Pericardial disease

Question 1

what is acute pericarditis

Answer 1

inflammation of the pericardium

Question 2

causes of acute pericarditis

Answer 2

viruses (coxsackie, flu, EBV,mumps, varicells, HIV), bacteria (pneumonia, rheumatic fever, TB, staphs, streps), fungi, MI, Dresslers, drugs (procainamide, hydralazine, penicillin), uraemia, rheumatoid arthritis, SLE, myxoedema, trauma, surgery, malignancy

Question 3

clinical features acute

Answer 3

central chest pain worse lying flat or inspiration +/- relief by sitting forward. pericardial friction rub. fever. evidence tamponade or pericardial effusion

Question 4

tests in acute

Answer 4

ECG- concave ST elevation, troponin may be raised, ESR, viral serology, blood cultures, autoantibodies, FBC, U&E, fungal precipitans, TFTs. cardiomegaly on CXR- pericardial effusion

Question 5

treatment acute

Answer 5

analgesia- ibuprofen,. treat cause. colchicine before steroids/immunosuppressants.

Question 6

what is pericardial effusion

Answer 6

accumulation of fluid in the pericardial sac

Question 7

cause of pericardial effusion

Answer 7

any cause of pericarditis

Question 8

clinical features pericardial effusion

Answer 8

dyspnoea, incr JVP, bronchial breathing left base, signs cardiac tamponade

Question 9

diagnosis pericardial effusion

Answer 9

CXR- enlarged, globular heart; ECG- low voltage QRS

Question 10

management pericardial effusion

Answer 10

treat cause, pericardiocentesis may be diagnostic or therapeutic. send pericardial fluid for culture

Question 11

what is constrictive pericarditis

Answer 11

heart encased in a rigid pericardium

Question 12

cause of constrictive

Answer 12

often unknown (UK), TB, following pericarditis

Question 13

clinical features constrictive

Answer 13

right heart failure signs- incr JVP; soft diffuse apex beats; quiet heart sounds; S3; hepatosplenomegaly, ascites, oedema, Kussmauls sign

Question 14

tests for constrictive

Answer 14

cxr- small heart +- pericardial calcification, echo

Question 15

management constrictive

Answer 15

surgical excision

Question 16

what is cardiac tamponade

Answer 16

accumulation pericardial fluid- increased intrapericardial pressure, poor ventricular filling and reduced cardiac output

Question 17

causes of cardiac tamponade

Answer 17

pericarditis, aortic dissection, haemodialysis, warfarin, post cardiac biopsy

Question 18

signs of cardiac tamponade

Answer 18

incr pulse, decr bp, pulsus parodoxus, incr JVP, muffled s1 and s2, Kussmauls sign

Question 19

what is pulsus parodoxus

Answer 19

large decrease in systolic bp during inspiration >10mmHg

Question 20

what is Kussmauls sign

Answer 20

JVP paradoxically rising with inspiration

Question 21

diagnosis of cardiac tamponade

Answer 21

Becks triad, CXR- big globular heart; ecg- low voltage QRS. echo

Question 22

what is Becks triad

Answer 22

for cardiac tamponade- falling BP, rising JVP, muffled heart sounds

Question 23

what is the echo diagnostic for tamponade

Answer 23

echo free zone around the heart +- diastolic collapse of right atrium and ventricle

Question 24

management of tamponade

Answer 24

drain pericardial effusion, fluid for culture, cytology, TB culture