Condition- Pericarditis

Question 1

Describe the anatomy of the different layers of the heart

Answer 1

• Endocardium: like the endothelium of blood vessels. It lines the valves and chambers and is trabeculated
• Myocardium: made of involuntary striated smooth muscle and enable heart contractions
• Pericardium:
  
  • Outer Fibrous Layer
  • Inner Serous layer: further subdivided into two layers
    
    • Parietal layer
    • Visceral layer = epicardium

Question 2

List some of the causes of pericarditis

Answer 2

• Idiopathic
• Infective:
  
  • Coxsackie B
  • Echo 8
  • Mumps
  • EBV
  • Strep
  • rubella
  • HIV
• Autoimmune:
  
  • SLE
  • Rheumatoid arthritis
  • Vascilitides
  • IBD
• Secondary Immune Processes: post-MI (DRESSLER’S SYNDROME), rheumatic fever
• Metabolic diseases: uraemia, myxoedema
• Surgery, radiotherapy
• Trauma
• Malignancy
• Drugs

Question 3

List some of the presenting symptoms of a patient with pericarditis…

Answer 3

Chest pain:

• S: Central pain
• O:
• C: sharp, stabbing, pleuritic pain
• R: to trapezius ridges (phrenic nerve innervates this area)
• A: High spiking fever= infectious cause, cough, SOB, nausea
• T: continuous, constant not responsive to nitrates etc
• E: worse on lying down, improves on sitting/standing
• S:

Question 4

What is the criteria for diagnosing pericarditis?

Answer 4

Need at least 2 of the 4 following criteria:

• Chest pain
• Pericardial rub
• ECG- widespread ST elevation
• Percardial effusion

Question 5

List the signs of pericarditis on physical examination

Answer 5

• Pericardial Rub: heard at left lower sternal border with patient leaning forward on end-expiration and sounds high-pitched/ sqeuaky
• Pyrexia
• Tachycardia - bacterial

Question 6

What would be seen on an ECG of a patient with pericarditis?

Answer 6

upwards concave ST-segment elevation globally with PR depressions

Question 7

Other than ECGs which investigations can you perform on a patient with pericarditis?

Answer 7

• Echocardiogram: asses pericardial effusion and function
• Pericardial fluid/ blood culture: to see bacterial infection
• Bloods:
  
  • FBC
  • U&Es- serum urea to check if uraemic cause
  • ESR/CRP
  • Cardiac Enzymes- troponin (see myocardial involvement)
• CXR- usually normal may be globular if large pericardial effusion

Question 8

In an acute situation if a patient has a cardiac tamponade as a result of the pericarditis which medical procedure would have to be carried out?

Answer 8

Periardiocentesis (aspiration of pericardial fluid)

Question 9

How would you acutely treat pericarditis if it was prurulent?

Answer 9

• Antibiotics + pericardiocentesis
• NSAIDs
• PPI (to prevent gastric irritation from NSAIDs)

Question 10

How would you treat non-prurulent pericarditis?

Answer 10

• NSAID + PPI or Corticosteroids
• Colchicine
• Anti-viral therapy

Question 11

List the complications of pericarditis (4)

Answer 11

• Pericardial effusion
• Cardiac tamponade
• Constrictive pericarditis
• Cardiac arrhythmias