Pericarditis Flashcards
(33 cards)
What are 7 clinical features of pericarditis?
- Chest pain - may be pleuritic, relieved by sitting forwards
- Non-productive cough
- Dyspnoea
- Flu-like symptoms
- Pericardial rub
- Tachypnoea
- Tachycardia
What is the definition of pericarditis?
inflammation in the pericardium
What are 12 causes of pericarditis?
- Uraemia
- Viral
- Bacterial
- Malignancy
- Tuberculosis
- Vasculitis
- Autoimmune: SLE, RA, scleroderma, sarcoid
- Radiation, drugs
- Trauma
- Post-myocardial infarction→ Dressler’s syndrome
- Connective tissue disease
- Hypothyroidism
What are 5 viral causes of pericarditis?
- coxsackie
- echovirus
- CMV
- herpesvirus
- HIV
What are 5 bacterial causes of pericarditis?
- Staphylococcus
- Pneumococcus
- Streptococcus (rheumatic carditis)
- Haemophilus
- M. tuberculosis
What types of malignancy can cause pericarditis? 3 types
- lung cancer
- breast cancer
- Hodgkin lymphoma
What are 2 cardiac causes of percarditis?
- Heart failure
- Post-cardiac injury syndrome (Dressler syndrome) including post-trauma
What are 6 drug causes of pericarditis?
- Anthracycline chemotherapy (doxorubicin)
- hydralazine
- isoniazid
- methyldopa
- phenytoin
- penicillins (hypersensitivity)
What are 4 autoimmune causes of pericarditis?
- Systemic lupus erythematous (SLE)
- Rheumatoid arthritis
- Sarcoidosis
- Vasculitides (Takayasu’s, Behcet’s)
What are 2 key ECG changes in pericarditis?
- Saddle-shaped ST elevation
- PR depression
Which ECG leads show changes in pericarditis?
often global/widesppread as opposed to territories
What is the most specific ECG marker for pericarditis?
PR depression
How do ECG changes in pericarditis change over time? 3 stages
- 1-3 weeks: normalisation of ST changes, T wave flattening
- 3-8 weeks: flattened T waves become inverted
- 8+ weeks: ECG returns to normal
What investigation must all patients with suspected acute pericarditis undergo?
transthoracic echocardiography
What are the 4 key investigations to perform in pericarditis?
- ECG
- Troponin
- Echo
- CXR
What changes do troponins tend to show in pericarditis?
30% of cases - will be elevated. tend not to peak like MIs but stay constantly elevated in the acute phase
When is a chest x-ray indicated for pericarditis?
if tamponade suspected
What are 3 aspects of the first-line management of viral or idiopathic pericarditis?
- Exercise restriction
- NSAIDS
- Colchicine
In which groups of patients should colchicine be used with caution to treat pericarditis?
patients with renal or hepatic impairment
What is the second-line treatment of pericarditis providing it is non-viral?
corticosteroids for patients unable to tolerate or refractory to NSAIDs
Why shouldn’t corticosteroids be used in viral pericarditis?
risk of re-activation
What are 3 aspects of management of bacterial pericarditis?
- IV antibiotics
- Pericardiocentesis if purulent exudate present
- Pericardectomy can be performed if adhesions or recurrent tamponade occurs
What are 3 possible complications of pericarditis?
- Cardiac tamponade
- Pericardial effusion requiring pericardiocentesis
- Occasionally constrictive pericarditis in long-term
What is constrictive pericarditis?
result of scarring and loss of elasticity of the pericardial sac - upper limit of cardiac volume constrained by rigid pericardium, which prevents normal cardiac filling
as a result of resitriction on ventricular volume, stroke volume and cardiac output are limited
