Acute pericarditis/Cardiac tamponade

Question 1

What are the most common causes? (4)

Answer 1

1.Post MI
early (1-3 days) : fibrinous pericarditis
Late (weeks to months post MI) : autoimmune pericarditis (Dressler’s syndrome)
2. Connective tissue disease : SLE/RA
3. Malignancy - Lung ca/Breast ca
4.Ureamia/Tuberculosis/Hypothyroidism/Coxsackie virus

Question 2

What are the typical clinical features of acute pericarditis? (5)

Answer 2

• Chest pain, often pleuritic - relieved sitting forwards, worse on lying flat and during inspiration
• Fever
• Pericardial run
• Non productive cough, dyspnoea, flu like symptoms
• Pericardial rub

Question 3

What are the ECG changes in pericarditis?

Answer 3

Global wide spread ECG changes - ‘saddle shaped’ ST elevation and PR depression

Question 4

What is the gold standard investigation for Pericarditis?

Answer 4

Transthoracic echocardiography

Question 5

What are the blood result findings?

Answer 5

Raised inflammatory markers and troponin levels

Question 6

What is the management of Pericarditis?

Answer 6

• Can be managed as OP
  -High risk features such as fever >38 or elevated troponin should be managed as an inpatient
• Treat underlying cause - if viral infection, no specific treatement is indicated
• Full dose NSAIDs and colchicine is used first line

Question 7

What are the complications associated with pericarditis?

Answer 7

1. Pericardial effusion (Enlarged globular heart on chest X-ray)
   * If severe enough, Cardiac Tamponade can also develop

Question 8

Cardiac Tamponade : Definition

Answer 8

Cardiac tamponade is characterized by the accumulation of fluid in the pericardiac sac under pressure.

• Exerts pressure on the heart -> Impaired cardiac function
• Medical emergency

Question 9

Cardiac Tamponade : Causes

Answer 9

1. Inflammation of the pericardium
   * Pericarditis - most common cause, may occur secondary to
   -infection, autoimmune, MI or radiation therapy
2. Trauma/Penetrating injury
3. Aortic dissection

Question 10

Cardiac Tamponade : Clinical features

Answer 10

Classical features - Beck’s triad:
* Hypotension
* Raised JVP
* Muffled heart sounds

• dyspnoea
• tachycardia

Question 11

Cardiac Tamponade : Clinical signs

Answer 11

• Pulsus paradoxus - an abnormally large drop in BP during inspiration
• Raised JVP

Question 12

Cardiac Tamponade : Investigations

Answer 12

ECG: electrical alternans, altered QRS amplitude between beats

Question 13

Cardiac Tamponade : Management

Answer 13

Urgent pericardiocentesis