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MORNING REPORT Friday September 3, 2010 PERICARDIUM Encloses Heart Ascending aorta Pulmonary trunk Terminal segment of the vena cavae Serous vs Parietal Fluid Ultrafiltrate of plasma PERICARDITIS Infectious Autoimmune Rheumatic fever Uremia Malignancy Drug reaction Post Surgical Idiopathic VIRAL CAUSES 10 to 14 day prodromal illness Respiratory or GI Coxsackie Echo Adeno Epstein-Barr Influenza HIV BACTERIAL CAUSES Higher mortality Toxic Higher fever Irritability Cardiomegaly on CXR Spread from surgery or infection Staph and H.flu TB in immunocompromised SIGNS AND SYMPTOMS Chest pain Substernal, sharp, worse with inspiration, relieved by sitting upright and leaning forward Radiation to scapular ridge Friction rub Scratchy, high-pitched, to-and-fro LABS Elevation WBC ESR CRP Troponin Myocardial involvement Specific Cause Blood culture, viral culture, TB, RF, ANA ECG ECG Stage 2 Stage 3 Normalization of the ST and PR segments Development of widespread T-wave inversions Step 4 Normalization of the T waves PERICARDIAL EFFUSION CXR “water-bottle heart” Echo Support the diagnosis MANAGMENT Treat the underlying cause Alleviate pain and inflammation NSAIDs Colchicine if recurrent or chronic (>2 weeks) What about steroids? Controversial Avoid Diuretics Avoid Intubation COMPLICATIONS Recurrence 1/3 Constrictive pericarditis Cardiac tamponade Tachycardia, hypotension, increased JVP, muffled heart sounds, hepatomegaly, narrow pulse pressure Pulsus paradoxus Electrical alternans STICK A NEEDLE IN IT! Pericardiocentesis Hemodynamic compromise Cardiac tamponade Purulent pericarditis Neoplastic pericarditis Pericardial window or pericardiectomy Resistant cases