Acute Pericarditis:Â
- Idiopathic, MCC: infectious (viral; coxsackie B), inflammatory (SLE, RA), metabolic (uremia), recent MI (acute or Dresseler’s syndrome)
- Sx: positional pleuritic chest pain, relieved by sitting up and leaning forward, worsened by laying down and breathing
- PE: pericardial friction rub
- ECG: diffused PR depression + diffused ST elevation
- Do Echo to determine extent of effusion
- Tx: Aspirin + NSAIDs ± steroids
Pericardial Effusion:Â
- Not a diagnosis, but a manifestation of an underlying cause
- Can be:
- Transudate: fluid overload, CHF, hypoalbuminemia
- Exudate: chest injury\trauma
- Serosanguineous: TB, neoplasm
- Frank blood: ruptured aortic aneurysm \ coronary, LV free wall bleed post-MI, penetrating trauma
- PE: muffled HS, pericardial friction rub, JVD (if severe, hypotension, LOC), Ewart’s sign
- ECG: low QRS voltage, flat T waves, electrical alternans
- CXR: “water-bottle” configuration of the cardiac silhouette
- Dx: Echo
- Tx: fluid aspiration + tx underlying cause
Cardiac Temponade:Â
- EMERGENCY! rapid filling of fluid into pericardial sac
- Anything that causes pericarditis -> can cause tamponade
- Sx: pressure surrounding the heart -> can’t pump -> left sided HF (SOB, orthopnea, cough), LOC
- PE: pulsus paradoxus, Kussmaul’s sign, tachcardia
- Beck’s triad: muffled heart sounds, hypotension, JVD
- ECG: low QRS voltage, electrical alternans
- Dx: Echo
- Tx: pericardiocentesis
Constrictive Pericarditis:Â
- Chronic inflammation, either due to multiple acute pericarditis attacks or post open-heart surgery
- Sx: constrictive = heart can’t expand and pump -> both Lt + Rt sided HF (SOB, orthopnea, cough, peripheral edema, ascites, hepatosplenomegaly)
- PE: pericardial knock sound, distant HS, Kussmaul’s sign, Friedreich’s sign (prominent “y” descent)
- Dx: echo -> cardiac MRI for definitive dx
- Tx: diuretics, salt restriction -> pericardiectomy
Download the PDF version: here
References:
- Dr Alghamdi’s lectures
- Kaplan lecture notes
- Toronto notes
- Paul Bolin’s videos
- Lifeinthefastlane.com