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Cardiovascular 2 > Pericarditis + Pleural Effusion > Flashcards

Pericarditis + Pleural Effusion Flashcards

1
Q

What is pericarditis

A

Pericarditis is inflammation of the pericardium.

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2
Q

Epidemiology of pericarditis

A
  • Pericarditis accounts for up to 5% of presentations to the emergency department
  • M>F
  • Most common 20-50 years of age
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3
Q

Virus + Bacterial causes of pericarditis

A
  • Coxsackievirus - moxt common cause
  • Mumps
  • Epstein-Barr virus (EBV)
  • Cytomegalovirus (CMV)
  • Varicella-Zoster virus (VZV)
  • HIV
  • TB
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4
Q

Other causes of pericarditis

A
  • Dressler syndrome
  • Connective tissue disorder
  • Hypothyroidism
  • Trauma
  • AI disorders
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5
Q

RFs of pericardititis

A
  • Male gender
  • 20-50 years of age
  • Previous MI
  • Viral or bacterial infection
  • Systemic autoimmune disorders
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6
Q

Pericardium

A
  • 2 layers
  • protects and restrains heart
  • phrenic nerve
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7
Q

Pathophysiology of acute pericarditis

A
  • Fluid + IC move from tiny BVs in fibrous and serous pericardium into intersitium of those layers - makes layer thicker
  • Due to inflam of pericardium - effusion may develop in pericardial space - serous pericardium cant remove fluid as quickly as it comes in
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8
Q

Pericardial effusion features

A

pericardial effusion that is large enough to adversely affect heart function is called cardiac tamponade, which is potentially life-threatening. The heart is unable to pump properly, leading to a reduction in cardiac outpu

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9
Q

How long does acute vs chronic pericarditis last for>

A

Acute - few weeks
Chronic - more than 6 months

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10
Q

Signs of acute pericarditis

A
  • Pericardial rub
    • Heard at the left sternal edge as the patient leans forward
    • Extra heart sound of a to-and-fro character
    • High-pitched or squeaky
  • Diminished heart sounds: if there is large effusion
  • Tachycardia
  • Tachypnoea
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11
Q

Symptoms of acute pericarditis

A
  • Pleuritic chest pain - relieved by leaning forward
  • Hiccups
  • Fever and myalgia
  • Shortness of breath
  • Peripheral oedema
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12
Q

ECG for pericarditis

A

widespread saddle-shaped ST-elevation (highly sensitive) and PR depression (highly specific) followed by T-wave flattening and eventual T-wave inversion.

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13
Q

Pericardial effusion ECG

A

low QRS complex voltage or electrical alternans (QRS complexes have different heights)

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14
Q

Other investigations for pericarditis

A
  • Chest X-ray: “water-bottle heart”
  • Transthoracic echocardiogram: ‘dancing’ heart as
  • ESR and CRP:elevated secondary to inflammation
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15
Q

Acute idiopathic + Viral pericarditis management

A
  • 1st line: NSAIDsandcolchicine are often both used together
  • 2nd line: NSAIDs, colchicineandlow-dose prednisolone
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16
Q

Bacterial pericarditis management

A

IV antibiotics and pericardiocentesis (removal of fluid) with washout, culture and sensitivities

17
Q

Cardiac tamponade management

A

Urgent therapeutic pericardiocentesis

18
Q

Complications of pericarditis

A
  • Pericardial effusion
  • Myocarditis
  • Constrictive pericarditis
19
Q

Chronic pericarditis pathophysiology

A
  • IC initiate fibrosis of serous pericardium - produces inelastic shell around heart - hard for ventricles to expand
  • SV decreases over time - compensate HR increases
  • Not as life threatening as cardiac tamponade
20
Q

Clinical manifestations of chronic pericarditis

A
  • Kussmaul’s sign: rise in jugular venous pressure and increased neck vein distension during inspiration
  • Pulsus paradoxus: an exaggeration in the normal variation in pulse pressure seen with inspiration, such that there is a drop in systolic blood pressure
  • Diffuse heart sounds
  • Right heart failure signs
  • Ascites
  • Oedema
  • Atrial dilatation
21
Q

Investigations for chronic pericarditis

A
  • CXR: small heart with/without pericardial calcification
  • ECG: low voltage QRS
  • ECHO: thickened calcified pericardium restricting the heart’s movement; small ventricular cavities
22
Q

Management of chronic pericarditis

A
  • May require complete resection of the pericardium
  • Complications - Congestive HF
23
Q

DDs of pericarditis

A

MYOCARDIAL ISCHAEMIA
pneumonia
pul embolus

Cardiovascular 2 (10 decks)

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