Download Pericarditis

Pericarditis
Causes
 Infections
- Viruses (especially Coxsackie)
- TB (often rapid effusion, look for calcification)
- Other bacteria
- Parasites
 Malignant pericarditis
 Uraemia
 Myocardial infarction
 Dressler's syndrome (10 days post MI)
 Trauma
 Radiotherapy
 Connective tissue disease
 Hypothyroidism
Symptoms
 Sharp, constant sternal pain
 Relieved by sitting forwards
 May radiate to left shoulder, sometimes down arm or into abdomen
 Worsened by lying on left, inspiration, coughing and swallowing
Signs
 Pericardial friction rub - scratchy, superficial sound best heard at Left Sternal edge
 Check signs of tamponade ( Raised JVP, Pulsus Paradoxus)
Tests
ECG:
Concave-upwards (saddle-shaped) ST segments in all leads except aVR
No reciprocal changes
CXR:
Normal, unless effusion
Treatment
1. Treat cause
2. Ibuprofen after food for pain
3. Consider steroids in resistant disease
Pericardial Effusion
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Accumulation of fluid in pericardial sac.
Caused by anything that causes pericarditis
The Patient
Left and Right Heart Failure
Tamponade - if effusion large enough to cause a drop in BP
 Tachycardia
 Hypotension
 Peripheral shutdown
 Pulsus paradoxus (fall of systolic pressure > 10mmHg on inspiration)
 High JVP rises with inspiration (Kussmaul's sign)
Beck's Triad
1. Rising JVP
2. Falling BP
3. Small, quiet heart
Differential Diagnosis: MI and PE
CXR: large globular heart
ECG: loss of voltages and alternating QRS morphologies (electrical alternans)
Echocardiography: diagnostic. Echo-free zone surrounding the heart.
Management
1. Treat causes
2. Tamponade - drain effusion urgently
3. Send fluid for culture, cytology and haematocrit.
4. Leave pericardial drain in situ
Constrictive Pericarditis
Encasement of the heart within a non-expansile pericardium
Causes
 TB (usually)
 Any cause of pericarditis
The Patient
 Mainly right heart failure signs
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Severe ascites
Hepatosplenomegaly
Raised JVP (rising paradoxically with inspiration)
Hypotension
Pulsus paradoxus
Loud, high pitched S3 (pericardial knock)
CXR: Small heart (in 50%), may show calcification
Management
Surgical excision of the pericardium