pericardial heart disease Flashcards
(37 cards)
What is the most common cause of Acute pericarditis?
Infection (90%, MC viral – Coxsackie)
What are other causes of acute pericarditis?
- Idiopathic (prob postviral)
- Acute MI or Post MI syndrome (Dressler’s syndrome)
- Metastatic Neoplasm (lymphoma, breast, lung)
- Blunt Trauma
- Drug Induced
- Endocrine (Myxedema)
- Uremia (metabolic d/o) – d/t elevated BUN & metabolic acidosis
- Autoimmune d/o (SLE, rheum arthritis, Reiter syndrome)
- Iatrogenic (radiation therapy → cancer, cardiac surgery, catheter)
- Bacterial, Fungal, Parasitic (underdeveloped countries)
Who is at risk of getting pericarditis?
20-50 yo, M > F
~ 5% Chest Pain complaints in the ER = acute pericarditis— why is this fact important?
What is the clinical presentation of acute pericarditis?
- MC = severe chest pain that worsens with breathing (inspiration) & lying down
- Pain localized to the retrosternal & left precordial area radiating to trapezius ridge and neck
- Chest pain is positional: relieved w/ sitting up and leaning forward
- Pericardial friction rub: high pitched, heard along left sternal boarder (best heard w/ pt sitting up during expiration – closer to chest)
- Few days of low grade fever (100F), myalgias, malaise, weakness, anxiety, restlessness, dysphagia, sinus tachycardia
what are complications with acute pericarditis?
cardiac tamponade (15%) -pericardial effusion (any cause of acute pericarditis that can lead to exudation of fluid into pericardial space)
How long is acute pericarditis
<6weeks inflammation
How long is sub-acute pericarditis
6wks-6months
How longs is chronic pericarditis
> 6months
what is recurrent pericarditis
Intermittent (symptom free intervals)
Incessant (recurs w/ anti-inflammatory cessation) Effusive-constrictive pericarditis
Effusion in pericardial space with constriction by the thickened pericardium
what are the types of pericardial effusions
fibrous
effusive
constrictive
Fibrous pericarditis is classified as?
dry, no effusions
Effusive pericarditis is classified as?
purulent exudate (serous) hemorrhagic exudate (serosanguineous)
what is constrictive pericarditis?
- Impedes diastolic filling
- Occurs after acute pericarditis —Can be a late complication of acute pericarditis
- Can lead to Tamponade
what are the clinical pericardial heart disease? signs and symptoms?
few days with low grade fever Myalgias Malaise, weakness Anxiety, restlessness dysphagia Followed with sudden onset of severe anterior chest pain that worsens with breathing and lying down
What will you pick up on exam for a person with pericardial disease?
Low grade fever, sinus tachycardia
Pericardial friction rub along left sternal boarder High pitched
Heard better sitting up/leaning forward at end of expiration/left sternal border
(85%) and are heard intermittently in those who do have one.
what will you see on EKG testing
ST elevations, PR depressions EKG changes due to epicardial (visceral pericardium) inflammation No Q waves Q waves = infarction ST elevation = ischemia/inflammation
what will you see on an echocardiogram?
pericardial effusion
Assesses for tamponade and degree of chamber compressions
what will you see on lab tests?
Serum troponin
-slightly elevated, will normalize after 1-2 weeks
Troponin: I/T if elevated can imply myocardial inflammation
Inflammatory process
-ESR
-CRP
Serum BUN
->60mg/dl
CBC
↑WBC w/ purulent exudate and infectious causes
What are the chest pain characteristics that are more specific to heart disease?
Not related to exertion Does not respond to NTG (nitroglycerine) Sharp, severe, constant, retro-sternal CP that radiates to the trapezius ridge (very characteristic) Worst with inspiration and supine Stabbing, pleuritic CP
What will you see on a CXR with pericardial heart disease?
water bottle heart silhouette
CXR Can show possible cause: TB, cancer, fungus, PNA
200cc (7 oz) of fluid must accumulate before silhouette enlarges 2L
what is pericardiocentesis used for?
Obtain exudate (effusion) for culture and histology Biopsy pericardium for suspected metastasis or primary neoplasm
What are the DDx’s you should be thinking of along with pericardial heart disease?
MI
-present Q wave, inverted Twaves, responds to NTG, CP no change with respiration, modest rise in CK, pain lasts minutes
PNA
-fever, cough, neg ECG, positive CXR
PE
-CP not positional in nature, no friction rub,
Pneumothorax
-pleuritic, non-positional CP. unilateral decreased BS, CXR pos for pneumothorax
Costochrondritis
-reproducible pain with costochondral palpation, negative ECG, CXR
what is the 1st line treatment for pericardial heart Dz?
1st line: ASA (2-4g/day) or NSAIDS + colchicine–prevents fibrosis
1-2 weeks NSAIDs
3 months Colchicine
PPI
What do you add to the treatment regiment if patients do not respond to NSAID?
Prednisone (40-80mg/day)
In pts w/o purulent bacterial exudate
Prednisone can increase recurrence
1-2 weeks
