Pericardial Disease Flashcards
(39 cards)
Describe the structure and layers of the pericardium.
Fibrous pericardium (outer tough sac) and serous pericardium (parietal and visceral layers), with a potential space containing 15–50 mL of lubricating fluid.
What are the main functions of the pericardium?
Fixes the heart in mediastinum, prevents acute dilation, provides lubrication for movement, and acts as a barrier to infection.
List five histological types of pericarditis.
Serous, fibrinous (dry), suppurative (purulent), hemorrhagic, and caseous.
What are the common causes of serofibrinous pericarditis?
Viral infections, uraemia, post-MI (early), systemic lupus erythematosus.
Which organisms most often cause purulent pericarditis?
Staphylococcus aureus, Streptococcus pneumoniae, gram-negative bacilli.
What is tuberculous pericarditis and how does it present histologically?
Caseous necrosis with granulomas; common in endemic areas, may lead to constriction.
What three key features constitute Beck’s triad in tamponade?
Hypotension, raised JVP, muffled heart sounds.
How does pericardial friction rub evolve?
Scratching/squeaking sound, best heard with patient leaning forward; may come and go over hours–days.
Name two clinical signs of constrictive pericarditis.
Kussmaul’s sign (JVP ↑ on inspiration) and pericardial knock (early diastolic sound).
ECG stages of acute pericarditis.
1) Widespread ST elevation & PR depression; 2) Normalization; 3) T-wave inversion; 4) Return to normal.
What does electrical alternans indicate?
Swinging heart in large effusion or tamponade—beat-to-beat variation in QRS amplitude.
Describe the “water‑bottle” cardiac silhouette.
Globular enlargement of the cardiac shadow on chest X‑ray due to large pericardial effusion.
Echocardiographic features of tamponade.
Diastolic collapse of right atrium/ventricle, exaggerated respiratory variation in transvalvular flows.
Role of CT/MRI in pericardial disease.
Detects pericardial thickening, calcification, effusion loculations, and inflammation.
Key pericardial fluid analysis tests.
Protein, LDH (Light’s criteria), cell count, Gram stain/culture, cytology, ADA for TB.
First‑line therapy for idiopathic or viral acute pericarditis.
NSAIDs (e.g., high‑dose ibuprofen) ± colchicine to reduce recurrence.
When are corticosteroids indicated?
Autoimmune pericarditis, systemic inflammatory disease, refractory cases to NSAIDs/colchicine.
Emergency management of cardiac tamponade.
Urgent pericardiocentesis (echo‑guided) and pericardial drain.
Indications for surgical pericardiectomy.
Chronic constrictive pericarditis causing symptomatic right‑heart failure unresponsive to medical therapy.
What is Dressler’s syndrome?
Autoimmune pericarditis occurring 2–10 weeks post‑MI, presents with fever, pleuritic chest pain, pericardial rub.
Define effusive‑constrictive pericarditis.
Coexistence of tamponade physiology (effusion) with constriction: pericardial drainage does not relieve elevated diastolic pressures.
What characterizes haemorrhagic pericarditis?
Blood in pericardial sac, often due to malignancy, trauma, or post‑surgical bleeding.
Risk factors for recurrent pericarditis.
Younger age (<50 years), subacute onset, lack of colchicine use, high CRP at presentation.
Long‑term outlook for constrictive pericarditis post‑pericardiectomy.
Symptom relief in ~80%, but carries perioperative mortality (5–10%) and risk of right‑heart failure if incomplete resection.
