vitals - fever (bacterial)
Heart - pericardial rub LSB
Lungs - rub
Acute pericarditis diagnostics
ECG - diffuse ST elevation, PR segment depression, Concave upsloping ST
CXR
Echo
Lab - CBC, ESR/CRP, cardiac enzymes
Acute pericarditis tx post MI
ASA + Colchicine
No steroids or NSAIDS
Acute pericarditis tx viral/idiopathic
Rest
Colchicine + NSAIDS (motrin, indomethacin)
Steroids (refractory only)
Pericardial effusion
Amount of pericardial fluid exceeds normal
Majority of pericardial effusion results from?
Aortic dissection Hypothyroidism Mediastinal radiation Post MI or cardiac surg Renal failure w uremia
Clinically silent pericardial effusion?
Yes its a thing
Slow onset