CM1 E3 L4 Pericardial Disease

incessant pericarditis

lasts longer than?

Lasts longer than 4-6 weeks, not yet at 3 months. No interruption insymptoms

recurrent pericarditis

lasting longer than 4-6 weeks, has interruptions in symptoms

chronic pericarditis

lasting greater than 3 months, no breaks

acute pericarditis

timeline

inflammation of the pericardium for less than two weeks

acute pericarditis dx criteria

need 2 of 4 criteria

1. chest pain

2. pleural friction rub

3. diffuse ST changes on EKG

4. new or worsening pericardial effusion

acute pericarditis cause

infection, surgery, connective tissue disease, radiation, malignancy, drug induced, myxedema, pericardial injury, MI

viral acute pericarditis

how is this crucial to pericardtis

what is rare?

most common cause of acute pericarditis and probably responsible for many cases classified as idiopathic

ex. Coxsackie viruses, echo viruses, influenza, Epstein Barr, varicella, hepatitis, mumps and HIV, COVID

TB possible in developing countries

Bacterial pericarditis is rare

viral acute pericarditis RF

males under 50

uremic acute pericarditis

common complication of chronic kidney disease

may be asymptomatic

Dressler Syndrome

happens after what?

how long

Cause of acute pericarditis 2-5 days after MI dueto inflammatory reaction to transmural myocardial necrosis

Drug induced acute pericarditis

what drugs

minoxidil, penicillins, clozapine

pericarditis S/S

pericardial friction rub, fever, dyspnea, chest pain

viral acute carditis labs and diagnostics

Leukocytosis

Cardiac enzymes may be slightly elevated reflecting myocardial involvement

Normal echo

tuberculosis acute carditis labs and diagnostics

AFB found elsewhere and a small pericardial effusion usually present

bacterial acute pericarditis dx

pericardiocentesis

uremic acute pericarditis dx

shaggy pericardium with hemorrhagic and exudative effussion

acute pericarditis imaging

EKG: generalized ST and T wave changes

CXR: may show cardiac enlargement or pulmonary disease

Echo: pericardial effusion

MRI/CT: tumor in neoplastic pericarditis

neoplastic acute pericarditis dx

bx of effusion and cytology

Post MI acute pericarditis dx

elevated ESR with large pericardial effusion

myxedema pericarditis dx

hypothyroidism present along with cholesterol crystals within the fluid

acute pericarditis tx

this has 3 parts

1. Activity restriction x3 months

2. ASA x 1-2 weeks OR Ibuprofen x 1/2 weeks

3. Colchicine x3 months to prevent recurrence

uremic acute pericarditis tx

dialysis or partial pericardiectomy

prevents tamponade

neoplastic acute pericarditis tx

what ab it is bad?

effusion drainage within pericardial window

tetracycline to prevent reaccurrence

poor prognosis

acute pericarditis complications

cardiac tamponade

colchicine intolerance

patient cannot take or remain on colchicine due to severe adverse effects (most commonly gastrointestinal distress such as severe diarrhea, nausea, or abdominal cramping) or contraindications

treatment escalates to immunosuppressive therapy to calm down systemic and pericardial inflammation

immunosuppression: cyclophosphamide, azathioprine, or methotrexate

Post MI acute pericarditis tx

what to abs avoid?

ASA and colchicine

DONT use NSAIDS or steroids as they can impair healing

refractory acute pericarditis tx?

drug and how long

colchicine or 6 months with CRP monitoring to see effective ness of treatment

indomethacin instead of ibuprofen

systemic corticosteroids if autoimmune origin

- Refractory/Recurrent: Colchicine ≥6 months; systemic steroids, anakinra; pericardial stripping.

pericardial effusion

accumulation of fluid in the pericardial sac

may be transudate or exudate

transudate pericardial effusion cause

Left heart failure, overhydration, hypoproteinemia

pericardial effusion progression

slow and fast what does fast cause

slow growth: pericardium can stretch and not compress heart

fast growth: can cause cardiac tamponade

pericardial effusion S/S

muffled heart sounds, poor palpable apical pulse, pulsus paradoxus

pericardial effusion imaging

CXR: "water-bottle" heart

Echo to visualize fluid

cardiac tamponade

pressure on the cardiac tissue, that can interfere with cardiac perfusion, cardiac filling, cardiac output

right atrium and ventricle are first affected

Beck's Triad

For cardiac tamponade:

Hypotension

Jugular venous distension

Muffled heart sounds

pericardial effusion tx

underlying cause and NSAIDS

if large effusion or cardiac tamponade: pericardiocentesis

recurrent pericarial effusion tx

pericardial window

constrictive pericarditis

Pericardial inflammation can lead to thickened, fibrotic, adherent pericardium that restricts diastolic filling and produces chronically elevated venous pressures

constrictive bronchitis cause

MCC: purulent bacterial pericarditis

constrictive pericarditis clinical findings

Kussmaul Sign

elevated JVP pressure

edema and ascites

afib

constrictive pericarditis imaging

pericardial calcification

MRI: pericardial thickening more than 4mm required for dx

ECHO: Septal "bounce" reflecting the rapid early filling

Catheterization: dx in difficult cases

constrictive pericarditis tx

1st line: aggressive diuretics

or pericardiectomy if that fails