Pericarditis

Question 1

what is the definition of pericarditis

Answer 1

inflammation of pericardium
acute
subacute
chronic

Question 2

what is the aetiology of pericarditis

Answer 2

idiopathic
infective(coxsackie B, echovirus, mumps, streptococci, fungi, staphylococci, TB)
CTDs(SLE, sarcoidosis)
post MI(24-72h in 20% of patients)
dressler's syndrome (weeks/months post MI)
malignancy(lung/breast/lymphoma)
metabolic(myxoedema/uraemia)
radiotherapy
thoracic surgery
drugs(hydralazine/isoniazid)

Question 3

what is the mnemonic for causes of pericarditis

Answer 3

CARDIAC RIND:
CTDs(SLE/sarcoidosis)
Acute renal failure(metabolic-uraemia)
Radiotherapy
Drugs(hydralazine/isoniazid)
Infection(coxsackie B, echovirus, mumps, streptococci, fungi, staphylococci, TB)
Autoimmune(SLE)/Aortic aneurysm
Cardiac infarction(post MI- 24-72h in 20% of patients)
Rheumatic fever
Idiopathic
Neoplasm
Dressler's syndrome(weeks/months post MI)

Thoracic surgery

Question 4

what is the epidemiology of pericarditis

Answer 4

uncommon
<1 per 100 hospital admissions
males>females

Question 5

what is the history associated with pericarditis

Answer 5

chest pain
-sharp and central
-may radiate to neck/shoulders
-aggravated by cough/deep inspiration/lying flat
-relieved by sitting forward
dyspnoea
nausea

Question 6

what examination findings would you expect with pericarditis

Answer 6

fever
pericardial rub(at left lower sternal edge on aortic manouvre-leaning forward on expiration)
faint heart sounds with pericardial effusion

Question 7

why could cardiac tamponade be associated with pericarditis and what would you find on examination

Answer 7

fluid in pericardium builds up and causes compression of the heart

• raised JVP
• hypotension
• muffled heart sounds
• tachycardia
• pulsus paradoxus(reduced SBP by >10mmHg on inspiration

Question 8

what is beck’s triad and with which condition is it relevant

Answer 8

cardiac tamponade

• raised JVP
• hypotension
• muffled heart sounds

Question 9

what examination findings would you expect with constrictive/chronic pericarditis

Answer 9

raised JVP on inspiration
pulsus paradoxus
hepatomegaly
ascites
oedema
AF

Question 10

what is kussmauls sign and with which condition is it relevant

Answer 10

constrictive/chronic pericarditis

raised JVP on inspiration

Question 11

what investigations would be performed in suspected pericarditis

Answer 11

1 ECG
-widespread ‘saddle-shaped’ ST elevation
2 echo
-assesses pericardial effusion and cardiac function
3 bloods
-FBC, UEs, ESR, CRP, cardiac enzymes-usually normal
-if appropriate: blood cultures/rheumatoid factor
4 CXR
-pericardial calcification seen in constrictive/chronic pericarditis

Question 12

what would be the management for acute pericarditis

Answer 12

cardiac tamponade treated by emergency pericardiocentesis

Question 13

what would be the medical management for pericarditis

Answer 13

treat underlying cause

NSAIDs for pain relief+fever

Question 14

what would be the management for recurrent pericarditis

Answer 14

NSAIDs

Question 15

what would be the surgical management for pericarditis

Answer 15

excision of pericardium(pericardiectomy) in constrictive/chronic pericarditis

Question 16

what complications are associated with pericarditis

Answer 16

pericardial effusion
cardiac tamponade
cardiac arrythmias

Question 17

what is the prognosis associated with pericarditis

Answer 17

dependent on aetiology
viral-good prognosis(2wk recovery)
malignant-bad prognosis

Question 18

in what situations can pericarditis be recurrent

Answer 18

thoracic surgery