BOARD BASCIS: pericardial diseases

acute pericarditis is diagnosed clinically by the presence of at least two of four criteria: …

• chest pain typical for pericarditis

• pericardial friction rub (classically three phases)

• new ECG changes

• neri pericardial effusions

chest pain in … presented as sharp, severe, and position; worse in the supine position; and improves with sitting up and leaning forward

acute pericarditis

ST-segment contour in

acute pericarditis

concave upward

MI ST segment contour

convex upward

PR segment abnormalities in

acute pericarditis

depression in

treatment for acute pericarditis

first line treatment is colchicine plus aspirin or an NSAID

the preferred concurrent medication with colchincine in acute pericarditis after MI?

aspirin

when to add glucocorticoids to the treatment of acute pericarditis?

• recurrent (second or third recurrence), incessant (>4 to 6 weeks), chronic (>3 months)

• uremic, unresponsive to dialysis

• autoimmune

most common cause of pericardial effusion/tamponade

breast cancer

Consider pericardial effusion/tamponade in patients with these risk factors: …

• metastatic lung and breast cancer

• cardiac surgery

• viral or bacterial pericarditis

• systemic rheumatic disease

physical examination and ECG findings in pericardial effusion/tamponade

• tachycardia

• muffled heart sounds

• elevated jugular venous pressure

• pulsus paradoxus

• electrical alternans

treatment of pericardial effusion/tamponade

first line treatment includes pericardiocentesis or surgical drainage plus IV normal saline for hemodynamically unstable patients

pericardial thickening, fibrosis, and sometimes claficication that impair diastolic and limit total cardiac volume are seen

constrictive pericarditis

typically, it is associated with slowly progressive symptoms of right sied HF with clear lung and may include hepatomegaly, ascites, and peripheral edema

constrictive pericarditis

clinical findings of

constrictive pericarditis

• elevated jugular venous pressure, increasing with inspiration

• pericardial knock

• ECG showing low voltage

• pericardial calcification (CT, MRI more sensitive than x-ray)

treatment of

constrictive pericarditis

pericardiectomy is the most effect treatment, but it is unnecessary in patients with early disease (NYHA functional class I) and is unwarranted in many patients with advanced disease (NYHA functional class IV)