Acute Pericarditis

Question 1

What can AP occur secondary to?

Answer 1

Viral infection (chest infection potentially may be present)

Question 2

AP symptoms?

Answer 2

Acute, sharp, central chest pain
Radiates to left arm
Worse on inspiration/at night (positional)

Question 3

AP investigation findings?

Answer 3

Auscultation - HEART sounds may be soft, indicating a pericardial effusion is underway (like the same for breath sounds and pleural effusion)
CXR - may confirm pericardial effusion by demonstrating a globular heart

Question 4

What is cardiac tamponade?

Answer 4

Haemorrhage into the pericardium

Question 5

What happens in cardiac tamponade and how is it caused?

Answer 5

Caused by a penetrating wound to the heart
Pericardium is fibrous and inelastic thus the cascade:
Bleeding into pericardium –> reduced space for diastolic heart to expand into –> reduced cardiac output –> death if untreated

Question 6

How is cardiac tamponade treated?

Answer 6

Puncturing of pericardium with a large bore needle to relieve pressure
Needle should be kept in contact with an ECG lead as it is inserted; the live trace will jump when the needle reaches the myocardium (too far)

Question 7

ECG findings in acute pericarditis?

Answer 7

Widespread concave ST elevation (‘saddle-shaped’)
PR segment depression
Reciprocal ST depression and PR elevation in aVR and V1