Flashcards in Pericarditis, Cardiac Tamponade and Constrictive Pericarditis Deck (6):
What are the causes of pericarditis, pericardial effusion and cardiac tamponade?
Pericarditis is an inflammation of the pericardium, the membranous sac which surrounds the heart. The pericardium is made of an outer fibrous layer (Parietal pericardium) and an inner serous membrane (Visceral pericardium). There is a small amount of fluid (plasma ultrafiltrate) in between the two layers.
Acute Pericarditis Pericardial effusion (Extra fluid within the pericardial sac) Cardiac Tamponade (Extra fluid within the pericardial sac causes haemodynamic instability)
Chronic Pericarditis Fibrosis of pericardium Constrictive Pericarditis
What are the causes of pericarditis?
Common – Idiopathic, Viral Infection (Coxsackie virus, Influenza, Adenovirus, EBV, HIV), Dressler’s Syndrome (2-5 weeks post MI), Uraemia
Others – Bacterial Infection (Strep, Staph, TB), Autoimmune (Sarcoidosis, Rheumatoid arthritis, SLE/Scleroderma), MI, Aortic Dissection, Hypothyroidism, Malignancy, Direct Trauma E.g. Stab wound
What will you find on a history taking of pericarditis?
S – Precordial or retrosternal
I - Mild to severe
T - Constant
A -Lying Back or inspiration
R -Sitting up and Leaning Forward
Systemic - Fever, Chills, Lethargy, Cough
Rarely – Trouble breathings, palpitations
Symptoms of Pericardial effusion/Cardiac tamponade - light headedness, syncope, palpitations, cough, SOB
Commonly 20-50 years
Recent viral and bacterial infection
Any systemic autoimmune disorders
Myocardial infarction - Typical central crushing chest pain that is not affected by position and risk factors. Global STR elevation rules out MI
Pleuritic pain – Worse on inspiration, not affected by position (PE, Pneumonia, lung Collapse). Ruled out with troponin
Peptic ulcer disease or oesophagitis – Affected by eating
What will you find on examination of a patient with pericarditis, cardiac tamponade or constrictive pericarditis
Pericarditis –Pericardial Rub (heard best leaning forward), Tachypnoea, Tachycardia, Fever
Cardiac Tamponade – Becks Triad (Hypotension, Raised Systemic BP, Muffled Heart Sounds), Raised JVP, Pulsus Paradoxes (Fall >10mmHg in systolic BP on inspiration, may feel weaker pulse on inspiration). Ewart’s sign (Left Upper lobe of lung becomes dull to percussion with bronchial breathing as effusion causes collapse/consolidation)
Constrictive Pericarditis – Raised JVP, Kussmaul’s sign (JVP raises with inspiration), Hypotension
What investigations will you order in pericarditis?
ECG - Saddle Shaped Global ST elevation and PR depression. Cardiac tamponade may cause electrical alternans (alternation of QRS complex amplitude or axis between beats)
FBC - To look for any infection
U&E – Looking for any renal failure that might predispose uraemia
ESR/CRP - Will be raised in due to inflammatory state
Troponin - May be raised slightly but can help to rule out MI
Creatine Kinase – Will be raised
Anti dsDNA and ANA (Lupus) and Rheumatoid factor (Rheumatoid arthritis)– If no obvious cause
Sputum testing for acid fast bacilli – Ruling out TB
CXR – Rules out respiratory causes and may show pericardial effusion
Echo - If Suspected Pericardial effusion/Tamponade
Pericardiocentesis if effusion suspected – Microscopy, Culture and Sensitivity