Pericardial Diseases

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

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

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

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

Pericardial diseases 5

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