- Inflamation of pericardium - May contain exudates, adhesions, blood, or serous type fluid. - Often not apparent clinically - Mortality in untreated purulent pericarditis is nearly 100%

Staphylococcus most common - Streptococcus - pneumococcus - Neisseria - Legionella - Lyme disease - Via direct pulmonary extension, endocarditis, penetrating injury, hematogenous spread

(VIRAL= most common assumed cause) Coxsackie - Echovirus - HIV - Herpes - varicella - Measles, mumps - EBV - hepatitis, RSV

Pericarditis Flashcards by Kleedis K

Pericarditis

Inflamation of pericardium
May contain exudates, adhesions, blood, or serous type fluid.
Often not apparent clinically
Mortality in untreated purulent pericarditis is nearly 100%

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Fibrinous Pericarditis

Caused by: Dressler’s syndrome (delayed pericarditis 2-10 wks after mi due to antibodies. Responds well to corticosteroids), Uremia or Radiation

Hear loud friction rub
“Bread and butter” appearance

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Serous Pericarditis

-From noninfectious inflammatory diseases:
Rheumatic fever, SLE,
Viral infections (often coxsackie)

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Suppurative/Purulent Pericarditis

Caused by bacterial, fungal and parasitic infectious agents

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Most common form is

idiopathic, presumed to be viral (if they can’t pinpoint what’s causing it)

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Symptoms

**Chest pain**
Most common symptom
Substernal
Sharp, stabbing, burning, pressing
SOB--especially if pericardial effusion
May radiate to back, neck, shoulder, arm
**Pain referral to left trapezius ridge** (upper back/top of shoulder)

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What is pain from pericarditis referred to left trapezius ridge

Inflammation of the joining diaphragmatic pleura!!!

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Key symptoms in history

Chest pain worse when supine (laying down), with inspiration (pleuritic), swallowing (dysphasia) and with body motion
Chest pain better sitting up, leaning forward
This helps sometimes to distinguish angina from pericarditis…in that angina does not change with position.

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Other S/S

-Fever; usually low grade
-Pericardial friction rub
-Dyspnea; chest pain worse with inspiration
-Dysphagia; irritation of esophagus
-Tachypnea
-Tachycardia
Beck’s triad ON TEST
Hypotension, JVD, muffled heart sounds
cardiac tamponade

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What is Beck’s Triad

Hypotension, JVD, muffled heart sounds

cardiac tamponade

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Drug induced causes

Procainamide, hydralazine, isoniazid (INH)

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Other causes

-Malignancy
-Radiation therapy induced
-Uremia/renal failure
-Acute stemi
Post myocardial infarction (dressler syndrome)
-Autoimmune, rheumatic (SLE, RA, scleroderma, sacrcoidosis)
-Fungal (Histoplasmosis,
coccidiomycosis)
-Tuberculosis
-Hypothyroidism
-Cholesterol

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Bacterial causes

*Staphylococcus most common**
Streptococcus
pneumococcus
Neisseria
Legionella
Lyme disease
Via direct pulmonary extension, endocarditis, penetrating injury, hematogenous spread

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Viral causes

(VIRAL= most common assumed cause)

*Coxsackie**
Echovirus
HIV
Herpes
varicella
Measles, mumps
EBV
hepatitis, RSV

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Most common and important finding is

Pericardial friction rub
Best with diaphragm of stethascope
Lower left sternal border or apex
Sitting, leaning forward
Intermittent
Grating or scratching sound–leather rubbing against leather
Three components

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EKG findings for pericarditis (KNOW FOR EXAM!)

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-serious of EKGs taken over days/weeks
4 stages observed:
1- ST elevation (Diffuse, seen in almost all leads); PR depression
2- Still have PR depression (ST segment elevation has resolved)
3- T wave inversion (diffuse)
4- Normalization

Pericardial Effusion

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a complication of pericarditis
Collection of fluid in the pericardial sac
Can be so great as to alter cardiac function (e.g., cardiac tamponade)…death
Acute symptoms with 80ml of fluid
Chronic build up with collections of 1-2 liters of fluid in sac
EKG classically described by low voltage (amplitude of QRS are short, SHORT QRS, they don’t look tall) and electrical alternans; caused by pendular motion of beating heart in a large fluid filled sac.

Specific EKG findings for pericardial effusion

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Electrical Alternans
See high amp QRS then low amp QRS (tall, short, tall, short)
Specific for pericardial effusion!!! NOT specific for pericarditis*

Pericardial fat pad sign

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Seen on lateral cxr
Epicardial fat allows the silhouette of two layers of pericardium to appear separate from the heart
Pericardial effusion
Sometimes pericarditis
Not commonly seen

Test of choice to diagnose pericardial effusion

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Pericarditis is characterized by inflamation of the pericardial layers….this can cause a pericardial effusion
can find pericardial effusion as a complication; NOT used to diagnose actual pericarditis

CXR may show

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“Water Bottle Heart”
May see large pericardial effusion

-Can’t diagnose cardiac tamponade (need to use clinical s/s for that)

Labs to order

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-CBC (may reveal elevated WBC or leukemia)
-Chem (may reveal uremia)
-Streptococcal serologic tests
(In pts with hx of rheumatic heard disease or pharyngitis)
-Blood cultures/viral cultures
-UA, UDS
-TB, HIV
-ESR (sed rate)
-Thyroid tests (TSH)
-Rheumatologic studies (ana, rf, etc.)
-Cardiac markers (troponin, cpk-mb)
pericardiocentesis for C&S if purulent expected
-Pericardial biopsy (if no improvement for 3 weeks)

Treatment

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If idiopathic or presumed viral use NSAIDs for 1-3 weeks
Identify/treat cause
If bacterial, treat > 4 weeks w/ antibiotics
Pericardiocentesis should be performed

Poor prognostic indicators

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Immunosupression
Myocarditis
Severe pericardial effusion
Fever
NSAID failure
Trauma
Oral anticoagulation

Constrictive pericarditis is

- A possible result of pericardial injury - Fibrous thickening of pericardium - Thickened noncompliant pericardial sac - Slowly progressive - Usually specific cause not determined *Definition: when such fibrous response results in a decrease in passive diastolic filling of the normally distensible cardiac chambers

Constrictive pericarditis most commonly results from

- Cardiac trauma/intrapericardial bleeding - Open heart surgery - Idiopathic, Fungal, tb (in developing world), viral (in developed world), uremic

S/S of constrictive pericarditis

* *Dyspnea, worsening with exertion!!! - Chest pain, PND, orthopnea, B/L LE edema, JVD * *Pericardial knock (After 2nd heard sound; Due to accelerated RV inflow, followed by abrupt slowing of ventricular expansion) - heard during diastole - The RA is pouring into RV, but due to poor RV compliance, there is no RV expansion.

Cardiac tamponade is

compression of heart by fluid in pericardium—blood, effusion, etc -Equilibration of diastolic pressures in all 4 chambers (ventricles wont fill, atria wont empty, etc, very dangerous)

Cardiac tamponade leads to

- Decreased CO - Becks triad (low bp, distended neck veins, distant heart sounds) - Tachycardia

Cardiac tamponade is a complication of

**pericardial effusion (NOT a complication of pericarditis)**

A sign of cardiac tamponade is

Pulsus paradoxus: decreased SBP by 10 mmHg during inspiration (also seen in: asthma, obstructive sleep apnea, pericarditis, croup)

Pericarditis Flashcards

(31 cards)