Pericarditis Flashcards
(29 cards)
What purpose does the pericardium serve?
It helps to maintain compliance of the ventricles,increase cardiac efficiency by limiting dilatation, preserving starling curve, distributes hydrostatic forces, reduces external friction
AND protects against infection+malignant extension, reduces friction
What is pericarditis?
Inflammation of the pericardium (fibrous reaction often leads to adhesions in the pericardium and then a serous reaction)
A definite cause is found in what percentage of patients?
10-20%
What is considered the likely cause if no cause is identified?
Viral
What is the most common viral cause?
Coxsackie virus
People who suffer a viral pericarditis often have had what recently?
A viral infection such as a sore throat in the past few weeks
Name 9 other common causes of pericarditis…
Viral, TB, trauma (e.g. Post surgery), metastatic cancer, uraemia, MI (acute or delayed onset), rheumatic fever, SLE (most rheumatological conditions), rheumatic arthritis, bacteria
What is the name given to the secondary form of pericarditis that has a delayed onset after having an MI
Dressler’s syndrome (occurs 2-3 weeks post MI and occurs in 7% of MIs, most recover in a few days and rarely leads to tamponade)
What are the symptoms of pericarditis?
Usually sharp, retrosternal chest pain relieved by sitting up and leaning forward
What aggravates pericarditis pain?
Worsened on inspiration (pleuritic), swallowing, coughing
Where does pain radiate to?
Shoulder, trapezial ridge (esp. left) and precordium
What are the signs of pericarditis on examination?
Pericardial rub on auscultation, dysponoea, orthopnoea, Beck’s triad if tamponade (hypotension, elevated systemic venous pressure often with jugular venous distention, and muffled heart sounds)
How can you increase the loudness of pericardial rub?
Asking the patient to breathe in
What feature if found is pathogenomic for pericarditis?
Pericardial rub
What is the pericardium?
It is the two layers surrounding the heart, an outer fibrous sac and an inner serous membrane (epicardium) which are separated with 50ml of ultrafiltrate
Why do chest XRs often not reveal much in the case pericarditis?
As many look normal until the cardio thoracic ratio is reduced in effusions of 300ml+
What aetiologies should be checked before treatment?
TB and any other non idiopathic non viral causes however bar TB aetiology is not necessary for initiating treatment as most care is supportive
What else should be identified when deciding management?
Does the patient have any high risk features such as tamponade or constriction that need to be dealt with urgently
What are the major factors predicting a poor prognosis?
Fever (>38), subacute onset (symptoms slowly over several days), large effusion (diastolic echo free space over 20mm), tamponade, no response to NSAIDs/aspirin after a week
What are the minor predictors of poor prognosis?
Myopericarditis, immunosupression, trauma, oral anti-coag therapy
If patient has none of the poor prognostic factors, how should you manage them?
As outpatients, look for aetiology and trial with NSAIDs for a week, follow up or admit if not resolved
Also avoid too much physical activity
How should you manage patients with any poor prognosis factors (major or minor)?
Admit, search for aetiology, treat any underlying cause, provide aspirin or NSAIDs, low dose colchicine to improve response to therapy, restrict physical activity
What is incessant pericarditis?
Pericarditis that lasts 4-6 weeks without a clear cut remission after the episode (slowly resolves)
How long can new onset pericarditis last up to and still be considered simply acute pericarditis?
Less than 4 weeks
