2- Pericarditis

Question 1

Definition

Answer 1

Inflammation of pericardium . Can be chronic and acute

Question 2

Chronić pericarditis can be

Answer 2

Constrictive and effusive constrictive

Question 3

Anatomy of pericardium plus layers and innervation

Answer 3

Membranous structure surrounding heart.
Has fibrous , serous ( parietal, visceral ) layers.
Innervated by phrenic nerve

Question 4

Infectious pericarditis

Answer 4

• viral : coxsackie B,A, Echovirus, HIV
• bacterial: Strep., Staphyl., M. Tuberculosis
• fungal: Candida
• parasite: toxoplasmosis

Question 5

Post MI pericarditis

Answer 5

• postinfarction fibrinous pericarditis- within 1-3 days after transmural MI. In 20% of patients
• Dressler Syndrome- weeks, months after

Question 6

Etiology

Answer 6

• idiopathic
  -infectious
  -post MI
  -postoperative
  -uremic
• malignant
  -autoimmune
  -drug induced
  -radiation

Question 7

Clinical features of acute pericarditis

Answer 7

• pleuritic chest pain
• pericardial friction rub on auscultation
• pericardial effusion
• low grade intermittent fever

Question 8

Chest pain in acute pericarditis

Answer 8

• acute, sharp , retrosternal pain, can radiate to neck, shoulders
• Typically aggravated by coughing, swallowing, or deep inspiration

Question 9

Chronic pericarditis duration and types

Answer 9

Lasts over 3 months
Constrictive, effusive constrictive

Question 10

Types of symptoms of chronic pericarditis

Answer 10

Depends of type of failure: can be backward failure ( fluid overload), and forward failure ( reduced cardiac output )

Question 11

BACKWARD FAILURE SYMPTOMS

Answer 11

Jugular vein distention
Kussmaul sign
Hepatic vein congestion: hepatomegaly
Peripheral edema

Question 12

FORWARD FAILURE SYMPTOMS

Answer 12

Fatigue, dyspnea
Tachycardia
Pericardial knock on ausultation( sudden cessation of ventricular filling

Question 13

Diagnosis of pericarditis ACUTE

Answer 13

• clinical
• ecg
• echo: increase pericardial thickness
• cbc: leukocytosis
• Increased troponin I, ESR, CRP, CK
• ## culture

Question 14

ECG changes ACUTE PERICARDITIS

Answer 14

Stage 1: diffuse ST elevation, ST depression in aVR, PR segment decreased
Stage 2: ST normalize in 1 week
Stage 3: T wave inverted
Stage 4: return to normal

Question 15

TREATMENT

Answer 15

-Mainstray is to reduce pain , prevent recurrence, treat underlying problem, often self limited
-NSAID ( aspirin, ibuprofen)
- colchine with NSAID’s

Question 16

TREATMENT OF CHRONIC

Answer 16

Same
Plus
- Pericardiocentesis: indicated for cardiac tamponade, large pericardial effusion, acute management of effusive-constrictive pericarditis
- Pericardiectomy: complete removal of the pericardium
- diuretics

Question 17

Diagnosis of Chronic

Answer 17

The diagnostic approach and findings for chronic pericarditis are similar to acute pericarditis but ECG, echocardiography, and imaging findings may vary

Echocardiography:
- ↑ Pericardial thickness
Imaging methods:
CT and cardiac MRI:
- Pericardial thickening > 2 mm
- Calcifications
Chest x-ray:
- Pericardial calcifications

Question 18

Complications

Answer 18

• Constrictive pericarditis - as a complication of acute pericarditis
• Pericardial effusion → Cardiac tamponade