Cardiology

Question 1

Define Pericarditis

Answer 1

Inflammation of the pericardium; may be acute, sub acute or chronic

Question 2

Aetiology of pericarditis

Answer 2

1. Idiopathic
2. Infective
   Viral: Coxsackie B, Echovirus, Mumps Virus, Flu, HIV
   Bacterial: Streptococci, staphyloccocci, TB
   Fungi
3. Connective Tissue Disease: Sarcoid, SLE, Scleroderma
4. Post Myocardial Infarction (24-72hrs) in 20% pts.
5. Dresslers Syndrome (Weeks-months after acute MI)
6. Radiotherapy
7. Drugs: Penicillin, isoniazid, hydralazine

Question 3

Epidemiology of Pericarditis

Answer 3

Rare. <1 in 100 hospital admissions.

Slightly more common in males

Question 4

Presenting History of Pericarditis

Answer 4

CHEST PAIN: Sharp, central, (radiate to neck or shoulders- typically the left)
Made worse by coughing, deep inspiration (pleuritic) and lying flat.
Relieved by sitting Forwards.

Features of Fever

Question 5

Findings on Examination of Pericarditis

Answer 5

Fever

Pericardial friction rub. Best heard lower left sternal edge with patient leaning forward in expiration with diaphram.
Heart sounds might be faint in the presence of an effusion.

N.B CARDIAC TAMPONADE
Becks Triad: Raised JVP, Hypotension and muffled heart sounds; Tachycardia and pulsus paradoxus (Reduced systolic BP by 10mmHg on INSPIRATION)

N.B CONSTRICTIVE PERICARDITIS: Raised JVP with inspiration (Kussmauls Sign), pulsus paradoxus, hepatmegaly, ascites, oedema, pericardial knock (rapid ventricular filling) AF

Question 6

What is Becks Triad

Answer 6

1. Raised JVP
2. Hypotension
3. Muffled Heart Sounds