PERICARDIALDISEASES
ACUTE PERICARDITISThis is inflammation of the pericardium• May be :
• - Fibrinous
• - Serous
• - Haemorrhagic
• - Purulent
AETIOLOGY
May be idiopathic or secondary to:Viruses (coxsackie,flu,epstein-barr,mumps)
Bacteria (pneumonia,TB,staph,streps)
Fungi
MI
Drugs (penicillin,isoniazid,hydralazine,anti-neoplastic agents)
Others (uraemia,RA,SLE,myxoedema,malignancy,sarcoidosis)
Clinical Features
- The characteristic pain of pericarditis is retrosternal , radiates to the shoulders and neck, and is typically aggravated by deep breathing, movement, a change of position, exercise and swallowing.
- A low-grade fever is common.
- A pericardial friction rub is a high-pitched superficial scratching or crunching noise produced by movement of the inflamed pericardium and is diagnostic of pericarditis;
- it is usually heard in systole but may also be audible in diastole .
Investigations and management
- The ECG shows ST elevation with upward concavity over the affected area, which may be widespread.- PR interval depression is a very specific indicator of acute pericarditis.
- Later, there may be T-wave inversion particularly if there is a degree of myocarditis.
- The pain is usually relieved by aspirin (600mg 4-hourly) but a more potent anti-inflammatory agent such as indomethacin (25mg 8-hourly) may be required.
- Corticosteroids may suppress symptoms but there is no evidence that they accelerate cure.
Fliud in the pericardial sac There is sometimes a sensation of retrosternal oppression.An effusion is difficult to detect clinically. The heart sounds may become quieter, although a pericardial friction is not always abolished.
PERICARDIAL EFFUSION
Diagnosis
CXR (cardiomegaly)ECG (small and low QRS complex and sometimes abnormal shaped)
ECHO (show an echo-free zone surrounding heart)
Treatment
Treat cause
Pericardiocentesis (diagnostic for bacterial pericarditis and therapeutic for cardiac tamponade)
Pericardial fluid (culture, ZN stain/TB culture , cytology)
Meaning the heart is encased in a rigid pericardium.
Progressive thickening, fibrosis and calcification of the pericardium.Cause is unknown but can be TB or after any pericarditis.
Constrictive Pericarditis
Clinical Features
• Fatigue• Rapid, low-volume pulse
• Pulsus paradoxus (excessive fall in BP during inspiration):
• Sign of RHF
• Kaussmaul sign (JVP increase w inspiration)
• Quite heart sound
• Hepatosplenomegaly
• Ascites n oedema
Investigations and management
CXR (small heart)CT and MRI (see pericardial calcification)
ECHO
Treatment : surgical incision!!
Cardiac Tamponade
Accumulation of pericardial fluid with raised intra-pericardial P, so poor ventricular filling, hence reduce CO..Causes include :
Any pericarditis
Aortic dissection
Haemodylisis
Warfarin
Post cardiac biopsy
Post cardiac cathetherization
Sign
TachycardiaDrop BP
Pulsus paradoxus
JVP raised
Kausmaul’s sign
Muffled S1 n S2
Diagnosis
Beck’s triad (fall BP, raised JVP, small n quiet heart)CXR can be cardiomegaly (if >250mL fluid)
ECG low @ small QRS complex
ECHO (pericardial effusion, diastolic collapse of R atrium n R ventricle)
MANGMENT
Emergency Drainage