Pericarditis Flashcards
(44 cards)
What can chronic pericardial inflammation lead to
rigid, thickened, calcified pericardium
What are the causes of pericardial disease
Viral Bacterial Fungal Parasitic Systemic inflammatory dz (SLE) Malignancy Uremia
Why is the epidemiology of pericarditis
in 0.1-0.2% of hospitalized patients
up to 5% of ED patients with non-ischemic CP
What is the most common cause of acute pericarditis
Idiopathic
most are undiagnosed VIRAL infections; coxsackie B, Influenza
What is the most common presenting symptom in acute pericarditis
CHEST PAIN; sharp and pleuritic, improves by leaning forward, exacerbated by cough
Describe pericardial CP vs ischemic CP
Pericardial: sudden one, anterior chest, sharp, pleuritic, improves leaning forward, worse with cough inspiration or lying flat
Ischemic: radiates, relieved with nitro
What is common to see on pericarditis PE
Pericardial friction rub; squeaky, scratchy over LSB
What are characteristic ECG findings for pericarditis
Diffuse ST elevation (concave upward) and PR segment depression
Stage 1: diffuse ST elevation and PR depression
Stage 2: normal
Stage 3: diffuse deep T wave inversion
Step 4: normal
What other diagnostic tests should you get
CT (shows thick pericardium)
Cardiac MRI
Echo (normal unless effusion present)
Are pericardiocentesis and pericardial biopsy used in acute pericarditis
Rarely, they are low yield
but can be therapeutic and diagnostic
Pericardiocentesis if refractory to med therapy or in hemodynamic compromise
Biopsy if illness >3 weeks, or recurrent
What lab tests would be elevated in acute pericarditis
Troponin
High CRP, ESR, and WBC can help support the diagnosis
(if patient is febrile check blood cultures)
What further work up should you consider if patient isn’t improving
ANA, rheumatoid factor
TB testing
HIV serology
Malignancy work up
What is the diagnostic criteria for acute pericarditis
Need TWO of the following:
- Typical CP
- Pericardial friction rub
- Characteristic ECG changes
- Pericardial effusion
What is pericarditis admittance criteria
Fever immunocompromised subacute onset Hemodynamic compromise Oral anticoagulants (hemorrhagic effusion) trauma
How do you medically manage acute pericarditis
NSAIDs +/- Colchicine (reduce sx and decrease rate of recurrence) 2 weeks or less
-If pt can’t take NSAIDs, give glucocorticosteroids
-Activity restriction until Sx resolved and biomarkers normalize
How long until a patient shows improvement with medical management of pericarditis
within one week
if Sx persist, may need more workup
What is a pericardial effusion
amount of fluid in pericardium more than normal (15-50 ml) secondary to injury to pericardium
acute, subacute, or chronic
What kind of effusion progression is better
Slower development; the pericardium has more time to stretch and adapt
How does a pericardial effusion usually present
Asymptomatic!
May have CP/pressure/discomfort relieved by sitting up or leaning forward
Syncope, light headed, palpitations, Resp. Sx
What can you find on pericardial effusion PE
Usually none unless hemodynamically significant
**Pulsus Paradoxus (SBD decrease >10 with inspiration) = falling CO during inspiration
How do you measure Pulsus Paradoxus
When taking BP, listen for first korotkoff sound only on expiration, deflate cuff until you hear during inspiration and expiration
If difference >10, positive test
What is characteristic of an ECG for pericardial effusion
Low voltage QRS
- Sinus tachy
- *Electrical alternans (normal then abn QRS)
- **= highly specific for pericardial effusion
What is a characteristic CXR finding for pericardial effusion
Enlarged cardiac silhouette
What is your imaging modality of choice for pericardial effusion
ECHOCARDIOGRAM (large effusion= >20 mm)
