pericarditis

Question 1

pulsus paradoxus

Answer 1

A physical examination finding in which there is an exaggerated decrease (> 10 mm Hg) in systolic blood pressure during inspiration. Classically associated with cardiac tamponade and constrictive pericarditis, but can also be seen in noncardiac conditions (e.g., massive pulmonary embolism, hemorrhagic shock, obstructive sleep apnea, obstructive lung disease).

Question 2

pericardial knock

Answer 2

A high-pitched, early-diastolic sound that sounds like a premature S3 and is often present in patients with constrictive pericarditis. Caused by the sudden slowing of blood flowing into the ventricle during diastole because relaxation of the ventricle is impaired by the rigid pericardial sac. The knock is best heard between the apex of the heart and the left sternal border.

Question 3

Dressler syndrome

Answer 3

pericarditis occurring weeks to months after an acute MI

Question 4

post infraction fibrinous pericarditis

Answer 4

within 1–3 days as an immediate reaction

Question 5

post operative pericarditis

Answer 5

due to blunt or sharp trauma to the pericardium

Question 6

radiation associated pericarditis

Answer 6

Exudative pericarditis: develops acutely during or after radiation therapy
Constrictive pericarditis: develops several years after radiation therapy

Question 7

clinical features of acute pericarditis

Answer 7

pleurites chest pain
aggravated by coughing, or deep inspiration
improves on sitting and leaning forward, can radiate to the neck or shoulders
pericardial friction rub best heard over the left sternal border during expiration with the patient is sitting up and leaning forward
pericardial effusion
low grade intermittent fever, tachypnoea, dyspnoea, nonproductive cough

Question 8

clinical features of restrictive pericarditis

Answer 8

symptoms of fluid overload (backward failure)
- JVP distension, hepatomegaly, oedema
symptoms of reduce cardiac output (forward failure)
- fatigue, tachycardia, pericardial knock, pulsus paradoxus

Question 9

beck triad

Answer 9

A clinical triad of hypotension, muffled heart sounds, and distended neck veins that is seen in cardiac tamponade.

Question 10

ECG features of pericarditis

Answer 10

Stage 1: diffuse ST elevations, ST depression in aVR and V1, PR segment depression
Stage 2: ST segment normalizes in ∼ 1 week.
Stage 3: inverted T waves
Stage 4: ECG returns to normal baseline (as prior to onset of pericarditis) after weeks to months.

Question 11

imaging for pericarditis

Answer 11

the goal of imaging is to identify any new pericardial effusion and rule out alternative aetiologies
echo: first line, pericardial effusion may be present
cardiac MRI: consider if diagnosis is uncertain
CT scan with Iv contrast
CXR: usually normal, may show enlarged cardiac silhouette

Question 12

how much fluid indicates cardiac tamponade

Answer 12

Cardiac tamponade can occur with relatively small pericardial effusions if pericardial fluid accumulation is rapid.

Question 13

medical therapy for pericarditis

Answer 13

Acute pericarditis is often self-limited but NSAIDs can alleviate symptoms and prevent a recurrence. Consider anti-inflammatory therapy also for chronic pericarditis (transient constrictive pericarditis may respond).

Question 14

surgical therapy for pericarditis

Answer 14

Pericardiocentesis: indicated for cardiac tamponade, large pericardial effusion, acute management of effusive-constrictive pericarditis
pericardectomy for persistent symptoms of heart failure, high risk