Cardiology - Pericarditis Flashcards
(37 cards)
Inflammation of the pericardium
Acute pericarditis
Acute pericarditis typically manifests with
- low grade fever
- pleuritic chest pain (sharp chest pain that increases with inspiration)
- pericardial friction run on auscultation
Diagnostic criteria for acute pericarditis
Must have at least 2:
- chest pain
- pericardial friction rub
- EKG with features of pericarditis
- new or worsening pericardial effusion
Common causes of pericarditis
- idopathic (post-viral)
- viral (Coxsackie virus B, echovirus, adenovirus, EBV, influenza, HIV, Hep A or Hep B)
- radiotherapy
- cardiac surgery
- connective tissue disease (SLE, scleroderma, RA, sarcoidosis)
- tuberculosis
- MI (post infarction fibrinous pericarditis, Dressler syndrome)
- uremia (acute or chronic renal failure)
What EKG findings support the diagnosis of pericarditis?
- diffuse ST-elevations
- PR segment depression
- inverter T waves
Hallmark symptom of acute pericarditis
Pericardial friction rub
Scratchy, grating, high-pitched sound caused by friction between the roughened pericardial and epicardial surfaces best heard at the LLSB.
Pericardial frication rub
Treatment for acute pericarditis
NSAIDs and colchicine
A type of infectious pericarditis characterized by pus in the pericardial sac which can result in pericardial effusion and cardiac tamponade
purulent pericarditis
Most common causes of purulent pericarditis
- Staphlococcus spp.
- Streptococcus spp.
- TB (endemic countries)
Treatment for purlurent pericarditis
- pericardiocentesis
- empiric ABX
Complications of acute pericarditis
- pericardial effusion
- cardiac tamponade
A condition characterized by chronic pericardial inflammation ( > 3 months) with subsequent thickening and rigidity of the pericardium.
Constrictive pericarditis
Findings in constrictive pericarditis
- fatigue
- dyspnea
- JVD
- peripheral edema
- Kussmaul sign
- pulsus paradoxus
- pericardial knock
How is diastolic filling different in constrictive pericarditis and cardiac tamponade?
- In constrictive pericarditis - rapid filling in early diastole which is abruptly halted in late diastole (pericardial knock)
- In cardiac tamponade: ventricular filling is impeded throughout diastole
Decrease right ventricle compliance causing JVP to increase during inspiration instead of decrease.
Kussmaul sign
Sudden cessation of ventricular filling during early diastole that is heard best at the LSB
pericardial knock
Hallmark findings of constrictive pericarditis on CXR, CT or MRI
pericardial thickening and calcifications
Best initial test for pericarditis
CXR
Cardiac catheterization findings in constrictive pericarditis
Elevated right ventricular diastolic pressure with characteristic dip-and-plateau waveform (square root sign)
Sudden dip in the right and left ventricular pressure in early diastole followed by a plateau during the late stage of diastole on cardiac catheterization.
“square root sign” or dip-and-plateau waveform
Treatment of constrictive pericarditis
- diuretics
- treat underlying condition
- pericardiectomy
Contraindicated drugs in constrictive pericarditis
Beta-blockers (reduce compensatory tachycardia that maintains CO)
The build up of fluid in the pericardium as a complication related to acute pericarditis
Pericardial effusion
