Pericarditis Flashcards

1
Q

What purpose does the pericardium serve?

A

It helps to maintain compliance of the ventricles,increase cardiac efficiency by limiting dilatation, preserving starling curve, distributes hydrostatic forces, reduces external friction
AND protects against infection+malignant extension, reduces friction

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2
Q

What is pericarditis?

A

Inflammation of the pericardium (fibrous reaction often leads to adhesions in the pericardium and then a serous reaction)

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3
Q

A definite cause is found in what percentage of patients?

A

10-20%

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4
Q

What is considered the likely cause if no cause is identified?

A

Viral

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5
Q

What is the most common viral cause?

A

Coxsackie virus

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6
Q

People who suffer a viral pericarditis often have had what recently?

A

A viral infection such as a sore throat in the past few weeks

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7
Q

Name 9 other common causes of pericarditis…

A

Viral, TB, trauma (e.g. Post surgery), metastatic cancer, uraemia, MI (acute or delayed onset), rheumatic fever, SLE (most rheumatological conditions), rheumatic arthritis, bacteria

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8
Q

What is the name given to the secondary form of pericarditis that has a delayed onset after having an MI

A

Dressler’s syndrome (occurs 2-3 weeks post MI and occurs in 7% of MIs, most recover in a few days and rarely leads to tamponade)

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9
Q

What are the symptoms of pericarditis?

A

Usually sharp, retrosternal chest pain relieved by sitting up and leaning forward

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10
Q

What aggravates pericarditis pain?

A

Worsened on inspiration (pleuritic), swallowing, coughing

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11
Q

Where does pain radiate to?

A

Shoulder, trapezial ridge (esp. left) and precordium

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12
Q

What are the signs of pericarditis on examination?

A

Pericardial rub on auscultation, dysponoea, orthopnoea, Beck’s triad if tamponade (hypotension, elevated systemic venous pressure often with jugular venous distention, and muffled heart sounds)

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13
Q

How can you increase the loudness of pericardial rub?

A

Asking the patient to breathe in

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14
Q

What feature if found is pathogenomic for pericarditis?

A

Pericardial rub

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15
Q

What is the pericardium?

A

It is the two layers surrounding the heart, an outer fibrous sac and an inner serous membrane (epicardium) which are separated with 50ml of ultrafiltrate

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16
Q

Why do chest XRs often not reveal much in the case pericarditis?

A

As many look normal until the cardio thoracic ratio is reduced in effusions of 300ml+

17
Q

What aetiologies should be checked before treatment?

A

TB and any other non idiopathic non viral causes however bar TB aetiology is not necessary for initiating treatment as most care is supportive

18
Q

What else should be identified when deciding management?

A

Does the patient have any high risk features such as tamponade or constriction that need to be dealt with urgently

19
Q

What are the major factors predicting a poor prognosis?

A

Fever (>38), subacute onset (symptoms slowly over several days), large effusion (diastolic echo free space over 20mm), tamponade, no response to NSAIDs/aspirin after a week

20
Q

What are the minor predictors of poor prognosis?

A

Myopericarditis, immunosupression, trauma, oral anti-coag therapy

21
Q

If patient has none of the poor prognostic factors, how should you manage them?

A

As outpatients, look for aetiology and trial with NSAIDs for a week, follow up or admit if not resolved

Also avoid too much physical activity

22
Q

How should you manage patients with any poor prognosis factors (major or minor)?

A

Admit, search for aetiology, treat any underlying cause, provide aspirin or NSAIDs, low dose colchicine to improve response to therapy, restrict physical activity

23
Q

What is incessant pericarditis?

A

Pericarditis that lasts 4-6 weeks without a clear cut remission after the episode (slowly resolves)

24
Q

How long can new onset pericarditis last up to and still be considered simply acute pericarditis?

A

Less than 4 weeks

25
Q

If pericarditis lasts 3 months or more what is it termed?

A

Chronic pericarditis

26
Q

Define recurrent pericarditis…

A

Another episode after a 4-6 week symptom free interval

Note: Treatment is much the same

27
Q

What is the recurrence rate and what reduces this?

A

15-30%

Colchicine reduces chance of recurrence

28
Q

What may appear on the ECG of someone with acute pericarditis?

A

Concave st elevation (saddle shaped)

29
Q

How would you treat tamponade?

A

Zheil neelson th testing and urgent drainage by expert